Introduction to Clincal Medicine: Learning to probe orifices

As mentioned before, I am currently in the last quarter of my second year as medical student. The module my class is handling at the moment is called Introduction to Clinical Medicine. This is where, after almost two years of intense theoretical training, we get introduced to the clinical set-up of medicine. It is a time both exciting and scary.

He who studies medicine without books sails an unchartered sea,

But he who studies medicine without patients does not go to sea at all.

[Sir William Osler was a pretty deep doctor.]

We have been going into hospital, taking histories from patients and practising our general, abdominal, cardiac and respiratory examination techniques.

Some techniques, however, are best practised in a well-equipped clinical skills lab.

Take for example the gynaecological examination. Today it was my group’s turn to be educated in all things orifice-y.

At this point I should mention that our skills lab is probably one of the best in the country and has some excellent simulated models. Nonetheless the vagina we got to practice on consisted of little more than two half-thighs (in lithotomy position), a pelvis, perineum andabdomen.

It would probably be a good idea for these SIMS to be innervated and have the ability to say “ouch”. I’m pretty sure we caused a lot of fissures today.

How awkward practising groping around in a vagina (albeit fake) in front of 20-odd classmates. I got to see a cervix though – hope it looks like that in real life otherwise it’s not really of any use.

Worst realisation of theday? Becoming an OBGYN will not get me out of performing rectal exams. It appears that part of the standard gynae-examination includes a rectal exam. This apparently is firstly to feel the rectovaginal septum and secondly it enables gauging the size of the uterus.

Poor women. Men at least grow up knowing that they will one day need this kind of probing to improve their chances of survival (and healthy swimmers) into old age. Good thing I found this out before my first time at a gynae. [Though apparently, had I studied well enough for my Gynae exam a month ago, I would already have known this. Sigh.]

Speaking of which. I have decided that if I ever went to a male gynae, it would have to be a very experienced one. Those poor boys today had no concept of sensitivity, the way they were shoving those specula around…

Shame, a friend of mine realised that he had inadvertently closed the Cusco speculum around the neck of the cervix and was pulling it out. Talk about iatrogenic prolapse…hopefully that only happens with mannequins.

I suppose this is why we practise on dolls first before being given half a chance to do it to a real patient.

So I’ve learnt a few new skills today, but I reckon I’ll be paying the lab a few more visits before attempting any real procedures.

Also… my hands smell of latex and KY jelly.

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