OSCE A GO GO
Had more OSCEs today. Thought that was over with, actually. What does OSCE stand for, you may wonder? OsteopragmatipathSomethingClinicalExamination. Sounds about right. Had these on a regular a basis in medical school. Standardized patients, who are trained to act in a certain way and function as if they were a living "Choose Your Own Adventure" book, in that what I do or don't ask them determines how the visit goes. We're videotaped. We're given feedback from the standardized patients about every little thing we did. Of course, the more dramatic the more tempting the scenario is to set-up. I had to deal with an actress sitting in front of me reacting to the news that her pregnancy was culminating in a baby who would have no brain -- anencephaly -- and she had no idea before I sat down. The SP is able to cry on demand; it was impressive and believable. Another young lady had a history of trauma, was seeing me for a sprained wrist and would not make eye contact and repeatedly told me how stupid she was. Obvious domestic abuse scenario. The third and last scenario had me seeing a patient that my office had switched files, meaning that we had incorrectly diagnosed HIV six months prior and her life had fallen apart since then. Her husband was there and they had separated and she was sure he was cheating on her. The list went on. Of course, every word we say is scrutinized and judged. In my life, I've probably done nearly a hundred of these "fake" patient visits.
In fact, we get quite a bit of feedback from the SP's and we even watch ourselves on video (very painful and the cringe factor is way above the upper limit of normal. While in medical school I remember receiving feedback in this setting as if it were gospel. Today I found myself speaking up during the 'debriefing' session with the coordinators, which I'm sure everyone else there found annoying -- perhaps I even annoyed myself by speaking up. Sometimes I can't help it. We're graded on these very strict rubrics. So rigid that certain aspects of the visit have to happen at certain times. The actress who played the pregnant woman told me that I should have engaged in small talk before giving the bad news. I disagree. She did suggest that I inquire if she had people with her at the visit before giving her the news. I thought that was a good idea. I did enquire later in the visit.
My OSCE experience today serves as nothing less than a shining monument to just how much my clinical comfort and acumen has increased since I was a 'short-coat.' I went to the OSCEs feeling annoyed. I didn't want to go. On the long drive home (Pomona to Long Beach during rush hour? Oy vey) I had time in between trying not to look at my phone too much and screeching to a halt to reflect on what it meant that I actually had an opinion concerning the construction of the rubric. How dare I question the subjective opinion of standardized testing architects.
Indeed, how dare I. I fucking dare. I dare a lot.
The heart of this is my strong dislike of how standardized testing is used, viewed and abused in the medical training business. Board exams which are designed to ensure a base fount of knowledge and medical decision making competency. They are not meant for stratifying the student populace in a spectrum of residencies from perceived lucrative and competitive to lesser vocations. I will allow that just as gaining a bachelor's degree demonstrates an ability to stick to something, the ability to follow through, so does the USMLE and COMLEX serve to reward the most diligent studiers, and perhaps just as much, those naturally gifted in the art of deciphering multiple choice questions. My scores are solidly average. Thankfully I did not have my heart set on residency longer than three years. That leaves primary care. But I know many who had the choice made for them despite any protestations they may voice. What if one were to fail one of these exams? To a certain degree your choices were just paired down by, I don't know, half, maybe? One would have to be extremely exceptional to land in a competitive, good program.
The AMA announced a $15 million program to investigate and implement changes in post-graduate medical training. Oh to be a consultant in that endeavor. The real issue, in my opinion lies with the financing structure. Payments for training programs comes through medicare. Hospitals get a certain amount per resident. How the hospital and program utilizes the young physicians in training varies wildly but a lot of our days, across the country, amounts to little more than cheap labor. An argument can be made that even the most mundane procedures or patients no matter how disparate from our own future scope of practice is valuable in that all patient interactions are teachable situations. Some programs are net positives in terms of revenue and expenditures associated with a residency program, others are negative.
Just as the issue lies with monetary trappings, so does most of the issues in the world at large. This is no secret, but one would be forgiven thinking this was the case, listening to physicians act, talk and negotiate. My job satisfaction is derived from partnering with patients for better outcomes, no matter the setting. I am at my disposal ten years of experience in the real world of business prior to starting undergraduate school and eventually graduating as a physician. While my brain is tired, compared to my peers, pragmatic experience is valuable, too. I look forward to the day when we, as physicians decide to quit lighting ourselves on fire to keep the room warm.
In fact, we get quite a bit of feedback from the SP's and we even watch ourselves on video (very painful and the cringe factor is way above the upper limit of normal. While in medical school I remember receiving feedback in this setting as if it were gospel. Today I found myself speaking up during the 'debriefing' session with the coordinators, which I'm sure everyone else there found annoying -- perhaps I even annoyed myself by speaking up. Sometimes I can't help it. We're graded on these very strict rubrics. So rigid that certain aspects of the visit have to happen at certain times. The actress who played the pregnant woman told me that I should have engaged in small talk before giving the bad news. I disagree. She did suggest that I inquire if she had people with her at the visit before giving her the news. I thought that was a good idea. I did enquire later in the visit.
My OSCE experience today serves as nothing less than a shining monument to just how much my clinical comfort and acumen has increased since I was a 'short-coat.' I went to the OSCEs feeling annoyed. I didn't want to go. On the long drive home (Pomona to Long Beach during rush hour? Oy vey) I had time in between trying not to look at my phone too much and screeching to a halt to reflect on what it meant that I actually had an opinion concerning the construction of the rubric. How dare I question the subjective opinion of standardized testing architects.
Indeed, how dare I. I fucking dare. I dare a lot.
The heart of this is my strong dislike of how standardized testing is used, viewed and abused in the medical training business. Board exams which are designed to ensure a base fount of knowledge and medical decision making competency. They are not meant for stratifying the student populace in a spectrum of residencies from perceived lucrative and competitive to lesser vocations. I will allow that just as gaining a bachelor's degree demonstrates an ability to stick to something, the ability to follow through, so does the USMLE and COMLEX serve to reward the most diligent studiers, and perhaps just as much, those naturally gifted in the art of deciphering multiple choice questions. My scores are solidly average. Thankfully I did not have my heart set on residency longer than three years. That leaves primary care. But I know many who had the choice made for them despite any protestations they may voice. What if one were to fail one of these exams? To a certain degree your choices were just paired down by, I don't know, half, maybe? One would have to be extremely exceptional to land in a competitive, good program.
The AMA announced a $15 million program to investigate and implement changes in post-graduate medical training. Oh to be a consultant in that endeavor. The real issue, in my opinion lies with the financing structure. Payments for training programs comes through medicare. Hospitals get a certain amount per resident. How the hospital and program utilizes the young physicians in training varies wildly but a lot of our days, across the country, amounts to little more than cheap labor. An argument can be made that even the most mundane procedures or patients no matter how disparate from our own future scope of practice is valuable in that all patient interactions are teachable situations. Some programs are net positives in terms of revenue and expenditures associated with a residency program, others are negative.
Just as the issue lies with monetary trappings, so does most of the issues in the world at large. This is no secret, but one would be forgiven thinking this was the case, listening to physicians act, talk and negotiate. My job satisfaction is derived from partnering with patients for better outcomes, no matter the setting. I am at my disposal ten years of experience in the real world of business prior to starting undergraduate school and eventually graduating as a physician. While my brain is tired, compared to my peers, pragmatic experience is valuable, too. I look forward to the day when we, as physicians decide to quit lighting ourselves on fire to keep the room warm.
Comments