Practice makes perfect, eventually

Deirdre Newman

Stethoscope in hand, Tania Tajalli bends down and listens to the

patient’s abdomen. Then she takes a small hammer -- also used to test

reflexes -- and percusses it against the abdomen to try to identify where

the liver is. Next she palpates the abdominal area, poking and prodding

to feel for enlargement of the liver and spleen.

Tajalli is in her second year of medical school at UC Irvine and is

practicing her technique in a class called Patient/Doctor II. The class

is designed to familiarize students with communicating, performing

physical exams and clinical reasoning-analyzing patient problems to

obtain consistent findings.

The class prepares these future doctors for the following year when

they will spend most of their time with real patients. For now, Tajalli

and four of her peers hone their technique on standardized patients --

people trained to illustrate various medical scenarios -- under the

watchful eye of teacher, Michael Prislin, who practices family medicine.

Prislin wants his students to feel comfortable with their technique

before they move on to detecting abnormalities.

“I’m really interested in them thinking about the basic approach to

the patient,� Prislin said, stressing that exams should be done in a

systematic way. “When you cut corners, you make mistakes.�

He teaches his students to deal with patients the same way he does --

in a warm, personal fashion infused with a strong dose of humor.

“My hidden agenda is always to make medicine fun because,

theoretically, they’re going to be doing this for the rest of their

lives,� Prislin said. “And it’s important for the patient because [humor]

relaxes people and humanizes the process.�

He also keeps the class interactive, demonstrating the correct

technique as often as necessary.

On a recent afternoon, as the students poked and prodded the lucky

standardized patient of the day, some of the students had trouble getting

a reflex response after tapping the patient’s knee with the hammer.

Prislin illustrated how feeling around the knee first helps, then

demonstrated the proper horizontal swing wrist motion. After waiting for

the patient to relax, Prislin tapped her knee, eliciting a small kick.

“This is another one you can use on your friends for amusement,� he

joked.

Throughout the course of the second year, Prislin will work closely

with these five students as they progress through five different modules

that cover bodily systems like cardiovascular and

abdominal/gastrointestinal.

The first week of each module, the students interview patients with

illnesses typical to the category.

“Every now and then, we make the patient hostile to keep [the

students] on their toes,� Prislin said.

The second week, the students conduct physical exams on a normal

patient to practice their technique. The following week, the students

look for abnormal findings and the fourth week is spent doing follow-up

to reflect what was learned.

Medical student Ami Doshi, whose interest in science and helping

people led her to pursue a medical career, said she appreciates the

structure of the second-year patient/doctor course because it provides

practice without too much pressure.

“As second-years, we want a lot of patient contact, but we’re nervous.

So it lets us get the experience without consequences if we screw up,�

Doshi said.

* IN THE CLASSROOM is a weekly feature in which Daily Pilot education

writer Deirdre Newman visits a campus in the Newport-Mesa area and writes

about her experience.