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Reality Check: When it stopped feeling like just another day in medical school

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

In many ways, the first year of medical school feels just like undergrad to me: I spend much of each day in basic science classes, regularly meet with my academic advisor, work on problem sets with classmates, and try – as unsuccessfully as I did in college – to maintain a regular work-out schedule.

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Of course, there are aspects to my first year that were not present in my undergrad years. Patient presentations are a familiar component of our classes, with our instructors bringing in a patient and their family, who in turn share their unique stories with us and give us the privilege of asking them questions about their conditions and their care. In addition, we spend two hours every Monday and Friday in the clinical skills component of our Practice of Medicine (POM) course, learning the core components of the patient interview and the physical exam.

Both patient presentations and POM sessions have been the highlights of my first year but neither experience has made me feel like a "real physician." Yes, I'm drawn into patients’ hopes, struggles, and experiences during patient presentations, but it's a faculty member with extensive clinical experience, not me, who guides the conversation. In POM, I appreciate the opportunity to practice with standardized patients (SPs) and classmates in a safe environment, but it feels very much like “playing doctor” because – let’s be honest – both the SPs and I know my medical knowledge is pretty limited at this point.

Hamsika sketch2

For some reason, it wasn’t until we learned the genitourinary exam that the reality of becoming a doctor began to sink in for me.

We learned this exam in POM in late February, and to my immense relief, we practiced not on SPs (or classmates, thank goodness) but on simulation models. I should preface this by saying (and hopefully, this isn’t TMI for the blogosphere) that I have never had a pap smear and therefore had never seen a speculum in my entire life.

So my first reaction was, "Holy cow, that is a GIANT metal instrument, and you want me to put that WHERE?"

This was followed by: "Okay, I need to pay attention to every single word of this POM demo, because if I mess this up with a patient, that would probably fall under the 'Top 10 worst things that ever happened to me,' and I’d rather just stick with my first Top 10 list."

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As I was walking home after class that day, my thoughts turned from panicked to pensive, and I thought about how incredibly vulnerable it must be for a patient to come into the clinic and allow a physician – perhaps one who they've just met – to perform such an intensely personal and arguably invasive technique. I imagined the amount of trust my patients would have in me, not only to perform the procedure correctly (while causing as little discomfort as possible) but also to derive the right conclusions from results. The thought both scared and humbled me.

I know that the quote “with great power comes great responsibility” is often over-referenced, but at that moment, these were the words that came to mind. As future physicians, my classmates and I will encounter patients who welcome us into their lives, sharing deeply personal aspects of their lives and their bodies with us. And it will be up to us to act diligently, with compassion, to do our best to care for them.

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Hamsika Chandrasekar is a first-year medical student at Stanford’s medical school, with an interest in medical education and pediatrics.

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