Weekly Thoughts: First Year Week 8 Reflection

This week was amazing! This blog post is different from previous posts because I wanted to switch it up a little bit. 

Academics

On Sunday, I started a new schedule for learning the material. I’ve decided to go through the lectures using last year’s recordings and try to be one day ahead. This change is my way of trying to expose myself to new material, and reinforce it so that I am not frantically learning new material in the last week of the block. 

For this method, I continue to make Anki cards and I try to take notes either with the learning objectives or by sketching out the pathways. 

I am still trying to catch up on material from the first week, but I started using some outside resources from YouTube to better understand metabolism. 

My hope to be one day ahead was very helpful because I was able to complete my asynchronous modules on Wednesday instead of Thursday. This change allowed me to take part in an amazing opportunity that was presented to me on Wednesday. 

In addition, I did not feel as lost during this week’s case. Last week, I was very behind and had no idea what was happening. Being a day ahead, this week made much more sense so I will continue this method. 

Basic Life Support Training

On Wednesday, I had my required basic life support training. This training was done at another university’s emergency medicine services training center. Initially, I was embarrassed that I walked in late, but this session was still pretty great. 

We watched some videos that explained CPR for adults, children, and infants. The beginning of this session was not as exciting because we had to learn the background information. Personally, I was surprised at how much I remembered from my CPR training from 2016.

Before finishing up the videos and taking the quiz, we had a short break. During this break, a classmate approached me and a few friends about attending a breast and pelvic exam training session on Thursday during 10am to 12pm. After my initial concerns, about what and when, I was very excited about this training session! 

After the quiz, we broke into groups of 8 students and practiced the CPR techniques. These techniques include checking the person’s breathing and pulse, yelling for help and asking for an AED(automated external defibrillator), and starting compressions. For me, I need to work on making sure there is enough recoil between my compressions. 

The hardest part of CPR was keeping a good seal on the Bag-Valve Mask. Most of my fellow classmates with smaller hands struggled with that. I have a video, and I can’t figure out to add it to this post right now so hopefully I can get it on here later! But…here are some pictures:

Training Session 

After CAS on Thursday, I headed over to the area with the breast and pelvic exam training sessions with one of my friends. I was super excited, and very unsure of what was going to happen. I was under the impression that we would mostly be watching since there were M4 students (fourth year medical students) with us. 

This training session was being held because our school was training GTAs (Gynecologic Teaching Assistants). GTAs are standardized patients that teach medical students how to do a breast and pelvic exam on their own bodies. They essentially narrate the techniques and guide the student in real time on how to perform these exams. 

These GTAs have been doing this teaching for years, but our school was doing quality assurance checks to ensure these GTAs embodied our values and taught the students the desired methods. For this session, they had a few M4 students and wanted a few M1 students so that they could see if they were teaching the breast and pelvic exams in a way that would help our school’s students. (For context, M2s learn these exams so it was a really special opportunity to be given this chance).

In my training room, there was the GTA, one of our professors, a fourth year medical student, my friend, and another person. The GTA basically had a little less than two hours to teach us the breast and pelvic exams while our professor observed. At this point, it was clear that there was potential that me and my friend might have the chance to perform the pelvic exam if there was enough time. It was very nerve racking, but also super exciting. 

Just as a reminder, we haven’t had any anatomy in our first year yet. We start that next block. We also only finished learning the full interview, how to take vitals, and the core physical exam last week. For that reason, being in this training session to learn an invasive medical exam was a bit daunting. 

To begin, this GTA decided to teach us the pelvic exam first. She began by teaching my friend how to speak to patients and guide them to the most comfortable position for this exam. At some point, I asked how my friend was feeling, and it was decided it would probably be better for the M4 to demonstrate because she’s actually learned and performed these exams. 

My initial reaction to the beginning of this session was definitely discomfort because all of my standardized patients have been fully clothed. It was strange, but our GTA kept cracking jokes and just made the room comfortable to be in. 

She decided to teach us the internal exam first. Collectively, everyone in the room showed us how to check some glands, how to measure the length of the vagina to determine speculum size, and checking the cervix and uterus. It was so bizarre to have the GTA casually talk me through everything as I performed this exam for the first time, but it made sense and was very helpful. 

It was also really weird because I had no idea what I was supposed to feel for and what would be considered abnormal. For instance, I was very unsure if I found the cervix or if I had gone too far. It was still very interesting because I never realized what was being checked during the internal exam. 

After I completed the internal exam, the GTA wanted to teach us how to use the speculum because she would have time to work with the M4 student after the session ended. Since I had gone last for the internal exam, she had me go first for the speculum. 

The speculum has always intrigued me because I didn’t understand how it worked. The GTA, M4, and our professor took the time to explain how they worked and I was able to work it a little bit before inserting it. 

I was very scared I was going to hurt this person, but she reassured me that everything would be all right. I think that fear was very helpful for me because I worked slowly as she and the M4 guided me through this part of the exam. 

The GTA gave very good instruction, and was patient when I had questions. I felt very comfortable learning, and was able to insert the speculum in smoothly without any issues. When there was some light, it was so amazing to see how that instrument looked to give a good view of the cervix. After this portion, I was able to slowly take out the speculum and I felt very relieved that I wasn’t in the hot seat any more.

To my surprise, my professor made the comment that the speculum never goes in as smoothly as I was able to insert. There is usually some trial and error, and everyone else in the room agreed (besides my friend who was just as surprised as me to hear that). To be very honest, I am very proud of that. My first time using a speculum went perfectly?? Heck yeah, I am living off that high for this entire block. That reassurance was definitely what I needed to hear this week. 

Now, I feel bad because I was supposed to explain what to do to my friend…except I was holding my breath the entire time and I think very few memories were formed because I definitely couldn’t remember every step perfectly. It was interesting seeing this part of the exam being done from a different angle. My friend was also successful in completing this exam. We’re both amazed that this entire experience happened for us. 

After these exams, we were both guided through the breast exam. I think this exam is a bit more confusing to me because I need visuals to indicate where I should be examining the patient. It was very helpful that the GTA guided my hands, and also demonstrated the pressure that should be used. I think I might need more practice for this portion of the exam because I want to make sure that I do the technique correctly. 

However, I will be focusing on that next year. Overall, this was the most incredible experience. I am so happy that I lucked out and just happened to be near this classmate who asked if we would be interested. This entire experience also made up for the fact that I wasn’t able to sign up for the suturing clinic (all the slots filled up within 30 minutes!!). 

In all seriousness, this experience really reinforced my interests in OB-GYN. I am excited that next year I will be able to learn this in the context of anatomy and pathology. 

I also want to note that during this entire training session, the GTA and our professor focused heavily on the language we used throughout the exam. They emphasized saying “footrests” instead of stirrups as well as avoiding saying “for me” while speaking to the patient. There were many little phrases that I never really thought about that could potentially trigger someone, or create unwanted imagery. 

Below is a quick selfie I took right after we left this session: 

Conclusion

That was my week! It was incredible and I am so happy. Yesterday, my parents were also able to visit and they brought me a lot of food(so grateful!). They were also happy to sit down and let me practice taking vitals and practicing the core exam because I have my third FOSCE on Wednesday! 

I am very nervous for this FOSCE because we will be interviewing two patients in 20 minutes. For one patient, we will be performing a core physical exam and for another we will be doing vitals. I’m nervous because I always use up all the time for interviews without doing the vitals or physical exam.