Clincal Skill - relfection

This is an assignment I was required to do for my Clinical Science Learning (CSL) module. Well, I prereleased it here, before I hand in to my mentor tomorrow.

Ooi Zhi Hao A116684
Clinical Skills Learning 5 (CVS3) Reflective writing

On the 5th session of Clinical Skill Learning, I, as with my other colleagues, were required to perform skills that we learned from 2nd till 4th session, which including general and cardiovascular system examination on a standard patient. We were informed that the particular session was going to be a mock OSCE, just like what is going to be in our real final examination. As differ from 1st year standard patient session, this time, we were not only be tested our clinical examination skill, but we are also going to the particular cubicle in order and solo, without other colleagues watching what we were going to do. During that session, I offered to be the second person to be tested.

When it was my turn, I walked towards the cubicle and was told to read the question. During reading the question, I committed my first mistake as I was spending too much time to organize chain of question I was going to ask about history of presenting illness. Till my examiner / mentor reminded me of the limited allocated time, then I started to panic and began my history taking by greeting the standard patient. During the first question of taking history of presenting illness, I ended my question 2 minutes before time up. My examiner broke the silence by reminding me about asking patient’s symptoms at night. Before I could asked further question about patient’s paroxysmal nocturnal dyspnea, it was time up and I had to present my history taking. After my history taking presentation, my mentor told me that my history taking wasn’t impressive as the biggest flaw in my HPI was the lacking of any childhood disease that would suggest rheumatic heart disease.

Next, I was required to perform a cardiovascular examination on the same standard patient. This time, I couldn’t stop myself by thinking my mistake during history taking. This distraction caused my performance worse than I used to be during usual session. Couple of things I missed during my CVS examination, included radio-radial pulse, collapsing pulse, carotid pulse etc. With this poor performance, my mentor finally pointed out in her feedback that I was behaving nervous during the whole mock OSCE, and I will need a lot of practices to be more professional next time, which I couldn’t agree more with that.

As my reflection on my mistake during history taking, I realize how important it is for a medical student / doctors to be well prepared anytime with any situation of how the patient might be. Organizing chain of though when the patient is in front of me is surely not an impression I want to be in front of a sick person who might need emergency medical treatment. Patients seeking our help because of trust, hence, any delay in approaching to patient is not a good thing to do, but in fact, causing patient to doubt our professionalism. In more serious level, delay in approaching a patient because of “organizing chain of though” is not an excuse, as time is very precious especially patient attend to us with a serious medical problem which might be life threatening. A fast response and well-react to a patient’s medical problem can sometimes mean saving a life. Be well-prepared anytime is the first lesson I learn in this session.

In order to improve my approach of history taking, I realize that I was missing the part of nocturnal symptoms and childhood history is because I wasn’t formulating differential diagnosis in the process of asking history form the patient. Making use of clinical manifestations of various diseases I learned from books, I should be able to form a provisional diagnosis after knowing chief complaint of the patient. Based on this case, patient was young and presented with shortness of breath. I should have suspected rheumatic heart disease, on the ground of its prevalence among young population, and hence it would lead me into probing any history of rheumatic fever during childhood. From here, I learned that conversation with the patient and simultaneously making provisional diagnosis in my mind is a multi-task ability I should practice a lot. This is a big step from history taking in 1st year when there weren’t many diseases that we learned which limited our differential diagnosis in first year, but it shouldn’t be in second year right now. With our maturation during this year, it’s time for us to make differential diagnosis during history taking, and not after.

In the physical examination part of this mock OSCE, I should learn to overcome my distraction next time as it would influence my performance. From here, I realize that steadiness is very crucial when we are going to approach a patient physically. Steadiness would mean making sure oneself is not influenced by distraction, no matter what. With a clear thought, we will be able to complete all things that we need to do when we were examining particular system of a patient. Lacking any step would sometimes result in missing a sign that might suggest a particular disease. Furthermore, steadiness also enables us to appreciate some clinical signs even more, e.g. heart murmurs, apex beat etc., which is very fundamental to make every our action merely action, but an investigation.

Lastly, I should keeps reminding my weakness always, but not allowing them to influence me when attending a patient. I should also keep my mentor’s advice in mind, which the only way to perfectionism is through practices, and lots of practices.