Pandemic Virtual Medical School and Lack of Physical Skills

[FingersCrossedPls]

Hello there, 

I am 2nd year pre-clerk and my medical education has been about 90-95% virtual since we started. Over the last few months things began looking up, and we actually started receiving full clinical skills teaching sessions and in-person family medicine clinical placements. Unfortunately with Omicron, we have gone back to completely virtual learning once again for the foreseeable future. It is not my place to say how things should be run, and whether or not this is the best course of action, and so I wont. But, I am genuinely concerned about my complete lack of physical exam skills and physical clinical knowledge and capabilities. We also have not had any OSCE or physical exam evaluation to-date since starting medical school. Unfortunately, we have never even been taught how to take a manual blood pressure in-person. Everything has been either drastically cut down from the curriculum or converted completely to virtual (yes... I have been learning what heart murmurs sound like over zoom, and how to do a hip and knee exam virtually...lol). For current clerks in this position last year, did you feel ill-prepared to start clerkship? And for residents, did learning these skills during pre-clerkship actually help, or did the real learning begin in clerkship anyways? Will we genuinely be okay to continue on in our medical education after pre-clerkship with this large gap in our teachings? 

Currently I am hoping for the best, and preparing for the worst. I'd love to hear some thoughts or advice from upper years who have been through medical school before or during the pandemic and how we can maybe overcome these short-comings in light of recent events.  

[shikimate]

In my opinion you're quite astute in your concerns. Physical examination and interview skills cannot be mastered by passive absorption from a computer screen. It's similar to singing music, you can't master it just by listening to it without actually singing it yourself.

I think you should find some like minded classmates and try to simulate and practice as much as you can. There are lots of good instructional videos on YT, follow those along as you practice on each other. It's very important to say out loud what you are doing, and explain why you are doing it (eg, "I would like to inspect the abdomen for signs of liver failure including jaundice, spider angioma, caput medusae" etc).

Back in the day, another option was to do a summer non-credit elective somewhere rural, you get tons of exposure in small hospital, ER and clinics. Helps a great deal feeling the flow of clinical settings. Not sure if that's an option these days.

 

[jb24]

I feel bad for medical students who are not doing things in person. I don't think virtual will ever be the same as going to the cadaver lab with your friends and learning the anatomy as a team. Something about it, was profound and those memories will last me a lifetime.

Nonetheless, for physical exam much of this is practice and repetition. You will have plenty of time to apply it in clerkship and beyond. Your exams as you become more senior generally are more focused/problem based.

At this stage focus on learning a good comprehensive exam. That meant for me, going through the motions on my friends who were willing. You get better at it, the more you do it. 

The neurologic exam is one that I still struggle with, and wish I spent more time perfecting. TBH I didn't find the in person clinical examination component very helpful, rather I found it stressful and feeling judged relative to my peers. Exams are just about practice.

[gogogo]

The utility of physical exams has increasingly been fading from actual medical practice. I would estimate that, bar a few manoeuvres within each system, much of what you learn in pre-clerkship regarding the physical exam and OSCE is just for historical interest (though the MSK and neuro exams both seem high yield in their entirety). The most important aspect at your stage is getting a feel for what normal is, and this doesn't truly start until clerkship, because that's when you're physically examining many actual patients in the context of sickness (rather than a few classmates once a week). So overall, I don't think your (lack of) adeptness with the physical exam is going to be a large gap to fill or even hold you back that much in clerkship. In any case, I learned heart and lung sounds from YouTube and it genuinely helped me recognize abnormalities in real patients. 

[LostLamb]

On 1/2/2022 at 8:48 PM, jb24 said:

At this stage focus on learning a good comprehensive exam. That meant for me, going through the motions on my friends who were willing. You get better at it, the more you do it. 

...

TBH I didn't find the in person clinical examination component very helpful, rather I found it stressful and feeling judged relative to my peers. Exams are just about practice.

Agree with all of this.
I loathed in person physical skill sessions. Teaching was lousy and inconsistent between groups. It was super judgy, with half the people clearly having learned the skills already and then people like me who had no clue and thought i was there to learn but instead felt like an idiot.

In the end, I just practiced on myself, my teddy bear, my cat, and if i had access to any persons who were willing and didn't break out into laughter while i practiced.

It'll work out. It is not ideal, though, but you'll all find your way.

[shikimate]

I want a cat to practice on!

Percuss their chest, soft and fluffy. Palpate their abdomen, round and squishy. Inspect their teeth, sharp and stinky...etc

[FingersCrossedPls]

On 1/2/2022 at 10:39 PM, shikimate said:

In my opinion you're quite astute in your concerns. Physical examination and interview skills cannot be mastered by passive absorption from a computer screen. It's similar to singing music, you can't master it just by listening to it without actually singing it yourself.

I think you should find some like minded classmates and try to simulate and practice as much as you can. There are lots of good instructional videos on YT, follow those along as you practice on each other. It's very important to say out loud what you are doing, and explain why you are doing it (eg, "I would like to inspect the abdomen for signs of liver failure including jaundice, spider angioma, caput medusae" etc).

Back in the day, another option was to do a summer non-credit elective somewhere rural, you get tons of exposure in small hospital, ER and clinics. Helps a great deal feeling the flow of clinical settings. Not sure if that's an option these days.

 

Thank you for the validation of my concerns and also for the advice. I have been vocalizing the physical exams just to get into the habit of what to do when we finally have an OSCE. I was looking into the rural medicine program as well! Unfortunately, it has been placed on hold as well for the last little while as far as I am aware. I understand, given that rural/community medicine doesn't have the same health care human resources as a large urban centre would, let alone during Omicron season. Thanks for taking the time to respond 

[FingersCrossedPls]

On 1/2/2022 at 10:48 PM, jb24 said:

I feel bad for medical students who are not doing things in person. I don't think virtual will ever be the same as going to the cadaver lab with your friends and learning the anatomy as a team. Something about it, was profound and those memories will last me a lifetime.

Nonetheless, for physical exam much of this is practice and repetition. You will have plenty of time to apply it in clerkship and beyond. Your exams as you become more senior generally are more focused/problem based.

At this stage focus on learning a good comprehensive exam. That meant for me, going through the motions on my friends who were willing. You get better at it, the more you do it. 

The neurologic exam is one that I still struggle with, and wish I spent more time perfecting. TBH I didn't find the in person clinical examination component very helpful, rather I found it stressful and feeling judged relative to my peers. Exams are just about practice.

Yes you're right. Unfortunately we don't know the majority of our classmates very well, and seldom do we get to see each other at academic events. I could count on 2 hands the amount of times I have seen classmates in an academic setting. Thankfully I have been able to make a strong bond with a few, and I am grateful for that. Thank you as well for the reassurance about physical exam skills. I have heard similar things from others about how the in-person sessions often felt uncomfortable and judgmental. I thought maybe virtual clinical skills was going to be the Great Education Equalizer since we were all going through the same thing, I didn't think about all the people in the class with physician family members who have basically been outsourcing their clinical skills education for the last 2 years  But as you said, its only practice and we still have time  

[FingersCrossedPls]

On 1/3/2022 at 2:22 AM, gogogo said:

The utility of physical exams has increasingly been fading from actual medical practice. I would estimate that, bar a few manoeuvres within each system, much of what you learn in pre-clerkship regarding the physical exam and OSCE is just for historical interest (though the MSK and neuro exams both seem high yield in their entirety). The most important aspect at your stage is getting a feel for what normal is, and this doesn't truly start until clerkship, because that's when you're physically examining many actual patients in the context of sickness (rather than a few classmates once a week). So overall, I don't think your (lack of) adeptness with the physical exam is going to be a large gap to fill or even hold you back that much in clerkship. In any case, I learned heart and lung sounds from YouTube and it genuinely helped me recognize abnormalities in real patients. 

That's great to here! Thank you for the reassurance, I appreciate it. Thankfully we were able to have some in-person training (albeit limited) in MSK and Neuro before we went back to a virtual format, and so I feel comforted knowing that maybe we lucked out there. 

[FingersCrossedPls]

On 1/4/2022 at 12:08 AM, LostLamb said:

Agree with all of this.
I loathed in person physical skill sessions. Teaching was lousy and inconsistent between groups. It was super judgy, with half the people clearly having learned the skills already and then people like me who had no clue and thought i was there to learn but instead felt like an idiot.

In the end, I just practiced on myself, my teddy bear, my cat, and if i had access to any persons who were willing and didn't break out into laughter while i practiced.

It'll work out. It is not ideal, though, but you'll all find your way.

Thank you for this comment, it really sums up a lot of how some of my classmates and I have been feeling wrt practicing on yourself, people you live with, or the wall (if you're trying to learn percussion, or which way your stethoscope goes into your ears so you can hear lol). I appreciate the honesty in your response