My First Patient Experience as a PA Student

Posted By: Kubin   |   School Life

My first patient as a PA student?  A woman for a pelvic and breast exam.  Just to be clear for the men in the reading audience, a pelvic is a gynecological exam.  No, I never saw that coming.  Or that right after, I would have another first patient, a male genital and rectal exam.  My class had been practicing the less intimate physical exam skills on one another for weeks.  But an essential part of the process is to learn and use your skills on real people.  Wait, I have to do what?  Okay, zoom out for just a second…

How PA and Medical Students Learn to Examine Patients

It’s actually not uncommon for PA students and medical students to do full exams on one another — yes, you heard that right (same and opposite genders).  Imagine your own classmates fumbling with specula and gloved, lubricated fingers, all up in your most personal anatomy.  My PA program, UC Davis School of Medicine, did it that way with PA students until 2004.  Nowadays, they break students in a little more gently, having them only do the simpler exams like the abdomen, lungs, eyes, and ears on each other with shirts or bras on.   When it comes to exams of the much more intimate kind, they find someone else to prod.  Thank you God.  Okay, zoom back in…

Introducing Pelvic Night

They told us t was coming.  Our first patients — the first patients strangers we ever examined — were for something “special.”  They shouted it in all caps on the whiteboard calendar: PELVIC NIGHT.  They told us that it would be an initiation of sorts and that after we sweated through the evening’s activities, we would share stories and eat pizza.

I viewed it as an awesome chance to look like a colossal idiot.  I’d heard horror stories of inappropriate things that students had done in previous classes, like a male student awkwardly declaring to a female patient that “Everything looks great down here!”  Or blurting out “Woah, I found her cervix!  It’s just like in the book!”  So in preparation for my first patient on pelvic night, I read.  I practiced on anatomic models.  There was plenty of youtube.  And still I stressed.  Out of desperation, I even asked my wife what a pelvic exam was like.  “Honey,” she said looking down her nose at me, “You have no idea.”  And she was right, of course. 

My own first patient

Thankfully, my patient, whom I’ll call Lauren, was very cool.  Lauren even gave me feedback about my technique, which was helpful, if a little weird.  A few years before my class there an OB/GYN physician who always volunteered to be the patient, so that everyone learned and performed the procedure well.  Please kill me if I’m ever that dedicated to anything.  

My first male patient gave me feedback too.  I had to give him a DRE (digital rectal exam).  He took his “work” seriously, giving me oddly detailed feedback, like “Okay a little farther and down…THERE.  That’s my prostate.”  These first patients are called standardized patients, and they are hired by the program.  Unconfirmed rumor had it they were paid $35 for every exam they receive, and that was in 2010.  They sometimes sit still for ten or fifteen sensitive exams in a night. Some standardized patients even do this work for a living.  If you imagine sharing that at a cocktail party, it’s clear they aren’t paid enough.

Epilogue

I can’t honestly say I enjoyed pelvic night, but  it was a positive learning experience.  Why?  Because I was trusted to do something extremely private with a total stranger.  Because it was another step closer to becoming a PA two years later.  Some initiations are weird, but that doesn’t mean they’re bad.   

For some reason, the pizza they promised us never showed up.  But it was all good — we shared our first patient stories with each other, much like this one.  And hey — I wouldn’t have been able to eat it anyway.