Back in the thick of medical school, today's post is a conglomeration of events/thoughts from the last fortnight. I kinda figured that since I'd not posted about med school related stuff for a while, an omnibus-type post would go well.

Half a baby and Broken necks

In pathology recently, we've been focusing on neuro stuff. There were three pots that I found fascinating. When asked to describe the first of these pots, one of my more timid classmates replied,

"It's half a baby". Well, not quite, it was actually less than half a baby, as the foetus had ancephaly. This is when the foetus' brain fails to develop anything more than a brainstem. The cranial vault was totally absent, and it's pretty much a case of two eyes on top of the shoulders. The reason the specimen had been cut in half was to illustrate the internal malformations of, well, everything. The heart was at the level of the umbilicus and the intestines were twisted around the great arteries. The spinal column was a mess. Several of my classmates were pretty grossed out. Not surprisingly, there are differing levels of these defects, and they fall into the term"Neural Tube Defect". Whilst these abnormalities are not usually compatible with more than a few hours of life, Spina Bifida also falls into this category.

The second pot was also in this vein. The pot contained a brain from a foetus that had holoprosencephaly. This is where the brain doesn't split into left and right, and there is a general absence of midline structures, such as the nose and mouth. Instead, there is a single eye, so the still-born child is a cyclops.

The final pot seemed to hit closer to home for many students. It was the c-spine of a 19 year old male. The last thing he ever did was pack down a rugby scrum, before braking his neck in two places. Resulting in instant death.

Why did the third of these pots hit so hard? I think that whilst it's easier to write off the first two as freaks of nature or alien, the notion of some kid a few years younger than yourself killing himself playing sport is a bit more abrupt. If you make it to term with one or no cerebral hemispheres, life is going to be brief. I guess there's inherently a stronger insinuation of the potential for success and the future for the young chap who's snapped his own neck.

Well Woman?

Another interesting event this week was the Pap Smear and Breast Exam Tutorial. This experience is dreaded by many medical students, and most of our group was no different. Rather than pass any judgements or point out the problems with the program, I will briefly describe what all this entails. This is certainly an essential experience and the current programme slash learning model we use is extremely good.

The program hinges on women whom train and demonstrate the examination. Firstly, the group of students (ten only), are shown the components of the 'Well Woman' checkup by two demonstrators. One takes the role of doctor, the other patient. Together they work through a sexual history, a breast exam, a pap smear and a bimanual pelvic exam, with an audience of ten students.

Next, each student is allocated a demonstrator, and two students and two demonstrators go into a clinical room. There, the students are shown how to use the speculum, and important points of hygeine are reinforced. The first student/demonstrator pair work through the 'Well Woman' check as above, with the addition of a debrief for the patient/demonstrator about what has been found. The student is assessed by both their demonstrator and the other demonstrator in the room. The other student also observes. Feedback is given at all times, and the demonstrators are very aware of everyone's wellbeing, both physically and psychologically. After the first student has completed the 'Well Woman' check, they are given specific feedback. Then, the same order of operations for the second student occurs. There is general feedback and assessment given, and if the student's performance is unsatisfactory, they are referred for another session at a later date.

From my point of view, it was a shitload scarier than it should have been. The main reason being that there was very little chance to prepare for the whole thing (twelve days heads up), and what few resources there were are crap. Also, as too much emphasis is placed on the clinical side of things, it makes it much more challenging to establish a relaxed yet professional atmosphere in the clinic room. One thing that was done really well was the constant feedback from both demonstrators. They really want you to do well, and make sure you pass if you're competent.

Like I've said, the whole program hinges on these women. As a med student, when it's your turn to do this whole thing, make damn sure you thank them thoroughly because they do a great job.