Wednesday, November 18, 2009

Another Day, Another Lecture

I've now been in medical school for 3.5 months, learned a lot, sat in a lot of lectures, looked at a lot of pictures, and memorized (as well as forgot) a lot of material. We are almost wrapping up our focused anatomy section. Next Friday we have an exam worth 30% of our mark for Course 2. In the past four weeks we have covered an astonishing amount of anatomy as well as some clinical information. I've discovered that orthopedics can be both very exciting and very boring. When we have trauma surgeons talking about polytraumas coming in with multiple injuries from high energy incidents things get quite interesting. However, after a three hour discussion of osteoarthritis orthopedics/rheumatology is not nearly as exciting, in fact it is terribly boring. However the irony is that osteoarthritis and rheumatoid arthritis are much more common than exciting polytraumas.

Yesterday one of my group members and I had our Orthopedics Clinical Correlation at one of the Cast Clinics here in Calgary. We worked with a group composed of cast techs, us, a clinical clerk, a resident, a fellow, and the attending physician. In my limited previous experiences with the healthcare system I've wondered why there always seems to be random people standing around doing nothing - yesterday I found out why. When you are the clinical medical student (as opposed to a clinical clerk) you are pretty much at the very very bottom of the totem pole. However, even the resident (two or three steps up the totem pole) still had to wait for the attending physicians go ahead/ok on any diagnosis or advice. So for any of you frustrated by people standing around when you are waiting in the hospital it might simply reflect protocol as opposed to laziness.

The Cast Clinic was pretty cool. The cast techs who are amazing at their job showed us how to put casts on the resident who kindly volunteered his arm. My group member and myself successfully wrapped both his arms with cotton batting after pulling a sleeve on them and then applied the fibreglass casting material. We got lots of good advice and tips from the cast techs and fellow and did a decent job of it (although it took us much longer than the demonstration by the cast tech). After the casts were examined for flaws - they had a few - we got to cut them off with the cool cast cutting tool. It has a vibrating blade that can't cut through moveable material, i.e. skin and padding that you wrap the arm in before casting. Thus it won't cut through skin, unless it is stretched tightly over bone. When the cast tech demonstrated this for me by placing the rapidly vibrating serrated half moon on my palm I jumped and it didn't feel good but it certainly didn't cut me at all.

MSK has a ton of anatomy in it which I'm still attempting to learn (hopefully I'll have a good handle on it by next Friday). Anatomy is important for any medical specialty because it allows you to place things happening in the body in a physical context - where they are, what they are attached to. As part of this course we are also learning a large number of physical exam tests for a large number of things like anterior cruciate ligament tears (ACL), nerve root compression, damage to sensory nerves, reflexes, tears to the glenoid labrum, damage to the rotator cuff, just to name a few. These kind of tests are annoying to learn because most of them are named after some random doctor who lived more than 70 years ago and decided to name a kind of fracture after himself. However, they are tests that are relatively easy to perform and can be strongly diagnostic of given problem, without fancy diagnostic tools like CT scans.

In one month we will be done school for the Christmas break and also finished Course 2. This will mean that I'm done better than 2/7s of my theoretical medical training. However, in the meantime I'd better get learning that the fibula and tibia form a mortise joint that articulates with the talus allowing for plantar and dorsi flexion of the foot, as well as a whole bunch of other stuff.

Friday, November 6, 2009

I Passed!

Thank you all for your good thoughts and emails following my previous post. I received my results from my Course 1 final exam and I passed with flying colours. I was very happy with my result. It doesn't matter in the long run as all we will see on our transcript is a Pass or Fail but it was still nice to see that I had a solid margin above the minimum pass. With that I've put Course 1 to rest, but not fully. The topics we learned about - liver disease, blood, clotting problems are still relevant but they are just taking a backseat to our most recent course the Musculoskeletal System.

MSK is intense. This unit is likely to be our busiest in terms of anatomy memorization. In twelve hours we covered virtually all the muscles, bones, and ligaments of the hand, arm, shoulder, spine, pelvis, leg, and foot. Suffice to say, after three four hour sessions our brains were well and truly stuffed with information. This is the only formal instruction we are going to have specifically about the anatomy. The synthesis and further understanding of it we need to gain on our own through time spent with text books, in the lab with the cadavers, and optional sessions run by some fellow students and one of the anatomy instructors. The moral of this story is that I'm thinking about muscles and bones more than I ever have before. When I see people who are really thin and fit I'm tempted to stop and ask them if they could flex for me to see if I can identify the muscles I'm seeing.

The first week of this course was somewhat overwhelming and definitely different than Course 1. The course chairs and primary teachers are different and it shows. I suspect that I'm going to reflect on Course 1 with fondness for the rest of my education here at UofC. We are now getting into the clinical aspects of the muscle and bone. Today was all about trauma, Advanced Trauma Life Support (ATLS), fractures, and incident prevention. We also had a presentation from a patient who had been in a severe motor vehicle collision suffering multiple fractures and then had to go through five months of intense and painful rehab to regain function. It is days like this that make med school interesting. The orthopaedic surgeons are also doing their best to make Trauma and Orthopaedics sound like the best specialty. I'm not entirely convinced but they are definitely making a good effort. We've also had some incredibly painful lectures about topics like the physiology of bone growth and healing - not nearly so glamorous but just as relevant.

This afternoon was also super cool. We learned how to draw blood and insert IVs. While we understand that this is not necessarily something we will do a lot of (depending on location and specialty) it was still really cool to practice. We didn't have the opportunity to practice on each other but the stimulator arms we practiced on 'bled' when we poked them so it certainly felt real and we will be getting some real practice in the near future I believe. Being in the lab today playing with needles or 'sharps' definitely made me feel quite doctor like.

Anyways, it is Friday night and I'm off for the weekend...to the hot springs to study some anatomy.