Formative Portfolio Review #3

As we complete the preclinical chapter, it occurs to me that I have encountered and learned a
lot more about medicine, the human body, and the ability to interact with patients than I ever expected
to encounter and retain. Its a shock turning to study for Step 1; just glancing over the material in First
Aid gives me chills. It's a daunting amount of information I realize I've received, and all of my colleagues
in my program (and the 3rd years, who are also studying) are shocked over how much information we
managed to cover in 18 months (and will subsequently re-review for multiple weeks). If I have gained an
appreciation for anything, it is for the fact that not only have I acquired a whole glut of knowledge, Im
not anywhere close to done learning. Instead of finding this challenge daunting, I find it rather
refreshing: another few weeks of intense review and preparation awaits me, and after that, I should,
theoretically at least, have the knowledge to assess and even give input on treatment for virtually any
case that I can face in the clinic. This is a mind-boggling amount of knowledge I, as a student, have
acquired, and I find that simply amazing.
Now, on to the actual assignment: there is a lot to say about the development of my skills in
patient interaction. I was previously concerned with maintaining the flow of conversation with a patient
through the entire interview. Now that has become less of an issue the standard patient interview
where we try to find out more about the condition that the patient presents with is becoming more
natural. I can get a relatively thorough history fairly consistently (obviously, practice makes perfect) and
a goal for now would be to improve further and maintain it throughout my PhD years. This would
probably require some clinical shadowing while I do lab-work, which should be fairly easy to set up so
long as I portion out time for it. Further considering the different aspects of patient care, I have
learned a lot about the standard physical exam (head to toe). The newer aspects of the exams (limbs,
head and neck) are still somewhat rusty - we didn't get many opportunities to practice these in

particular - but that will resolve itself later in the future, and I foresee little trouble. This is another thing
where I have technical knowledge but simply need practice and exposure to make it a naturally-flowing
exercise. Another potential trouble spot would likely be the fact that I still have almost entirely practiced
on male patients; a female patient has very different concerns and the exam needs to be approached, or
at least narrated, differently. An example of this was the physical exam practical, where, for the first
time, I examined a female simulated patient; it was an entirely benign experience, and everything went
as it should (no reason for it not to), but it was still somewhat anxiety-provoking (though I was able to
shelve that feeling for the purpose of the exercise). While there might be a few awkward exams, I feel
like I have enough tact to avoid any egregious errors.
Finally, the area that I feel I can improve in the most is in the area of providing counseling to my
patients about their personal lives, such as smoking or medication compliance. In terms of making a
logical argument to the patient or understanding their point of view, I feel comfortable and my SPs have
rated me well in those areas. However, the convincing portion of the conversation tends to be difficult
for me. Some of this stems from a desire not to be patronizing and wanting the patients to be
responsible for their own life choices; even in conversations with my friends, I often abstain from giving
life advice unless I feel strongly about it. While this comes with the strength of having a strong impact
when I say something, it makes it more difficult for me to make a point when Im talking to someone
unfamiliar. This and my tendency for introversion do not combine to make a very forceful argument;
indeed, I even lower my voice when I have to give advice like this because I am not comfortable doing it.
Furthermore, now that I have more medical knowledge, I felt like I inadvertently overstepped my
boundaries during our final OSCE's, where my patients asked me what I thought and I flat-out said the
disease that I had deduced (correctly, technically); this, I realized as I was speaking, was definitely not
what I'd do in a real-world situation, but the artificial-ness of the OSCE prompted it. I know I can and will
get over this problem simply with practice with real patients, but clinical years seem far off. Ill try to

find some volunteer work on my own that would give me this sort of practice during my PhD years, and I
think I can make up some significant ground by the time I reach the wards.
In terms of professionalism, I feel this is a strong category for me. Often in free clinic or
bedsides, my patients will pull me aside and mention that they feel I would be a good doctor and that
they felt comfortable with me and my demeanor; friendly and non-threatening while knowing what
youre doing, as one patient described me. In terms of preparation, I feel that I participate enough if
not with the potential for more and I can always handle the situation at hand. I definitely believe I act
respectfully towards my peers and teachers, if not to a fault I could potentially be more buddybuddy with some of the surgical instructors and cardiology faculty in order to network better, but that
is tough to muster the effort for when my clinical years are so far away. In terms of feedback, I never
hesitate to help out my peers in person, and even prioritize the feedback for them. The other feedback
exercises required of us, however, I find excessive and honestly do not approach with the same gusto.
As I have mentioned in the past, exercises like these are relatively pointless, as I know I have already
evaluated my flaws and strengths without any need for outside prodding. As it stands, this is really not
the most fundamentally helpful use of my time, but more of a diary of thoughts I had ages ago,
especially during the boards-studying phase of my schooling now.