Standardized Student
Ben Parsley, M3

General description of the problem

Mr. Ben Parsley is a 3rd-year student presently in your internal medicine clerkship. His progress to date has been uneventful. This is his first rotation of the clinical years. His basic sciences grades ranged between A and B. You are his attending of the month, and you are also clerkship director. You have no reason to believe that Ben is anything but a remarkably solid, even very good student.

During the present clerkship, he has so far proven to be a generally good clerk, works fast, and is particularly adept at picking up and understanding new concepts very quickly. He has a very good fund of knowledge about basic sciences and diseases, and has shown good adaptability to this new clinical setting. He is sociable and appreciated by the other student members of his team, the residents, and the nursing staff.

However, occasionally, some minor incidents have also occurred. These appear unexplainable. For example, two weeks ago, one night around 7:00 pm, the chief resident asked Ben to call Mr. Osborn's private doctor to get some specific information about Mr. Osborn's previous medical condition. Mr. Osborn is a 73 y/o Caucasian male patient admitted with atrial fib to your service. Although Ben agreed to do so, he did not make the call.

And now, just 20 minutes ago, long after Ben's having been observed performing the percussive technique and abdominal examination for splenomegaly in the appropriate manner, Ben missed a rather significant enlargement of the spleen in Miss Ancipne, an 82 y/o African American female in generally frail health. Ben had proved on several other occasions that he was able to perform this examination procedure correctly. You are extremely surprised about this error, and might have discounted it, had you not been present and seen it for yourself. You thought her spleen was extremely evident because of her extremely gaunt condition. You want to take this opportunity to find out what is missing in his experience. This is the first feedback opportunity with Ben. Actually you are looking forward to this, because Ben is a very likeable and intelligent guy who, you have heard has many interests both inside and outside of medicine.

Ben is very interested in Hypercholesterolemia and you think that this might be a good time to discuss this with him, and to give him a chance to redeem himself. You think that you would like to give him an opportunity to discuss its role in cardiac disease, the lipids, and the basic treatment strategies.

Standardized Student Script

1. General Behavior

• You are very friendly, you smile, you speak in a refined language, you like speaking with people about any topic, you are extremely expressive both in language and in gesture.

2. Answers to specific questions

• Your medical interests and the reasons for having chosen a medical career: you like understanding the processes of diseases, and the clinical research link with the basic sciences.

• Aspiration: to become a researcher. You are less interested in becoming a practitioner. You feel the everyday work of gathering information from the patient, writing a chart, making telephone calls, ordering labs (in short scut) this is necessary for of a medical service functioning well.
• IF some feedback is given to you about a performance which you did not do very well, you smile, you agree with the remarks, although you also look somewhat detached from practical and material considerations.

Other interests and personal life

• you are single

• involved in many activities: you play the piano, play chess at a high level, and you have a passion for history of the interwar period.

Why you did not call the patient's private doctor, as requested by your chief resident

Hypercholesterolemia

• You know that it leads to cardiac disease

• You understand that there is HDL and LDL.

• You understand that the best treatment strategies include, diet and exercise and in more intractable situations the use of Mevacor, Prevacor, Zocar to lower lipid levels.

• BUT, you mess up on the fact that high HDL is good. And you think that mevacor, etc act to lower the HDL rather than LDL.

Career Goals: