Did we all watch Junior Doctors last year? In the first episode, one of the doctors, Lucy, explained that one of her patients needed a rectal examination and that, although she had done that on a plastic model, this would be her first time with a real person. The very thought of medics learning these things by using plastic models seemed to be fascinating to her crew. And afterwards, I had three separate phone calls from family members who wanted to know if it was true, which does sort of imply that the Great British Public were equally fascinated.
So, you can imagine the reaction when I announced last week that I was spending my day with plastic vaginas.
I suppose there are a limited number of fields in which the training involves probing fake disembodied body parts.
In the midst of all this business of trying to cram five years worth of medical knowledge into my head, I am also doing an obs and gyn rotation. I haven’t had obs and gyn before, unless you count the five weeks I once spent learning exclusively about vulval carcinoma. So, part of my first week was taken up with being taught how to do the relevant examinations — on plastic vaginas.
There are all sorts of plastic models available. There are pregnant abdomens with foetuses that can change position. There are heads that can have a whole variety of pathology slides hidden inside their eyes. There is a plastic arm from which blood can be taken and into which cannulas inserted. In one of my local hospitals, there is an acute care training facility with an entire plastic person who actually talks.
Of course, it’s extraordinarily difficult to do a proper fundoscopy on eyes that don’t move even when you ask politely and extraordinarily difficult to miss a vein when the plastic arm is dotted with literally hundreds of trackmarks, the pregnant abdomen doesn’t feel much like a real pregnant abdomen at all, and I nearly jumped out of my skin the first time SimMan talked to me. Still, there is a point to it all, which is that although hospital patients are extraordinarily kind and usually quite happy for legions of medical students to listen to their heart murmur and feel for their spleen and have a go with the tendon hammer, even the kindest and most understanding patient would rather not have a PR done for anything other than the very best of clinical reasons and neither would you. This is where the simulated stuff comes in.
Well, I say that. I had a patient last year who won the award for Most Understanding Patient In The Universe, who was getting a routine cervical smear and immediately agreed, at the request of the nurse, to let the medical student repeat the speculum examination ‘for practice’. It was all I could do to stop myself from saying, “Seriously?!”
The patients who will agree to that kind of thing are rare (and with good reason, too) and I wouldn’t normally even ask. And yet we do need to learn how to do these things, just as we needed to learn how to listen for heart murmurs.
It goes a bit like this.
In the clinical skills department, a plastic groin which has tragically lost its torso and legs lies on a table. In an exam situation, we are told by the instruction card to treat it as though it is a real person. This can get a little farcical. “Hello,” I say to it. “I’m Beth. I’m a final year medical student. You are Plastic Groin #2, correct? I understand that you’re here for your smear. Have you had one done before?” At this point, I hope that one of the eight people watching me will take pity and start acting. I explain the procedure. I get consent. I give it some privacy to get undressed while I go to wash my hands and get a chaperone. I come back and ask it to pull its legs up to its bum and let its knees fall apart, and, perhaps unsurprisingly given that seems to have lost its motor cortex along with the torso and the legs, it never ever does. I ask it to cough, and it doesn’t do that either. I explain that I am going to insert the speculum, and I do so. I tell the spectators that the appearance is normal, which is a lie – even the very best plastic doesn’t look like a human mucous membrane of any sort. I take the smear. I pretend to put it into a histology pot. I explain that I am going to remove the speculum, and I do so. I say, “Thank you, Plastic Groin #2.” It never thanks me.
When I said that this was what I had spent my day doing, I was asked, slightly incredulously, if this is how the whole thing works – plastic one day, real life the next.
It is a bit weird, I suppose, when you consider it from the point of view of normal people, people who haven’t spent a few years becoming accustomed and slightly immune to the medical student brand of weird.
Nevertheless, I’m appreciative of the fact that I get to make mistakes in an environment when it doesn’t matter, because when it’s the first time, there’ll always be someone who’ll try to do a PR with two fingers (or without lubrication) or a testicle examination without gloves or pull a speculum out when it’s still open or use an otoscope in such a way that it would probably go straight through a real eardrum. I leave it to you to decide which of the above mistakes you think was the one that I made.