I spent a lot more time with my preceptor this week. Instead of performing most of the histories and focused physicals myself, I saw most patients with my doc. We took this approach so that with each patient we could focus on a "clinical pearl," something I could take away as a learning point with each patient. For example, we saw a little five year old boy with the flu. He had a very dry cough and there was a red tint to his eyes. Clinical pearl: almost every patient with the flu has a very unique dry cough; if you aren't coughing, you don't have the flu. Patients also may present with eyes that can be red or bloodshot ("flu eyes"). So with each patient he discussed some clinically relevant tool that I could use moving forward.
I would say that I recognize/understand about 90-95% of what he talks about, but cannot always recall the information directly. I know that the three most common causes of meningitis in the first three months of life are E. coli, Listeria, and Group B Streptococcus, but if he asked about that information on the spot, I wouldn't be ready to regurgitate it back (however, after working through "Clinical Microbiology Made Ridiculously Simple" this week, I have made much progress in my Microbiology knowledge). When we're on the wards next year, this is part of the teaching style. Professors/Attendings will ask us questions to assess our knowledge, and keep asking questions until we're stumped (which probably that won't take long). I realized over Community Week that I have a long way to go before I seem even remotely intelligent.
Since I've spent the first few Community Weeks in Pediatrics, I was supposed to spend some time in a general medicine clinic for at least a day this week. The Emergency Room is right next to our AHEC housing, so I decided to take a morning and shadow around in the ER. The doc I worked with only knew that I was midway through my second year in medical school, so he began asking me questions right off the bat to see where I was in my training. I was also working with a PA student who was in her last year of school. She had been working in the ER all week as part of a one month rotation. The doc threw up an X-ray of a woman's thumb and pointed to a tiny little white spot medial to the thumb that looked like it was hanging in suspension. He asked me what bone it was, but the blank stare on my face was a dead giveaway for my incompetency (I thought it looked more like an errant calcification than a bone). The PA student quickly piped in, "I think that's a sesamoid bone!!" (enthusiasm exaggerated).
That's correct, and it looks like someone needs to go back and start flipping through their Netter's flashcards...
So for the first time in my life I was very glad I had a smart phone on me. I quickly pulled up the entry in Wikipedia for BlackBerry (after figuring out how to spell it correctly), and came up with the following:
In anatomy, a sesamoid bone is a bone embedded within a tendon. Sesamoids are found in locations where a tendon passes over a joint, such as the hand, knee, and foot. Functionally, they act to protect the tendon and to increase its mechanical effect. The presence of the sesamoid bone holds the tendon slightly farther away from the center of the joint and thus increases its moment arm. Sesamoid bones also prevent the tendon from flattening into the joint as tension increases and therefore also maintain a more consistent moment arm through a variety of possible tendon loads. This differs from menisci, which are made of cartilage and rather act to disperse the weight of the body on joints and reduce friction during movement.Now at least I didn't feel like an idiot for the next couple hours. So then I decided that I would be the one who asked the questions. It was my way of saying, "I know that I don't know anything, but hey, at least I'm interested and ready to learn. I will be your Padawan learner. Teach me, Yoda."
And I am interested. I just have a long way to go before I have a good handle on the force.
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