Test 1 Grades and LCE Day 1

My name is Derrick Antoniak, and this is my blog about being a medical student.



The College of Medicine decided that we would get our exams back on Fridays, so there was a predictable rush to the mailboxes (tests are returned via campus mail, and all 132 of us have mailboxes in about a 15 foot space on the wall of boxes) Friday morning, and I could not help but take part. Long story short, I did fine. Anatomy is one of five 'cores' that we have to take this year, and that exam was one of four that we have to take for this core. So there are a lot of other pieces to pay attention to.



One of those other pieces is called the 'longitudinal clinical experience' (LCE), in which we are assigned a preceptor in whose clinic we work five times per semester for a pass/fail grade that is factored into the Integrated Clinical Experience core. Today was my first day of LCE, and I was far more excited for today than I was for the first anatomy exam.



My preceptor, who I'll call Dr. R, runs a tiny pediatric clinic in South Omaha. She is a very nice, very short, sort of middle-eastern looking woman of about 40(?) years of age. I arrived a solid ten to fifteen minutes early, wearing my shirt and tie, white coat, UNMC name badge, stethoscope around my neck, and some other tools in my pocket (tendon hammer, tuning fork, physical exam handbook, etc.). In about 2 and a half hours we saw three kids, two of whom were brother and sister sharing the same bacteria.



I sat down on the little stool with the wheels like any good doctor would, pulled my pen out of the breast pocket of my white coat, clicked it once, and started the interview: "So what brings you in today?" Unfortunately, this is a small clinic. Dr. R has seen this woman and both her kids about once a month (at least) for the course of their little lives, prompting the 'my kids are sick, you idiot' look from the mother. More questions: How long has he been sick? Oh, discharge from the nose? How long for that? Any cough? Sore throat? Fever? Any other symptoms? Then on to the exam, and at this point I am just following Dr. R, who is trying to show me the tympanic membrane (eardrum) through the otoscope, but all I can see is hair and earwax. Kids don't stay still for long, so we're trying to hold his head, and finally she's pointing out the 'cone of light' that indicates a normal eardrum, and I can see it, but I doubt that I could have found it myself. The process is complicated by the fact that we just learned some ear anatomy, and two different professors mentioned that kids have short auditory canals, so you have to be careful not to stick an otoscope through their eardrum (no pressure).



What's scary about all this is how essential it is. Middle ear infections (the type you can diagnose by looking at the tympanic membrane through an otoscope) must be actively treated because with the middle ear's proximity to the brain, they can lead to meningitis. So it is absolutely necessary that I learn this skill. On the bright side, to get from where I am today to Dr. Roy's position (licensed pediatrician working with no supervision) will take seven years, and I think I should have it by then.



So we had two kids with upper respiratory infections (URI), and we prescribed them both a cheap antibiotic and one of them some extra asthma medicine (some type of corticosteroid, I don't know the names). I went back to my desk, looked in the pediatric handbook, looked in the massive textbook of pediatrics, looked at a few point-of-care resources on UNMC's intranet, and all sources said that URI's are mainly viral and resolve themselves. Stumped, I asked Dr. R why antibiotics had been prescribed, only to find out that I had apparently missed something. The drainage from the nose was very thick, indicating probable bacterial involvement, and amoxicillin is cheap, and usually an effective first-line antibiotic.

So, not the smoothest first day, but I left with an experience to build on and some nice learning objectives to look up before next time. Meanwhile, back to the library and gross lab and hopefully home for at least the second half of the game.