Two students sit in chairs in a medical exam room. They each have notebooks and are cramming for their final
Ziggy : “I’m so stressed about this class! Graduation is next week and this is my last requirement. Aren’t you nervous?
Gabi : “Yeah, but the final is only 25% of our grade. How bad could it be?
Instructor walks in
Instructor : “Hello. As outlined in the course syllabus, the final will consist of performing a full head to toe physical exam, and then working through a patient scenario where you will demonstrate a few nursing procedures that were covered in class. Unfortunately, due to unforeseen circumstances, our professional standardized patients are unavailable today, so the committee has decided that you will perform the exams and procedures on each other.
Ziggy : “Umm… I really don’t feel uncomfortable with that.
Gabi : “Neither do I – can’t we wait until the standardized patients are available?
Instructor: I’m afraid that’s impossible, given that graduation is next week. The good news is that you’ll each only have to complete one part of the exam – either the physical assessment or the patient scenario. We realize it might be a little awkward, but it will be good for you to experience exactly what your patients will experience.
Ms. Star, we’ve decided that you will be tested on the physical exam. You should already know this material, but here’s a flow chart listing all of the areas that you will examine (hands her a sheet of paper). You must carry out all parts of the exam as stated, with no exceptions! And Ms. Paltrova – you will be graded on your participation as well. You should follow all of Ms. Star’s instructions exactly. I’ll be observing the exam through a video feed from outside the room, and it will be recorded.
Instructor leaves the room
Ziggy pauses to collect herself
Ziggy (cheerily, but nervous) : “Hello Ms. Paltrova. My name is Ziggy, and I’ll be doing your physical assessment today. Is it OK if I call you Gabi?”
Gabi : “Sure – that’s fine.”
Ziggy “OK. I’d like for you to undress to your bra and underwear and change into this gown.”
Ziggy hands her a gown and says “I’ll leave the room and will be back in a few minutes.”
Gabi undresses. She first takes off her sneakers, then socks, then labcoat, then shirt, and finally pants. Gabi piles her clothes neatly on a counter near the exam table and puts on the gown.
Ziggy (knocking on door) “Is it OK for me to come in?”
Gabi : “Yes”
Ziggy enters and glances at the sheet.
Ziggy “OK Gabi – let’s start with your vision. Could you please stand and read the lowest line that you can on the eye chart?”
Gabi stands, grabbing at the back of the gown, struggling to cover herself
Ziggy (hands Gabi a piece of paper) : “Could you please use this to cover your left eye? Just keep your other arm by your side.”
Gabi covers her eye, her gown opens in the back as she lowers her other arm. The camera view is from her back, facing the eye chart and showing her exposed backside
Gabi : “PECFD”
Ziggy: “And now the right eye”
Gabi : “PECFD”
Ziggy : “OK, great, could you please take a seat on the table? I’ll be examining your ears, nose, and throat next.”
Gabi : “OK.”
Gabi swings her legs over the side of the exam table. Ziggy examines Gabi’s ears, nose, and throat. She glances at the sheet once she finishes.
Ziggy “I’ll listen to your heart next. Could you please lower your gown in the front?”
Ziggy listens at a few places above the bra
Ziggy “Now I’m going to listen a little lower – could you please lift your bra up a little.”
Gabi (hesitantly) : “Umm, sure”
Ziggy puts the stethoscope under the lower part of bra to listen
Ziggy “That all sounds good – I’m going to listen from the back now.”
Ziggy moves behind Gabi and opens the gown from the back. This makes Gabi’s bra and panties visible. The camera starts with a side view, and moves to the back view where Ziggy is.
This view shows Gabi’s entire exposed spine. Ziggy has Gabi take a few breaths. She glances at the sheet once she finishes.
Ziggy “Good – could you please lie back on the table for the abdominal exam?”
Gabi lies back
Ziggy grabs a drape and places it over Gabi’s chest and stomach
Ziggy “I’m going to raise your gown a bit.”
Ziggy lifts Gabi’s gown to her chest, trying to keep her covered with the drape.
Ziggy listens to Gabi’s abdomen with the stethoscope in a few places. She then moves the sheet down and places the stethoscope on the femoral artery
Ziggy “I’m just going to check your femoral pulse.”
Ziggy raises the sheet to expose the region.
Ziggy listens for a bit
Ziggy “That sounds good. So the next part of the exam is the (hesitates and looks at the sheet) …oh…breast exam.
Ziggy becomes more nervous
Gabi : Breast exam?
Ziggy (shyly) : “That what it says on the sheet. Umm…Gabi, would it be OK if you sat up and removed your bra?”
Gabi (hesitantly) : “I guess so”.
Gabi sits up and looks a little embarrassed, but then removes her bra. Ziggy turns away while
Gabi removes her bra. The top of her gown falls to her waist.
Ziggy : “OK – first, I’d like for you to lift your arms over your head. Good. Now put your arms at your hips and lean forward. Good. Please lay back down.”
Gabi lies back down
Ziggy : “Now I’m going to palpate your breasts for any abnormalities”
Ziggy now palpates each breast and nipple a bit.
Ziggy : “Everything seems normal. The next exam is the …”
Ziggy pauses while she looks again at the sheet
Ziggy “Oh…( pauses, then slowly ) …pelvic exam.
Gabi : “Are you serious?”
Ziggy “This is really weird, but I guess it’s required. Gabi, would you mind removing your underwear?”
Gabi : “Ugh – fine!”
Ziggy turns away.
Gabi stands up and removes her panties while keeping her gown on.
The camera view is from the side, showing her ass as she removes her panties.
Gabi curls up the panties in a ball places them under her pile of clothes. Ziggy “Gabi – could you just lie back on the table with your knees bent and try to relax”
Ziggy puts on a latex glove, moves towards the table and raises Gabi’s gown.
Ziggy inspects the vagina and anus and then performs a bimanual exam
Gabi appears stiff throughout
Ziggy “Everything looks and feels OK. I’m also going to do a rectal exam – would you mind turning over and getting on your hands and knees?
Gabi : “This is really embarrassing!”
Gabi sighs and reluctantly gets on all fours. Ziggy moves her gown to fully expose her. You can see Gabi’s breasts hanging down from this position. Ziggy puts on a new glove and grabs some lubricant. She looks at Gabi on the table and decides against the knee-chest position.
Ziggy : You know, I think it might be more comfortable if you lie on your left side and pull your legs up to your chest. Is that OK?”
Gabi : Yes.
Gabi gets in the fetal position, anus and vagina fully exposed. Ziggy puts a glob of lube on her index finger and raises Gabi’s right butt cheek
Ziggy: “Just take a deep breath”
Ziggy inserts finger for about 5 seconds, palpating around. Camera shows Gabi’s face, in clear discomfort.
Ziggy “All set – here are some wipes to clean yourself up”.
Ziggy turns her back on Gabi while Gabi stands up, wipes off the lube and throws out tissue. She looks at the procedure sheet again.
Ziggy “We’ll finish with the neurological and musculoskeletal exam. Could you please sit back on the table with your legs hanging to the side?”
Gabi : Would it be OK if I put my underwear back on first?
Ziggy : Sure.
Gabi puts on her panties and sits up on the table with her legs hanging off one side. As Ziggy performs the knee reflex test, Gabi’s panties are not fully covered by the gown and are partially visible. The camera moves behind Ziggy to the side of the table.
Ziggy “Please lie on your back. We’ll check your leg flexibility – could you please lift your right leg as high as you can?”
Gabi lifts her leg, exposing her panties
Ziggy “Now the left leg”
Gabi lifts the left leg
Ziggy “Using both hands, could you pull your right knee towards your chest”
Gabi pulls in her knee, which exposes her panties again
Ziggy “And now the right”
Gabi repeats with the left knee
Ziggy “Could you please stand up?”
Gabi stands
Ziggy “Could you twist as far as you can to the left? And the right?”
As Gabi twists, her gown opens in the back and you can see her panties
Ziggy “Great. I’m going to check your spine from the back now. Could you raise your arms as high as you can and then bend over like you’re diving into a pool?”
The camera starts with a side view as she lifts her arms, her panties again revealed. As Gabi bends, the robe falls in front, revealing her breasts. Ziggy moves in behind Gabi and pulls her robe together
Ziggy “Oops – sorry about that. (looks at the sheet) I think we’re done.”
The Instructor enters with a clipboard and addresses both students.
Instructor: “Good job Ms. Star. My only criticisms are that you should have had the patient undress completely before the exam, and you shouldn’t have apologized to her. Remember: this is your job! Let’s let Ms. Paltrova get dressed and then we’ll return for the second part of the exam.”
Instructor and Ziggy leave the room.
Gabi takes a deep breath. Gabi gets dressed, taking off the gown and putting on her bra, socks, pants, shirt, sneakers, and lab coat in that order.
Ziggy knocks on the door
Ziggy “Are you all set?”
Gabi : “Yes”
Ziggy and the Instructor enter
Instructor : “Now this part of the exam is more freeform. I will provide a scenario to both of you, and Ms. Paltrova will carry out whatever exams and procedures she sees fit to diagnose and treat Ms. Star. Ms. Star is expected to do a convincing job as the patient, and will also be graded on participation. (to Ziggy) Ms. Paltrova and I will leave the room while you change into a gown.
Ziggy : “Should I undress to my bra and underwear?”
Instructor : “The list of possible exams and procedures is quite far ranging, so you’d better disrobe completely.”
The Instructor and Gabi leave the room.
Ziggy undresses nervously, removing shoes first (leaving socks on), then labcoat, then shirt, then pants, then bra, and finally panties. As she undresses, she places her clothes on the counter and finally puts on the gown.
Gabi knocks.
Gabi : “Can we come in?”
Ziggy : “Yes, I’m all set”
Gabi and the Instructor enter.
Instructor : I’ve decided on the following scenario: Ms. Star has come in with a complaint of stomach discomfort. As I had explained, Ms. Paltrova will diagnose and treat the complaint, using any methods covered in class. Good luck.
Instructor leaves the room.
Gabi (to Ziggy) : “Hi Ms. Star. Is it OK if I call you Ziggy?”
Ziggy (nervously) “Sure, that’s fine.”
Gabi : “So Ziggy – your chart says that you’ve been having some stomach discomfort. Could you describe it for me?”
Ziggy “Well, I’ve been feeling bloated for the last few days, and have mild pain all around my stomach.”
Gabi : “OK – when was your last bowel movement?”
Ziggy “I’d say about a week ago.”
Gabi : “How often do you usually go?”
Ziggy “Usually once a day”
Gabi : “Well it could just be constipation, but the exam will help me figure it out. We’ll start by getting some basic vitals on you. Would you mind stepping over to the scale so that I can record your height and weight?”
Ziggy walks over to the scale and gets on Gabi measures Ziggy’s height and weight. Ziggy tries to keep her gown closed in the back as she is weighed.
Gabi : “Well your BMI is very healthy, so that’s good.”
Gabi: Ziggy – I’d like to examine your abdomen. Could you please lie back on the exam table?”
Ziggy lies back. Gabi finds a drape and places it over Ziggy’s abdomen.
Gabi : “Ziggy, would you mind lifting up your gown a bit.”
Ziggy lifts her gown to her chest but remains covered with the drape.
Gabi : “First I’m going to take a listen with my stethoscope.”
Gabi listens to Ziggy’s stomach, moving the stethoscope around.
Gabi : “OK, now I’m going to palpate your abdomen.”
Gabi presses on Ziggy’s abdomen in different places. As she approaches the groin area, the drape slides down, exposing Ziggy’s pubic area. She palpates all the way down to the lymph nodes in the groin.
Gabi : “When I press down, does it feel uncomfortable?”
Ziggy “Yes”
Gabi : “OK – I’m pretty sure it’s constipation, but I’d like to do a quick rectal exam to confirm my diagnosis. Could you please lie on your left side.”
Ziggy “Uhm… is this really necessary?”
Gabi : “It’ll be quick – I promise.”
Ziggy turns on her side. Gabi lifts up her gown to expose her anus. She puts on a glove and lubricates her finger.
Gabi : “Ziggy, I’d like you to take a deep breath”
Gabi inserts her finger as Ziggy breathes. Ziggy groans a little.
Gabi : “OK (removes her finger). Well you definitely have a severe case of constipation.”
Gabi takes off her glove.
Ziggy (timidly): Maybe you could just prescribe me some laxatives?
Gabi : “Well if this were just a mild case of constipation, I might send you home with a prescription for laxatives or suppositories, but this is pretty extreme.
Gabi starts walking over to the pole holding the enema bag. She starts to wheel it over by the exam table.
Ziggy watches her nervously.
Gabi : I want to make sure that you have a bowel movement before you leave the office today, so I’m going to give you an enema.”
Ziggy (softly, scared) : “What? I really don’t think that’s necessary.”
Gabi : “I know it might be a little uncomfortable and embarrassing, but I just don’t want this to get any worse”.
Ziggy (a little defeated) : “I guess that makes sense.”
Gabi (to Ziggy) : “Hmm..usually I’d have you lie on your left side, but I think the enema will be more effective if you get in the the knee-chest position. Would you mind getting on all fours with your elbows and head on the table?”
Ziggy gets on the table and lowers to the knee-chest position. Gabi pulls Ziggy’s gown aside, exposing her entire perianal region. You can see Ziggy’s breasts from this position. Gabi pulls over the filled enema bag and lubricates the enema tip.
Gabi : “Ziggy – I’m going to insert the enema nozzle now, and would like you take a deep breath”
Ziggy : “OK”
As Ziggy breathes, Gabi inserts the enema tip.
Gabi : “Good – I’ll start the flow now. If you have any discomfort just let me know.”
Gabi administers the enema for about a minute
Gabi : “How are you doing?”
Ziggy “I feel uncomfortable, and I’m a little sweaty”
While the water continues to flow, Ziggy’s face shows discomfort.
Ziggy “Gabi – this is really uncomfortable”
Gabi: “Ziggy, you’re about halfway done. Do you think you’d be more comfortable lying on your side?”
Ziggy :“Maybe.”
Gabi : “OK – I’m going to stop the water flow for a second.”
Gabi stops the flow
Gabi : “Ziggy, could you try to roll onto your left side?”
Ziggy rolls onto her left side
Gabi : “OK – how does that feel?”
Ziggy “A little better.”
Gabi : “Good – I’m going to start the flow again”
Gabi starts the flow again. Ziggy continues to look uncomfortable. Both Gabi and Ziggy watch the enema bag drain down.
Gabi : “It’s almost done”
Finally the enema finishes.
Gabi : “All done. I’m going to remove the nozzle now. A little water may come out when I do this – that’s normal.”
Gabi removes the nozzle.
Gabi : I think it would be good for you to get off the table and walk around for a bit to help the water circulate. Do you think you could do that for a few minutes?
Ziggy : “I’ll try, but I feel really full.”
Ziggy gets off the table and walks around a little, grabbing at her stomach. Her gown opens in the back while she walks.
Ziggy : “Walking is too uncomfortable. I’m just going to lean over the exam table.”
Ziggy leans over the table with her elbows on the table. From the side, her gown hangs in front of her, which exposes her bloated stomach. Ziggy struggles to hold the enema a few more minutes.
Ziggy : “Oh my god – I feel so bloated!”
Gabi : “OK – just another minute”
Ziggy tries to hold it a little longer.
Ziggy “Gabi – I feel like I’m going to explode! I really need to go right now!”
Gabi : “OK. The bathroom is just down the hall.”
She leaves the room as quickly as she can, waddling towards the bathroom. The camera follows her from behind, showing her gown opening from behind.
Gabi (chuckling a little) : “Are you OK?”
The Instructor returns
Instructor : “Well Ms. Paltrova, you did an excellent job. Based on Ms. Star’s reported symptoms, your choice of exams and procedures were spot on. (to Ziggy) Ms. Paltrova and I will leave while you get dressed.”
Gabi and the Instructor leave room. Ziggy takes off the gown and gets dressed, putting on her panties, bra, pants, shirt, labcoat, and shoes. She looks exhausted
Instructor and Gabi return
Instructor : “Congratulations! You both received very high marks!”
Gabi : “Thanks professor.”
Ziggy : (To instructor) “I’m so glad that this is over!”
Instructor : “I’m sure we’ll be using your exams as training videos for years to come!”
