Diary of a Med Student

During my first week of medical school I was excited, but also scared. I was scared that someone would realize I did not belong there, and that the admissions committee had made a mistake. I had that distressing feeling even a couple weeks after school started, until I realized no one was thinking this about me in their mind. Not even after I asked for help.

I was born with symbrachydactyly, a rare congenital hand defect in which the fingers are abnormally short and webbed or conjoined. I am used to doing things a little differently, whether it’s driving a car, opening a jar, or tying my hair. Medical school would be no exception. While I was confident in my academic ability and my ability to engage with patients, I was worried about my ability to perform manual tasks, such as a physical exam. Physical exams are essential – it’s a basic way for a physician to determine a patient’s current physical state and next steps for mitigating any issues.

When I realized there were textbook ways students were expected to perform physical exams, I scheduled a meeting with the program coordinator and physician for the clinical skills program. Although I disclosed my disability in my medical school application and discussed it in my essays, I did not know which individuals in my medical school knew about my disability. During this meeting, I was asked if I was confident in my ability to do everything that was required. It was a hard question to answer because I had never performed any of the physical exams before. How was I supposed to confidently tell them I could do everything if I didn’t know what everything entailed? I responded that I had confidence in my ability to be flexible and adapt to situations. I knew this, because I have been doing that my whole life. The clinical education team was determined to help me by offering additional time with a standardized patient and instructor so that I could be sure that although I was performing some exams differently, they were effective. Through trial and error, as well as the tools in my medical bag, we were able to find a standard that was appropriate for me.

One of the most challenging situations in medical school is when I am in a lecture and hear a faculty member say, “with both hands.” This happened during a lecture on the female reproductive system where the instructor was explaining how to physically examine ovaries. I had a deer in headlights moment, because in such an important and sensitive exam, I wanted to be sure that my prosthetic would not negatively impact the patient. I stayed after class (and before seeing the standardized patient,) to ask why the exam had to be done that way. It often seems we default to a procedure because it has always been done or taught that way, so we assume that it is the only correct or acceptable method. Prior to the scheduled clinical skills class, I practiced every physical exam taught at my school with a standardized patient. The techniques I adapted to examine patients ranged from manipulating their limbs to test range of their motion with one hand to striking my finger with a reflex hammer as I percussed lungs or the abdomen. While the clinicians at my school were flexible and open to accommodating alternate methods of examination, I am unsure of what I will encounter as I begin my rotations. Being in a simulation room with physicians I have known for months to demonstrate a physical exam feels much safer than performing the examination at a hospital to a real patient, surrounded by attendings and residents.

Students with disabilities are everywhere, including in medicine. I am fortunate to have been connected with those further along in their medical career with missing limbs, whether congenital or acquired. They gave me hope and shared which accommodations and processes worked best for them as they learned how to do various procedures. With their guidance, such as how to best tie a knot during surgery with one hand, I have become more secure about my place in my program.

Even though I found individuals in medicine who can empathize with me, they are hundreds of miles away and busy with their own lives. I learned that I will have to dedicate time to developing methods that work best for me, perhaps more time than most of my peers will need to meet a competency.

I relearned the growth mindset – the belief that talents can be developed through hard work and deliberate practice, as opposed to the fixed mindset belief that talents are innate. I applied this mindset to my clinical education, to remind myself the power of self-efficacy. Becoming a physician can be extremely consuming, and when combined with a strong feeling of imposter syndrome linked to an identity, it can feel almost impossible. My advice for students is to connect with individuals who share an identity with you, for reassurance and for mentorship. Even though the journey may feel lonely, know that you are not alone and that if you seek help or community, you will find it.