Students often get nervous. It can be intimidating to have to demonstrate techniques in front of critical instructors and fellow students. Techniques are often scored. A missed item can lead to missed points. We struggle to keep all the details in the right order so we can check all the boxes on the instructor's clip board. Students wonder: if it's this hard in the classroom, it's got to be even harder in the real world. 

Not necessarily true. I've seen students go both ways: good in the classroom and bad in the real world - and - struggling in the classroom but good in the real world. The important thing is to understand what you're dealing with in both environments and to keep your confidence up. The two environments are very different. Here's why:

  • The classroom offers little context. In the classroom, students are often given scenarios verbally. They are asked to imagine conditions they are treating. This exercise in imagination can be difficult for both the new student and the experienced veteran. New students are wrestling with technique AND trying to imagine what they are seeing. These two things take up valuable processing power, and contribute to the student being overwhelmed. 
  • Imaginations are not perfect. New students often lack the experience to imagine what the real thing looks like, so both victim (usually played by one student) and provider (played by a second student) are making stuff up - often different stuff, and often unrelated to what one might really see in the real world. Experienced veterans know exactly what the real thing looks like. When they are asked to treat what they see, and what they see doesn't resemble the real thing, things can get confusing. 
  • There's a critical audience. Instructors with clip boards and students watching for technique put pressure on the student being evaluated. Granted, non-student medics will have pressure when they are performing in real life, but the pressures are different. 
  • Techniques are often performed in isolation. In the classroom, we isolate techniques and practice them for the technique sake. In the real world, techniques are often overlapping and/r easily flow into one another. Examining the posterior of a patient, for example, is usually combined with a log roll and patient placement on a spine board in the real world. Sometimes it's done out of order (as when we find a patient lying face-down). 
  • Equipment in the classroom is only an approximation. Rescue Annie, chicken bones, oranges and other classroom tools are only an approximation of the real thing. Individuals in the real world come in all shapes, sizes and mental states. 

I recently found myself performing a physical assessment on a student in front of a classroom. As an instructor, I had done this many times before, but as a student I found the experience more difficult. As an instructor, the scenario - to include all signs and symptoms - were clear in my mind (as clear as they are in real life). As a student, I had to guess as I went along. 

The technique I was asked to demonstrate (a 90 second rapid trauma assessment) was something that can be done two ways: with implied consent on an unconscious patient (in which case happens very quickly), or with explanation, clear patient communication and a more focused approach (the emphasis in the second case is on getting through the assessment with maximum patient comfort).

I had a hunch the instructor wanted me to show the class how this assessment looks in real time without the patient interaction, but I had a conscious patient who was alert, in good shape and smiling. I ended up doing half of a rapid assessment on an unconscious patient and half an assessment on a conscious, alert patient with a smile. The blend of the two techniques was awkward.

It didn't help that this instructor (a very good instructor) wanted to simultaneously demonstrate how to take a SAMPLE history from the C-Spine position. The SAMPLE history is something I usually do myself as a way to establish rapport with the conscious patient while examining him or her. We ended up talking to the patient at the same time - something that would confuse a real patient and doesn't usually happen more than once between partners in the real world. 

If you are a student and you're worried about having issues in the classroom, don't be too hard on yourself! The classroom offers unique challenges that you won't find in the real world. Make no mistake, there will be challenges and learning to deal with them in the classroom is a great way to start.

If you have classroom challenges, I suggest engaging your instructor directly. If they've been around for a while, they'll understand what I've described here & should be able to help you deal with them. Don't allow classroom challenges to shake your confidence. Use them to motivate you to practice and to master techniques. 

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