Med student's perspective

I've been ruminating on yesterday's post regarding simulated patients (SPs). Now, it's true that many medical students are, in fact, young, inexperienced in certain areas, and socially awkward. But there's more to it than med students being newbies who are stressed out by their inexperience with the undergarments of the opposite sex. So I thought it might be interesting to offer the medical student's perspective on the encounter.

Imagine that you need to perform a complicated task for your job, one that you have little experience with. You're asked to perform the task with a trainer. The task consists of 100 steps, each of which you must complete, in order, with your boss watching and listening via a swivel-mounted video camera and marking each mistake or deviation on a checklist. The video recording will be archived and reviewed by a committee of your supervisors (and peers, in some cases). The results will be entered into your permanent record, available to all of your future supervisors when you are considered for future promotions and raises. All in all, nervousness is probably a perfectly reasonable response.

Although medical students are often placed in situations where they will feel nervous, it is important to learn to control those nerves for the patient's good. And as students, of course, it is only natural that part of the stress of working with SPs comes from unfamiliar intimacy with a stranger in what is already an artificial situation. But I can say from experience that the stress of an SP encounter is often much more intense than that of encounters with actual patients. I appreciate the SPs who have contributed to my own medical education, and I thank them for it. I'm glad that my first rectal exams, genital and breast exams, and general physical exams were not performed on real patients, and instead were taught to me by well-trained, generous simulated patient instructors. But I'm also glad that now most of my face-to-face histories and physicals are with real patients seeking real care, without the whirring of a video camera on the ceiling tracking every move.