Wednesday, December 13, 2006

Intra-Trail: Boarded Again

The testing center for the clinical skills exam is near O'Hare airport. So, naturally, I fly into Midway. My friend Jen is a trooper, waiting for my flight to land in inclement weather, and lugs my butt all the way around the city to my hotel in Rosemont, Illinois.

Step 2 of the USMLE exams includes an eight-hour long session with a dozen standardized patients. In the end I'm not sure if this test really proves anything to anybody. I think it's wasted money - the only people benefitting are the people who administer the exam, and the word on the street is that they're still losing money on that despite the exorbitant cost to the students. The actors are troopers, though, exposing themselves to a myriad of medical students with cold hands or long fingernails trying to palpate the size of their livers. We're forbidden to perform breast exams, rectal exams, or pelvic exams - they are saved from that torture - for now.

I felt kinda ashamed of my off-white coat - it's still spotted with a myriad of unbleachable stains. Then, I saw the 'white' coat the kid next to me put on. Yeah - apparently he washed his white coat with like 5000 stray red socks. The patient encounters are pretty simple - 15 minutes to take a history, perform a physical, and provide closure for the visit, then 10 minutes to write your note. It's a bit of a game, really. The right questions unlock the right answers. Project warmth and compassion. Fake a competent physical exam. 96% of American medical students who take this exam pass it the first time around. That just proves to me that American medical schools are doing their jobs, and that this exam is increasingly unnecessary.*

Once I finish with the exam, I'm too tired to feel relieved. All I know is that I have a novel sitting back in my hotel room, and it has absolutely nothing (I think) to do with medicine. Rather than sit alone in my room with the cable television and the overpriced wireless internet, I'm going to sit in the hotel restaurant and join this clique of lone travelers and revel in our collective solitude, with novel in hand. I pick a seat near the bar and open the novel - nobody gives a second look. Actually, I'm fairly certain nobody gives a first look. Anyway, I pay more attention to the other souls in the restaurant/bar, mostly business types:
  • There's an executive who looks like he's just extending his six-martini lunch, working on the USA Today crossword puzzle.
  • A couple of individuals at the bar have struck up a conversation that wanders from business deals to baseball to football back to business.
  • Several others at the bar have chosen to sit near each other, but have declined to talk, only staring blankly at the same television.
  • A man sits at a table across the room barking orders into his cell phone, while eating dinner with - and I'm not sure - it's either his girlfriend or his 14-year old daughter.
  • And some thirty-something year old medical student who's trying to start a novel but just keeps on staring at the other people in the bar.

* Rumor has it that this is the final year of existence of this part of the USMLE Step 2. I'll believe it when I see it.

2 Comments:

Blogger An Adversary said...

Whenever I gave an exam that all of the students passed I attributed the result not to my having taught them so well, but rather to the fact that the test was too damn easy. It sounds to me like they need to make the USMLE harder. Palpate that healthy prostate and see if the person's acting can make you believe he has colo-rectal cancer.

BTW, what book are you reading?

8:14 AM  
Blogger Mikey said...

Yes, it is an easy exam. However, I don't think making it more difficult would necessarily mean that it would better accomplish its mission which is to ensure good communication skills by physicians in training.

The book is "Life of Pi" by Yann Martel.

3:06 PM  

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