Nathan McConkey January 24, 2011Free SPALing… One of the cardinal signs of obsession is when the object of one’s focus begins to play a prominent role in their dreams. In the case of medical students, it’s not unusual for us to have haunting nightmares of exams on subjects we’ve never studied, or peculiar fusions of reality and fiction in some medical or scientific principle…Then there are the dreams when you’re suddenly free-falling and about to hit the ground. I’m pretty sure everyone has that last one, but only medical students, while falling, start counting and naming the bones they’re about to break when they land. But last night, I had what was almost certainly the wackiest studying-induced med school dream of all time…A bit of background first: at DMU, we regularly have practical examinations called SPALs because they are in the Standardized Performance Assessment Lab. Some schools call them OSCEs (objective-structured clinical examination), but the acronym doesn’t really fit for us – we do so much more than mock examination in a SPAL. In these practicals, which take place in rooms designed to look exactly like an exam room, we practice skills such as physical examination and history taking, and sometimes even skills like ethical problem-solving, behavioral interventions and working with a translator. People are hired from the community and trained thoroughly to serve as patients, so it’s a unique opportunity to develop clinical skills without the chance of missing important diagnoses or harming a real patient.In my dream, I was all dressed up and ready for SPAL, and I stood outside my mock-patient’s exam room to review his chart. All that was written, however, was the following: “George is a 4-year-old male who is here for an annual physical.” I was confused, however, to see that George was 4-years-old as we had not been taught how to do a pediatric exam yet. I just assumed that I wouldn’t be graded on anything that differed from what I should do on an adult.As I had been instructed to do, I first knocked before entering the room. There was no response, so I knocked a second time. After again hearing nothing, I opened the door and went inside. Sitting on the table before me…was a white shih-tzu. Apparently, I had been expected to perform a physical examination on a dog. I turned to the instructor in the room with an odd sort of “Are you sure this is right?” expression on my face, but she merely put her pen to her clipboard, cleared her throat, and nodded expectantly toward the dog. Now, the first thing we’re supposed to do in a SPAL is make sure we’re seeing the right patient – in a real SPAL, we ask them to verify their name and birthdate. In my dream, I just checked George’s tags.Since taking a history would be impossible, I decided to begin with my examination. Now, I have no idea how you actually take a blood pressure on a dog, but in my dream, there was a canine BP cuff provided, which was about the size of a large band-aid. The dog held out one of its legs to allow me to place the cuff, and the rest of the exam went without incident (although, it turns out that the dog had a systolic murmur and possibly stage 1 hypertension). The dog was oddly cooperative, actually – for example, when I put on my stethoscope, the dog rolled over to allow me to listen to its heart and bowel sounds.Once the exam was finished, I sat down to write my progress note. After realizing that I never did manage to take a history, I simply assumed that the dog did not use tobacco or alcohol, that it was single and unemployed, and that it had no history of military service. I did notice that the dog had been neutered, so I noted this in the “past surgical history” section. When I finished, I turned in my note to a member of the SPAL staff, who quickly glanced over it. Suddenly, a look of confusion crossed her face.“Nathan, which exam room were you in? I told her I was in room 3. “Oh my…I’m so sorry, there’s been a mix-up,” she explained.Apparently, in my dream, DMU had opened a fourth college – a college of veterinary science – and the vet students were having their SPALs at the same time that I was. I had been sent to one of their rooms by accident.“Hrm…” I responded. “That sort of makes you wonder if a vet student went to the patient I was supposed to see…I hope they didn’t end up vaccinating a SPAL patient for rabies or anything!”We both laughed, and then I woke up. I take it as a sign, really, of my confidence for the next SPAL. It doesn’t matter how wacky and obscure a diagnosis they come up with – nothing can top having the wrong SPECIES. 2 responses to “Free SPALing…” Well Nathan.Be prepared because in real life medicine you might encounter “dogs”too.Or in rural areas you might become an attending for cattle births!!Watch out next time, they may ask you to deliver a calf??Log in to Reply Well Nathan.Be prepared because in real life medicine you might encounter “dogs”too.Or in rural areas you might become an attending for cattle births!!Watch out next time, they may ask you to deliver a calf??Log in to Reply Leave a Reply Cancel replyYou must be logged in to post a comment.