Scariest Test of the Year

Considering Halloween, I will tell you what scares me the most right now! SPAL’s are coming this week! AAAH!!! The SPAL exam is an exam in which we get to work up an actor-patient in a doctor/patient interaction. We will have multiple of these exams in the upcoming semester but just the one this semester. Mine is on Tuesday and I am nervous! I shouldn’t be because I feel well prepared for it. I’ve done practice runs with multiple students but it’s still a nerve-racking thing. For those patients that I’ve worked with in the past at Pueblo Ankle and Foot Care who might be reading this, I know you are thinking, Levi will be fine! He has nothing to worry about! That’s what I keep trying to tell myself. Its semi-working. We will have to take a full patient history including a chief complaint, the history of present illness (HPI), a review of systems (ROS), past medical history, past surgical history, medications, allergies, social history and family history. After that, we will do a basic heart, lung, and abdominal exam and an expanded exam of one of the three, depending on which exam fits their chief complaint. Now I know you are thinking, Levi you are studying to be a Podiatric Surgeon! What are you learning a heart, lung and abdominal exam for? Well let me tell you. 🙂 A podiatric surgeon, although they are not able to treat any issues from the knee and above (specifics depend on the state you are practicing in), are considered physicians, by law, and are required to know the things that a physician should know. Therefore, we learn examination techniques for the entire body and not just the foot. To me, these are incredibly valuable techniques and I think it’s an awesome experience to learn them. In these last few weeks I learned probably 15 to 20 different musculoskeletal tests from the arm drop test to check the rotator cuff muscles of the upper limb to the straight leg test that can show if a patient has issues with the sciatic nerve!!! I love medical school. 🙂 We also learned how to recognize various types of lesions in a dermatological exam and learned how to do a breast and axilla exam and what to check for! Tons of great information!
Anyway, back to the SPAL. I have 22 minutes to perform these exams and then 25 minutes to type a SOAP note (Subjective, Objective, Assessment, and Plan). During the exam, I am being recorded the entire time on video. I will also be graded by the patient not only on my technique, but also on my humanistic interactions with the patient. This means, although I may be nervous, I can’t act nervous. I need to be confident and able to speak with the patient in a pleasant tone and make them feel comfortable throughout the entire exam. You may think that isn’t that hard to do, but lots of students fail the humanistic part of their first SPAL. I don’t plan on being one of those students but there is always that chance! After the exam, I get to sit down and watch myself on video performing my exam and then critique myself. If anyone has ever watched themselves on video, it is not usually a pleasant experience. I will get to see all the little quirks that I have and talk about them for improvement on the next SPAL exam in the spring!
So that’s what I’ve got coming to me this week! I’ll let you all know how it goes!

Levi Smith, PMAC & Podiatric Medical Student @ DMU

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