Basic Doctoring

Basic Doctoring is a longitudinal course that happens in the afternoons on a week-by-week varied schedule. During the first half of Basic Doctoring, you will learn how to interview a patient and elicit a medical history. There are lectures during which you learn how to take an efficient and thorough history, and small-group opportunities to practice interacting with standardized patients (SPs). 

SPs are professional actors that act out clinical scenarios that are based on real-life patient interactions. During SP days, you meet with SPs in the Objective Structured Clinical Examination (OSCE) rooms while a small group of your classmates and supervising physicians watch live from one of the breakout rooms. You’ll then get to hear feedback from your peers and professors that will help you improve your interviewing skills. 

Your SP experiences are recorded so you can reflect on how you did in the written reflection later. You can access a recording of your interviews from B-line, which you access through a Mayo laptop.

For the second half of the course, you will learn how to conduct a physical exam. Videos will be posted to Brightspace demonstrating the different examinations for the different organ systems (head, abdomen, nervous system, etc.). You’ll also meet as a large class to see these exams demonstrated in person. The best way to learn is to practice yourself: you’ll have four total opportunities to meet in the OSCE rooms with a supervising physician to practice the physical exam on simulated patients and complete it in under 30 minutes. The full exam will include conducting a female breast exam and a male genital exam with a simulated patient and a digital rectal exam and a female pelvic exam on plastic models. 

In the end, you’ll be assessed by conducting a full history and physical on a simulated patient in the OSCE, while being virtually supervised by a physician. After this, you’ll have many opportunities to go to the community clinic and conduct histories and physicals on real patients. 

Throughout all of the Basic Doctoring course, you’ll be developing your write-up skills, including how to properly document the History of Present Illness (HPI), Review of Systems (ROS), Physical Exam (PE), Assessment, and Plan.

During the history-taking portion of the course, you’ll receive immediate feedback on your history-taking skills from a supervising physician and a small group of classmates. During the physical exam portion of the class, you’ll receive live feedback on your physical exam skills from a supervising physician who will be present with you in the room. After each history taking or physical exam, you’ll do a write-up, which is due the day of your skills practice. At the end of the course, you’ll be assessed on your ability to do an entire history and physical exam within the required time (an hour total). As long as you put in the effort to improve over time, you will do great in this course.  

**Tip: Since the final assessment is in January, many students practiced on family and friends over the winter break. 

• Practice - It is so important to work on your physical exam skills during this portion of Basic Doctoring by practicing regularly. Taking just 30 minutes every once in a while to run through the entire physical exam - ideally with a buddy, or even just in your room alone, verbalizing and pantomiming the exam - will help you immensely. Know the flow of the exam solidly. Memorize the order of the organ system exams (spine, then eyes, then ears, etc.) and you’ll be able to go through the motions in the exam room with no problem. Having the flow down pat will also help a great deal with the next important component of Basic Doctoring - confidence!

• Often wrong, never unsure - For some of you, the physical exam may be challenging. It can be uncomfortable to be alone in the room with a patient, and touching a patient’s body can take some getting used to. The reality is, the physical exam is intimate and can be awkward at first. But this is our role now, and it is a beautiful, trusted, privileged position to hold. Doing a thorough physical exam is one of the most compassionate things we can do for our patients, to ensure that we catch anything insidious before it causes harm. Remember that this is where you belong, and what you’re practicing now will make you the best possible provider for your future patients! 

Sometimes the strangeness of this new role can cause you to forget the next step. Additionally, some of the physical exam skills, like percussion or auscultation, require some repetition and finesse, but that’s why you get these opportunities to practice with a supervising physician. Remember, during practice sessions, they aren’t there to grade you, but to help you get better. If you blank on the next step, or you’re not sure if you’re auscultating correctly, don’t look to the physician for direction every time; just keep going, stay confident, and remember “Often wrong, never unsure.” You can always ask questions at the end and the attending physician will intervene if there’s something to correct, and developing confidence and the ability to maintain efficient flow in this setting is one of the most important components of this course. This is a skill you can develop; it’s not that you’re either cut out for it or you're not. Every physician will need to be good at history taking and physical exams, and every physician will need to be confident with one-on-one interactions with patients. Being able to develop this confidence in your first year is a fantastic opportunity. We all start off nervous, but by the end, we all get it right.

• Clinical Application - During the History Taking portion of this course, you’ll be equipped with a lot of skills for actively listening and demonstrating empathy. You’ll learn how to use “pearls,” or empathetic phrases that show your patients that you are listening and understanding them. Add these tools to your toolbox, and remember that in an actual clinical practice, you’ll cater to the personality and needs of individual patients. Some will feel heard when you say things like “I’m so sorry that happened to you,” while other patients may find it ingenuine, or feel patronized. All phrases may not be universally appropriate, and sometimes using them may feel a little fake, but it helps to practice saying them anyway. During Basic Doctoring, soak up all the skills Dr. Mookadam and Dr. David equip you with, and over time you’ll develop the ability to discern when and how to use them. When it comes time to do your write-up, you’ll find a template on Brightspace or ask an upperclassman for their template and you should do just fine.

All of the information for this course can be found on its Brightspace page. No outside resources are required.