On Friday we had our first 'formative' exam (monitored by an invigilator no less). It you don't know what they mean by formative you’re not alone. My favorite definition of formative is - forming or capable of forming or molding or fashioning. I could use some fashioning. Or at least some new shoes.

Anyway, it was a test that was formatted just like our final (or summative) exam with representative questions but doesn't contribute to our mark. It was a good judge of how we are doing so far. Except I already knew that I was very far behind because I have been working on some papers for my lab that have held over from my Masters, so for me it was mostly just a kick in the teeth. Probably a kick in the teeth that will be good for me in the long run but I am still a little bruised right now.

We also had clinical correlation on Friday. As always, it was the best learning experience of the week and provoked issues that I wasn't expecting. Specifically the issue of consent and the doctor - patient - student relationship. We have examined one patient that was alone and had ascites and encephalopathy from chronic liver disease. We practiced shifting dullness, fluid thrill and palpitation. Though we repeatedly asked permission, she was obviously in some pain and was having difficulty talking. I doubt she understood all that was going on even if she did know what she was agreeing to.

Another patient we visited (on a different occasion, with a different preceptor) was an older gentleman that was being visited by his wife. Though there was no issue of reduced capacity, it was clear from the interview that they did not know how the many tests were going and were hoping for some answers, even from us. The wife thanked me for coming and helping. I had to explain that we were students and not in any position to give her information. That we were there to learn. This took me aback because I thought our preceptor had explained this to them. All I could hear coming out of my mouth was 'No, we aren't here to help you. We are here to take from you and give you nothing in return." I know this isn't entirely true; that we have to gain experience and knowledge so that we can help other people later. It just feels a little too easy justifying our actions in the name of education. Maybe I am a too prone to obsessive self reflection but I feel like part of learning to be a doctor is examining how our actions have an effect on the people we are lucky enough to call our patients. The reason that clinical corre. is such a good learning experience is because we get to see actual people, not just study cases. If we can't see them as people and think about how we are affecting them then we are losing out.