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.