The first time I saw that quote was in a fellow classmate's email signature a year and a half ago. At the time, I had a very strong, negative, visceral reaction to it. I always thought it was about the effort, the hard work that led to the reward. But then I had my first OSCE experience, and I now understand that quote...
Objective Structured Clinical Examination, or OSCE, is where medical students draw upon the clincial knowledge they've acquired over the last two years and utilize it in a timed, videotaped, physician-proctored exam with an actor/patient. It's a sneak peek of what's to come in third year when we find ourselves in an actual hospital room on the first day of our clinical rotations ordered to do a complete history (by an actual resident or attending) of an actual patient. OSCEs serve as a transition from "let's pretend my healthy, albeit stressed out and sleep deprived, classmate is an 87 year old man with rheumatoid arthritis and prostate cancer and a glass eye" to "Oh no, I forgot to ask my patient if she travelled recently - she might have some obscure infectious disease that I missed because I forgot to ask that one question about her social history and now she might die and I will have killed my first patient because I have no idea what I'm doing." Yes, OSCEs serve as a nice bridge from second year to third year.
I was scheduled for this week, a comprehensive history of a new patient. I had some time to prepare and I definitely made use of it. I practiced with people, I wrote out all of the questions and committed them to heart. I felt prepared, and I had managed to get everything done in the alloted 20 minute time frame. So when the day finally arrived and I was standing outside of the door in my Ann Taylor navy pinstriped pants, tan heels, and a slightly stiff kind-of-itchy short white coat, I felt okay about it. Sure, my hands were shaking and the thought hurling passed my mind, but I grabbed my actor/patient's chart and went into the exam room. In my head I thought it was going well. I had a good rapport with my actor/patient, I was writing everything down for the SOAP note I would have to write later, and I was midway through the review of systems when all of a sudden someone in the hall belted out, "TIME!"
What? Time already? But I'm not done. No, this can't be. I didn't finish.
All that practice, all that preparation for nothing. I guess it's true - "Measure results, not effort."
When I returned a few hours later for my faculty review session, I asked my physician proctor if 20 minutes is an average allotment of time with a patient. "Oh sure, I would have done the history and physical in 15 minutes." How is it humanly possible to ask all of those questions plus a complete physical in only 15 minutes? I was really enjoying getting to know my "patient" and hearing her story. I wanted her to talk freely, but I should have kept it to quick yes/no questions. I have to admit, I feel frustrated by the fact that I only get such a short amount of time to do everything, do it with quality, and do it correctly. But I guess that's the real world experience of a physician - too much paperwork and not enough patient time, dealing with insurance companies and overbooked patient appointments. I feel the rose-colored glasses slipping off.
I know I should be happy with my actor/patient's critique. This was my first clinical encounter and she said she would have wanted me as her doctor. I'm only a second year and she said I made her feel comfortable. But all I can think about is that I didn't finish, which correlates to a grade that reflects that I didn't finish. My professors won't see all of the effort I put into preparing for this first OSCE or that I know what questions to ask, they'll just see what I missed because I ran out of time. And residency programs won't see that my actor/patient thought I was caring and competent or that my physician proctor thought I had good interviewing skills; they'll see the grade that reflects that I didn't finish in time.
I've been pretty down about it. I know I should move on, focus on studying for the Boards, prepare for the next OSCE assignment - that's what a rational, sensible person would do. Not me! I play it over and over again in my head, letting the frustration stew in my head until it gets me into a bummed out mood. And at the end of a very long day and my brain couldn't handle to eight hours of class and self-punishment, I headed home to wallow in my "why can't I do this?" mood and a box of cookies. And on my way out I held the door open for the security guard who walks throughout the building monitoring the rooms and takes notes on his clipboard. I see him throughout the day, sometimes at too late/too early hours of the day, and I always wave or say hello. But today, when I held the door open for him as I was simultaneously balancing a heavy backpack with one hand and fishing my gloves out of my coat pocket with the other hand he said, "You're always in a nice mood. There are some folks around here that aren't, they always have a frown on their face. But you, you always smile. You have a nice aura."
It was so unexpected. I thought about what he had just said, and I felt my perspective re-shuffle itself. As I walked home I thought to myself, "You know what, that actor/patient said she would have wanted you as her doctor. She felt comfortable and cared for, and isn't that more important? Isn't that the only thing that's important?" I get so bogged down in grades and numbers and scores that sometimes the big picture escapes me. The results will always be measured, but I still believe that the effort is just as important too.
Objective Structured Clinical Examination, or OSCE, is where medical students draw upon the clincial knowledge they've acquired over the last two years and utilize it in a timed, videotaped, physician-proctored exam with an actor/patient. It's a sneak peek of what's to come in third year when we find ourselves in an actual hospital room on the first day of our clinical rotations ordered to do a complete history (by an actual resident or attending) of an actual patient. OSCEs serve as a transition from "let's pretend my healthy, albeit stressed out and sleep deprived, classmate is an 87 year old man with rheumatoid arthritis and prostate cancer and a glass eye" to "Oh no, I forgot to ask my patient if she travelled recently - she might have some obscure infectious disease that I missed because I forgot to ask that one question about her social history and now she might die and I will have killed my first patient because I have no idea what I'm doing." Yes, OSCEs serve as a nice bridge from second year to third year.
I was scheduled for this week, a comprehensive history of a new patient. I had some time to prepare and I definitely made use of it. I practiced with people, I wrote out all of the questions and committed them to heart. I felt prepared, and I had managed to get everything done in the alloted 20 minute time frame. So when the day finally arrived and I was standing outside of the door in my Ann Taylor navy pinstriped pants, tan heels, and a slightly stiff kind-of-itchy short white coat, I felt okay about it. Sure, my hands were shaking and the thought hurling passed my mind, but I grabbed my actor/patient's chart and went into the exam room. In my head I thought it was going well. I had a good rapport with my actor/patient, I was writing everything down for the SOAP note I would have to write later, and I was midway through the review of systems when all of a sudden someone in the hall belted out, "TIME!"
What? Time already? But I'm not done. No, this can't be. I didn't finish.
All that practice, all that preparation for nothing. I guess it's true - "Measure results, not effort."
When I returned a few hours later for my faculty review session, I asked my physician proctor if 20 minutes is an average allotment of time with a patient. "Oh sure, I would have done the history and physical in 15 minutes." How is it humanly possible to ask all of those questions plus a complete physical in only 15 minutes? I was really enjoying getting to know my "patient" and hearing her story. I wanted her to talk freely, but I should have kept it to quick yes/no questions. I have to admit, I feel frustrated by the fact that I only get such a short amount of time to do everything, do it with quality, and do it correctly. But I guess that's the real world experience of a physician - too much paperwork and not enough patient time, dealing with insurance companies and overbooked patient appointments. I feel the rose-colored glasses slipping off.
I know I should be happy with my actor/patient's critique. This was my first clinical encounter and she said she would have wanted me as her doctor. I'm only a second year and she said I made her feel comfortable. But all I can think about is that I didn't finish, which correlates to a grade that reflects that I didn't finish. My professors won't see all of the effort I put into preparing for this first OSCE or that I know what questions to ask, they'll just see what I missed because I ran out of time. And residency programs won't see that my actor/patient thought I was caring and competent or that my physician proctor thought I had good interviewing skills; they'll see the grade that reflects that I didn't finish in time.
I've been pretty down about it. I know I should move on, focus on studying for the Boards, prepare for the next OSCE assignment - that's what a rational, sensible person would do. Not me! I play it over and over again in my head, letting the frustration stew in my head until it gets me into a bummed out mood. And at the end of a very long day and my brain couldn't handle to eight hours of class and self-punishment, I headed home to wallow in my "why can't I do this?" mood and a box of cookies. And on my way out I held the door open for the security guard who walks throughout the building monitoring the rooms and takes notes on his clipboard. I see him throughout the day, sometimes at too late/too early hours of the day, and I always wave or say hello. But today, when I held the door open for him as I was simultaneously balancing a heavy backpack with one hand and fishing my gloves out of my coat pocket with the other hand he said, "You're always in a nice mood. There are some folks around here that aren't, they always have a frown on their face. But you, you always smile. You have a nice aura."
It was so unexpected. I thought about what he had just said, and I felt my perspective re-shuffle itself. As I walked home I thought to myself, "You know what, that actor/patient said she would have wanted you as her doctor. She felt comfortable and cared for, and isn't that more important? Isn't that the only thing that's important?" I get so bogged down in grades and numbers and scores that sometimes the big picture escapes me. The results will always be measured, but I still believe that the effort is just as important too.