Monday, November 16, 2009

So That's Over With

Thank goodness! To become a physician, one must take several licensing exams, also known as steps. Step 2 has two parts--a multiple choice "clinical knowledge" test and a hands on "clinical skills" test. The clinical skills test is only offered at 5 locations in the US, hence why I'm in Houston. Before I continue, I must thank Google for the free wi-fi in airports this holiday season, or else I'd still be bored waiting for my flight.

So today, I spent 8 hours interviewing standardized patients (SP's) and writing notes. It's supposed to test our clinical skills, but it really doesn't. The SP's are trained to observe whether or not we listen to the heart in four spots, shine a light in their eye, etc. Basically, we students just have to go through the motions to get the credit for performing the exam. And that's exactly what I did. I couldn't tell you whether or not my patient with high blood pressure had arterial nicking in the back of his eyes, but he thinks I looked back there. I couldn't tell you if my patient who complained of a fast heart rate had an irregular rhythm, but she thinks I listened long enough to tell. The fact of the matter, it's all an act. They tell us in the beginning to be cautious with the exam and realize the SP goes through this 12 times. I wouldn't feel comfortable diagnosing half of my patients today with the exam I did. Now you ask, why didn't you do a better exam? I didn't have time. It's either make sure you go through all of the motions and get the points for the motions, or actually take your time, get the findings, but exceed the 15 minute limit and get docked points. What would you do? Needless to say, the patient's life isn't hanging on my exam.

Ok, so along with my above gripes, let's talk about the expense of the exam. It's easy to find, so I'll just put it out there. For me, it cost $1200 for the exam itself (I think it's since gone up). Yes, that's right, I didn't accidentally add an extra zero. To fly to Houston, it cost me about $250 and then another $65 for my hotel. So for 8 hours of making sure I'm "clinically competent" I had to dish out $1500 because US med schools don't do a good enough of a job ensuring this (note sarcasm). We're not allowed to leave the testing area for breaks, so they provide lunch. For $1500, you'd think it would be a very decent lunch. Umm...not really. Someone made spaghetti with meat sauce. They put together their own lunch meat tray with slimy turkey, and someone made a salad. Now don't get me wrong, all of this food is perfectly fine, but for $1500, I was expecting something like Panera lunch boxes. I guess then that's favoring certain chains and USMLE doesn't want that.

Oh well. I'm just happy it's done and God-willing I passed and won't have to do it again.

I'm also hoping I don't have the same travel nightmares tonight as I experience yesterday!


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