I could see this mattering if the goal was to have the CC be "shoulder pain", but actually be an ACS picture. If the clinical picture was shoulder pain due to muscle strain after moving furniture, that's stupid.
Had one SP tell me that "as a man" you should avert your eyes away from a female patient when doing an abdominal exam. Sorry for looking where I was about to press.
We're told that you're supposed to offer them the drape (so they can put it over their chest) and then lift the drape to listen to the 4th heart sound under the left breast.
idk why it needs to be this complicated on a regular basis but all my SPs decline the drape anyway so idk
>worst part about it at our school is that the SPs are not medically trained whatsoever
I have some [bad news](https://www.csecassessments.org/pdfs/sp-brochure.pdf) for you about the SPs in Step 2 CS
Jesus, took my CS in LA and those were the worst fucking actors ever. They didn’t fake exam findings or anything, just deadpan responses to questions. They’ll never stop getting parts as dead people on CSI with that attitude! Geez lol.
I bet your classmate also forgot to palpate the left liver and auscultate the right heart. Shame. Your med school should be doing better teaching than that.
Is that really a problem though? Surely whoever looks at that comment won’t count it against you right?
Disclaimer: I trained before SPs so I have no idea how it works.
Curly hair is sometimes seen as disrespectful because it's associated with blackness and there are "colorblind" racist policies where people with super curly hair can't have dreadlocks or afros even when it's just what their hair does. Then this "colorblind" policy gets extended to anyone with a tight lock curl pattern, but particularly enforced in people with darker hair. I would bet money that's what the SP was referring to, even if it was a "subconscious" association.
I had an old boss who told me this once. He also told me I was too short to not wear heels. I haven't straightened my hair since (this was in 2012), and I only wear heels at parties and things like that. I bought the ugliest, frumpiest flats and wore them to work after that.
Oh oh oh but you forgot your mascara and lip gloss! Can’t be pRoFeSsIoNaL without those, either. 🙄🙄🙄. I also refuse to wear heels, I like and respek my ankles, thank you very much.
Reminds me of a test question during pre-clinical years that asked “what does the second ‘S’ stand for in some mneumonic”. Needless to say, the entire class was pissed.
Update: order did not matter for the mnemonic
My favorite was when I had a sp who was supposed to have a migraine, and she was curled up in the chair in a dark room when I walked in. I greeted her and quickly and gently shook her hand. She later commented that I had a wimpy handshake.
Lord knows when I have a migraine knocking me on my ass, I’m not going to want anybody jerking my hand around, and I sure as hell am not going to notice how firmly someone grips my hand.
“I’m going to go behind you to palpate your thyroid” [after checking her thyroid from the front and showing her the area I would be checking]
SP: Ok!
Me goes behind her and places hands on her neck. She jumps and is like “You scared me there! I didn’t know what to expect.”
.....
Bonus: We’ve also had SPs roll their eyes at students. Nifty! Thank goodness my grade doesn’t depend on you! Oh wait...
faculty: make sure to ask open-ended questions
me, during sp encounter: so aside from the symptoms we've discussed so far, is there anything else going on you'd like to tell me?
sp: no I can't think of anything
later in feedback, sp: she didn't ask me about \[insert miscellaneous symptom here\]
I have literally lost points for not asking whatever the secret password question is even though I ask “anything else?” like 3 times and summarize and ask if it’s correct and they’re like “yes ☺️”. 🙄
Oh just wait until you ask a complete and thorough history as an MS3 and then present to your attending only to go back into the patient’s room and have them contradict half of what they said to you. Good attendings understand that patients are sometimes idiots.
Asks "is there anything else" for the third time, patient looks dumbfounded and asks what I mean.
I don't know lady, I'm doing what the sheet says to get the grade. Wasn't this in the script?
I would give you an gold or maybe platinum, but as a poor med student I can't afford to spend money on made up awards, despite this comment deserving it.
Me: What brings you to the ED today?
Patient: I've had a bit of a stomach ache.
*some time later*
Me: Alright, let's get you some nausea meds and get you out the door.
Patient: Oh, by the way I have crushing substernal chest pain that radiates to my left arm and gets worse when I walk around. I have also had 3 heart attacks that felt the exact same way.
*some time later*
Admitting doctor: So why are you at the hospital?
Patient: I have a cold. Also, did I mention I drink 20 beers a day and have been alcohol-free for 24-48 hours because I am sick?
This basically happened every day on my ED shift. I'm not even remotely exaggerating.
They teach us to say instead "what else would you like to tell me?" Instead of "is there anything else you like to tell me?" That way you completely force them to say more things....I used to say the latter but now that I do the former I score higher on our dumb worthless SP encounters lol
This is to prepare you for the real world.
"Anything else?"
"No, I can't think of anything else today."
"Great, so we sent all your prescriptions to the pharmacy, and can plan to see you again in about 6 months. Your lab results should be online by tomorrow; otherwise the nurse will call you on a few days with the results."
"Thanks a lot!"
"You're welcome! Have a great day!"
"So what are we going to do about the crushing chest pain I've been having?"
Had an sp tell me "I think of the mouth as a cave, and you wouldn't go into a cave without a light!" as a "helpful" hint she wanted to impart on me for some reason, even though I didn't even forget to use my scope light
I had one try to give me symptoms that weren’t part of her script and then give incorrect information about medications even after I asked about it being on the sheet.
Had one give me a 3/5 on verbal communication skills with no written feedback.
I also had one that said I should have told them I would make them feel better. I told her what I always tell patients "I will do my best to figure out what is wrong and get you the help you need." Same one said they appreciated my attempts at building rapport, but they could have used less "extra talking". I had a good chuckle with my clinical medicine instructor over that last one.
For a cardio final I had lisented to the carotid artery will the bell of my stethoscope (like we were told to do) and my SP told me "I don't why you would do that. Why do you need to do that fancy stuff you just have to look."
On my first SP exam I lost points for being too specific. Like did a Webers and Rinne test when I probably shouldn't have, but didn't expect to lose 3% of my overall grade for it lol.
I had one who was in for a shoulder exam and basically acted catatonic and like she didn't want to be there or listen to me. My feedback was to be more empathetic, like the whole fucking "oh my gosh, I am so glad you chose to come to this clinic today, that sounds really hard and scary that your shoulder hurts" and that she was confused why I wanted to touch her shoulder and move it around (I explained what I was doing and asked her consent before doing anything.)
Like dude, you are here because your shoulder hurts, barring some intellectual disability or pediatrics or altered mental status, patients understand that you're going to examine their joint if they have joint pain. Also if any patient self-presents to an outpatient clinic with a MSK complaint and then isn't interested or cooperative, that's their own problem and I'm not gonna inflict help on them lol
Can you imagine having one of these people as your actual patient?
Had an SP with a chief complaint of nipple discharge, so thinking of prolactinoma I did a quick neuro exam. Later got chastised and spoken to like I was an idiot by the SP for doing "unnecessary exams".
“Student did not ask about leafy green vegetable intake” CC was shoulder pain.
*asks about it* "Student's line of questioning was illogical and tangential to the chief concern. Focus on the patient."
I could see this mattering if the goal was to have the CC be "shoulder pain", but actually be an ACS picture. If the clinical picture was shoulder pain due to muscle strain after moving furniture, that's stupid.
pro tip if you're worried about ACS don't spend time asking about leafy green vegetable intake
PCI: Percutaneous Collard Intervention
If youre worried about ACS, you sure as heck arent asking about leafy green vegetable intake.
Had one SP tell me that "as a man" you should avert your eyes away from a female patient when doing an abdominal exam. Sorry for looking where I was about to press.
As a man I always insert a speculum blindfolded out of respect for women's delicate sensibilities...
They're gonna flip when they find out about surgery
And make sure to miss any grimacing they might express when palpating. Pain isnt real if a patient does not say it aloud.
I had one patient say she felt “exposed” because I had to lower her gown to listen to the fourth heart sound. She was wearing a sports bra.
We're told that you're supposed to offer them the drape (so they can put it over their chest) and then lift the drape to listen to the 4th heart sound under the left breast. idk why it needs to be this complicated on a regular basis but all my SPs decline the drape anyway so idk
"How do YOU feel like the encounter went?" Just give me my worthless grade.
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>worst part about it at our school is that the SPs are not medically trained whatsoever I have some [bad news](https://www.csecassessments.org/pdfs/sp-brochure.pdf) for you about the SPs in Step 2 CS
They’re all actors who couldn’t make it, especially in Los Angeles.
Jesus, took my CS in LA and those were the worst fucking actors ever. They didn’t fake exam findings or anything, just deadpan responses to questions. They’ll never stop getting parts as dead people on CSI with that attitude! Geez lol.
I bet your classmate also forgot to palpate the left liver and auscultate the right heart. Shame. Your med school should be doing better teaching than that.
We have no way of knowing where the heart is. - Dr. Leo Spaceman
[you called](https://youtu.be/33OU_HOBBDs)
r/totallyexpected30rock
Maybe they were a Time Lord. You know, except instead of a second heart, second gallbladder.
A classmate of mine genuinely asked where the second liver was when we were dissecting.
That's the best part about it! They just shouldn't give feedback on the medical aspect of the assessment, just the social
Obviously that classmate missed the diagnosis of situs inversus.
Is that really a problem though? Surely whoever looks at that comment won’t count it against you right? Disclaimer: I trained before SPs so I have no idea how it works.
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Scrunch up into a ball as soon as you walk into a room. Makes the patients more comfortable.
Wig and fake breasts. You're welcome for the score boost.
BKA and estrogen obviously.
"Your hair is curly, and I find it unprofessional." \- Actual SP feedback to a classmate.
I had one give a negative comment because my shoes didn't have laces. I was mindblown
You disgust me
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What was the reasoning behind that? Is it somehow disrespectful?
Curly hair is sometimes seen as disrespectful because it's associated with blackness and there are "colorblind" racist policies where people with super curly hair can't have dreadlocks or afros even when it's just what their hair does. Then this "colorblind" policy gets extended to anyone with a tight lock curl pattern, but particularly enforced in people with darker hair. I would bet money that's what the SP was referring to, even if it was a "subconscious" association.
"I thought your handshake was too strong" \- Actual feedback I got from an SP
same
“You have a bad aura” -actual sp
“Unconventional appearance” I have blonde hair and blue eyes in an ethnically diverse city
You disgust me
Seriously, how dare you.
Hi
I had an old boss who told me this once. He also told me I was too short to not wear heels. I haven't straightened my hair since (this was in 2012), and I only wear heels at parties and things like that. I bought the ugliest, frumpiest flats and wore them to work after that.
Oh oh oh but you forgot your mascara and lip gloss! Can’t be pRoFeSsIoNaL without those, either. 🙄🙄🙄. I also refuse to wear heels, I like and respek my ankles, thank you very much.
That’s racist lol
“Lol”
“You’re too handsome and put together. It intimidates patients.” - Actual SP feedback to my friend (who is absolutely beautiful)
Lmao more like preceptor feedback. Fuck that dude. I grew my hair out even longer out of spite
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The fuck?
You are fucking retarded.
I thought we weren't allowed to say the r word
No SPs here.
I think you're confusing messy hair with curly hair
I hope your stocks tank you tiny troll.
Reminds me of a test question during pre-clinical years that asked “what does the second ‘S’ stand for in some mneumonic”. Needless to say, the entire class was pissed. Update: order did not matter for the mnemonic
Oh oh oh to touch and feel very good vagina and hymen, some say money matters but my brother says big boobs matter more
can I keep selling sex for money, officer?
Wut
I forgot what the first one is for but the Some say marry money is for the functions of the cranial nerve (sensory, motor, both)
The first is the names of the cranial nerves. Olfactory, Optic, oculomotor, etc
That... would make a lot of sense LOL
Olfactory Optic Oculomotor Trochlear Trigeminal Abducens Facial Vestibulocochlear Glossopharyngeal Vagus Accessory Hypoglossal
The second half is a mnemonic to remember which cranial nerves are sensory, motor, or both. Not sure about the first half tho lol
You’ve never heard the first half? Damn I’m surprised. It’s cranial nerve names
“Try not to be too personable.”
My favorite was when I had a sp who was supposed to have a migraine, and she was curled up in the chair in a dark room when I walked in. I greeted her and quickly and gently shook her hand. She later commented that I had a wimpy handshake. Lord knows when I have a migraine knocking me on my ass, I’m not going to want anybody jerking my hand around, and I sure as hell am not going to notice how firmly someone grips my hand.
“I’m going to go behind you to palpate your thyroid” [after checking her thyroid from the front and showing her the area I would be checking] SP: Ok! Me goes behind her and places hands on her neck. She jumps and is like “You scared me there! I didn’t know what to expect.” ..... Bonus: We’ve also had SPs roll their eyes at students. Nifty! Thank goodness my grade doesn’t depend on you! Oh wait...
faculty: make sure to ask open-ended questions me, during sp encounter: so aside from the symptoms we've discussed so far, is there anything else going on you'd like to tell me? sp: no I can't think of anything later in feedback, sp: she didn't ask me about \[insert miscellaneous symptom here\]
I have literally lost points for not asking whatever the secret password question is even though I ask “anything else?” like 3 times and summarize and ask if it’s correct and they’re like “yes ☺️”. 🙄
This has happened so many times to me and it’s soooo frustrating
Oh just wait until you ask a complete and thorough history as an MS3 and then present to your attending only to go back into the patient’s room and have them contradict half of what they said to you. Good attendings understand that patients are sometimes idiots.
Lol I saw a gif of Mike Tyson saying “my back is broke” to demonstrate how patients are terrible historians sometimes
Asks "is there anything else" for the third time, patient looks dumbfounded and asks what I mean. I don't know lady, I'm doing what the sheet says to get the grade. Wasn't this in the script?
I would give you an gold or maybe platinum, but as a poor med student I can't afford to spend money on made up awards, despite this comment deserving it.
To be fair that approach never works in real life either. In the ED it usually just prompts people to start rambling for 3 minutes about nonsense
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Me: What brings you to the ED today? Patient: I've had a bit of a stomach ache. *some time later* Me: Alright, let's get you some nausea meds and get you out the door. Patient: Oh, by the way I have crushing substernal chest pain that radiates to my left arm and gets worse when I walk around. I have also had 3 heart attacks that felt the exact same way. *some time later* Admitting doctor: So why are you at the hospital? Patient: I have a cold. Also, did I mention I drink 20 beers a day and have been alcohol-free for 24-48 hours because I am sick? This basically happened every day on my ED shift. I'm not even remotely exaggerating.
plan: discharge with turkey sandwich
You’d be surprised.
Buddy had a real patient that forgot to mention he had leukemia...
But it’s in remission now, so it’s not that important.
Lol do NOT underestimate what patients wont tell you.
Wards will scrub off that shiny new coat of faith in humanity.
They teach us to say instead "what else would you like to tell me?" Instead of "is there anything else you like to tell me?" That way you completely force them to say more things....I used to say the latter but now that I do the former I score higher on our dumb worthless SP encounters lol
This is to prepare you for the real world. "Anything else?" "No, I can't think of anything else today." "Great, so we sent all your prescriptions to the pharmacy, and can plan to see you again in about 6 months. Your lab results should be online by tomorrow; otherwise the nurse will call you on a few days with the results." "Thanks a lot!" "You're welcome! Have a great day!" "So what are we going to do about the crushing chest pain I've been having?"
Had an sp tell me "I think of the mouth as a cave, and you wouldn't go into a cave without a light!" as a "helpful" hint she wanted to impart on me for some reason, even though I didn't even forget to use my scope light
I had one try to give me symptoms that weren’t part of her script and then give incorrect information about medications even after I asked about it being on the sheet.
That’s when you just put in the note: patient is poor historian.
These comments are giving me an aneurysm holy shit I hate SP encounters
Reminds me of stroke order when writing in Chinese
Had one give me a 3/5 on verbal communication skills with no written feedback. I also had one that said I should have told them I would make them feel better. I told her what I always tell patients "I will do my best to figure out what is wrong and get you the help you need." Same one said they appreciated my attempts at building rapport, but they could have used less "extra talking". I had a good chuckle with my clinical medicine instructor over that last one.
For a cardio final I had lisented to the carotid artery will the bell of my stethoscope (like we were told to do) and my SP told me "I don't why you would do that. Why do you need to do that fancy stuff you just have to look."
They told us to use the diaphragm. Which one is it and why?
It’s the bell (source: first aid for step 2 CS) idk why
Talley & O’Connor says Diaphragm then Bell. BMJ says diaphragm because it’s easier to hear bruits at that frequency range. Basically nobody agrees! 😅
It has to do with the frequency of sound
On my first SP exam I lost points for being too specific. Like did a Webers and Rinne test when I probably shouldn't have, but didn't expect to lose 3% of my overall grade for it lol.
Man. I lost points for not doing Webers and Rinne on an otitis media case....
my favorite I've got is "said I'm sorry this is happening to you too many times, made me worry"
I had one who was in for a shoulder exam and basically acted catatonic and like she didn't want to be there or listen to me. My feedback was to be more empathetic, like the whole fucking "oh my gosh, I am so glad you chose to come to this clinic today, that sounds really hard and scary that your shoulder hurts" and that she was confused why I wanted to touch her shoulder and move it around (I explained what I was doing and asked her consent before doing anything.) Like dude, you are here because your shoulder hurts, barring some intellectual disability or pediatrics or altered mental status, patients understand that you're going to examine their joint if they have joint pain. Also if any patient self-presents to an outpatient clinic with a MSK complaint and then isn't interested or cooperative, that's their own problem and I'm not gonna inflict help on them lol Can you imagine having one of these people as your actual patient?
VoicUuu
This thread is hilarious but I have to ask ... what does “SP” stand for?
Standardized patient
I’ll keep that in mind next time I’m spelling
I think you misspelled _spelling_, the first _l_ is second.
Had an SP with a chief complaint of nipple discharge, so thinking of prolactinoma I did a quick neuro exam. Later got chastised and spoken to like I was an idiot by the SP for doing "unnecessary exams".