It's the typical student problem. Everyone telling you a different thing, a different approach. For medical students it's all in the physical examination and history presentation. As far as I could remember during my days back in IMU the CSU sessions and OCSEs were the source of a lot of stress - not because it was difficult to perform an examination (it's pretty simple really) but it's because every lecturer and examiner would have their own preferences and one had to thread very carefully - one lecturer's method was another lecturer's dislike. But it was the students who would get the brunt of it. People even memorized the different methods and teachings of different lecturers so as to apply them if they happened to be examining them.
It's the same everywhere really.
Since paeds started I've actually been on the wards a fair bit (gasp!) and making a concious effort to clerk and present at least 5 patients a week. It's hard enough mustering the courage to talk to parents about why their precious kids are in hospital and asking sensitive questions like did they smoke or did the child live with their father. But that's the easy part. Presenting? You mean if the F1 or ST isn't running after someone's bloods and tapping away at some TTO's or if there's a nice registrar in the ward who doesn't think you're a waste of oxygen, thre might be a chance. I generally stay away from consultants on the ward because I'm terrified of them, don't say presenting. And that's if they're any doctors around at all.
But that's not my main problem. The problem here is presenting.
I've taken scores of histories - some good, some not so good, some with patchy examinations and most with none. But only about 20% of the histories get presented. That's if I'm lucky - or is it? How many times have I been stopped because the ST or SHO decided that the past medical history should be presented before the chief complaint, or felt that birth weight should be at the top instead of birth history further below. Some would say the PC should be just the main cause of admission and timeframe, others disagree and would have a bit of the HOPI in the PC in the patient's words. Sometimes I try to be smart and use jargon only to be caught up and asked 'did the parents really say 'apyrexial'? Use their own words.' I'm constantly being told different things and it reall affects me.
Just a couple hours ago I tried to present a case of a wheezy child to a rather nice ST but while I had all the information penned down, all I could think of was 'Is this how he would like it? What if he thinks the order should be like that instead of this?' And I was so caught up in those insecurities and thinking of past mistakes I ended up fumbling all over the presentation and mumbling to my knees. Needless to say he wasn't impressed.
I get that all the time. I have the information but what I can't do as of yet is translate everything into all that consultant-worthy jargon that doctors seem to be able to do. If there's one thing they don't teach us in medical school, it's how to not sound like a lay person. Which I sound like a lot. It's very frustrating because I am actuall making the effort to talk to surly parents, then gingerly ask these very busy-looking doctors if they could spare 10 minutes to listen to this hapless student present, only to mess it up and talk like a lay person. And at the end of it all have them tell me I need to improve and work on my presentation. I feel like I'm going nowhere.
It's been 6 weeks and while I think I have gotten better at clerking, my presentation skills remain static and unimproving. Which is probably worrying, seeing as our exams for this block will see us being marked mainly on presenting.
As a medical student you're really at the lowest possible rung of the food chain. You have no authority yet are expected to clerk and present 'like a doctor would' and get thrown into the shoes of one about to present to an impatient consultant who doesn't want to listen to you at all. Most parents/patients will let you clerk them but occasionally you get some snarky ones that just make you feel like shit, for the lack of a better description. Most F1s and SHOs/STs are friendly and helpful but it still takes guts to approach a busy person and bother them with trivial things like hearing you present, which they are under no obligation to do so.
This is why I hate being a medical student sometimes.
