What Surprised Me Most About Clinical Skills in Medical School

When I first started clinical skills in medical school, I thought it would mostly be about learning physical exams and memorizing the right sequence of steps. I pictured myself trying to remember where to place my stethoscope, practicing reflexes over and over again, and mentally running through checklists so I would not accidentally skip an important part of the exam. In my mind, if I could just remember the "right" order, I would be doing okay.

What I did not expect was everything that happens beyond the checklist.

I quickly realized that clinical skills is not just about learning how to examine a patient, it is about learning how to care for one. It is introducing yourself with confidence, even when your own heart is racing a little. It is figuring out how to ask personal questions with empathy instead of awkwardness. It is remembering to pull the gown back over someone's shoulders before moving on to the next part of the exam. And yes...it is probably asking a patient to "take one more deep breath" about six more times than necessary because you are so focused on not missing anything.

As the weeks have gone on, I have learned that the most meaningful parts of clinical skills have very little to do with performing the perfect physical exam. Instead, they have come from learning how to make someone feel heard, respected, and comfortable during what can be a very vulnerable experience. I have also realized that confidence is not something you walk into the room with on day one. It grows a little more with every patient encounter, every awkward moment, every piece of feedback, and every opportunity to try again.

Looking back, some of the biggest lessons I have learned were not the ones I expected to find in a clinical skills lab. They were lessons about communication, humility, and the incredible privilege of caring for another person. So this week, I wanted to share the things that have surprised me most about clinical skills so far, and how they have slowly changed the way I think about medicine, patient care, and the kind of physician I hope to become.

Making Patients Feel Safe Matters More Than You Think

One of the biggest surprises for me has been realizing that a good clinical encounter is not defined by how perfectly you perform the physical exam. It is defined by how the patient feels while you are performing it.

When you are first learning clinical skills, it is so easy to get caught up in the checklist. You are mentally running through every step, trying to remember what comes next, hoping you do not forget an important maneuver (and let me tell you...you will and it will haunt you), and silently celebrating when you finally remember where to place your stethoscope without second-guessing yourself. With so much happening in your own head, it is easy to forget what is happening in theirs.

I think this becomes especially apparent during OSCEs. If you have never experienced one before, imagine trying to remember every question you are supposed to ask, every part of the physical exam, every transition between systems, all while someone is silently watching and grading your every move, and you are racing against the clock. It is stressful. There are moments when it feels like you are doing everything wrong, and all you can think about is making it to the end before time runs out.

When you are in that mindset, it is surprisingly easy to become so focused on checking every box that you forget the person sitting in front of you. Not because you do not care, but because your brain is juggling a hundred different things at once.

That is exactly why I think these moments matter the most. Slowing down just enough to introduce yourself warmly, explain what you are doing, make eye contact, or adjust a patient's gown is not "extra"; it is part of the encounter. Those few seconds may or may not earn you a separate checkbox on an evaluation, but they have the power to make someone feel respected, comfortable, and genuinely cared for.

Then it hits you: lying on an exam table while someone you have never met asks personal questions or performs a physical exam can feel incredibly vulnerable. For us, it is another afternoon practicing clinical skills. For the patient, it is their body, their privacy, and their trust they are placing in someone they have only just met.

That realization completely changed the way I think about patient care. Before I even begin the physical exam, I want the patient to know who I am, what I am doing, and that they always have a voice in what is happening. Taking a few extra moments to explain each step, ask for permission, and check in throughout the encounter helps transform what could feel intimidating into something collaborative.

I have also learned that how we communicate matters just as much as what we say. Speaking calmly, choosing words without judgment, and allowing patients the time to answer without rushing them can make an incredible difference. Medicine is full of unfamiliar words, bright lights, and uncomfortable situations. Sometimes, simply being a steady and reassuring presence is one of the most meaningful things we can offer.

Another lesson that has stayed with me is the importance of protecting a patient's dignity. Something as simple as making sure they are properly draped, uncovering only the area you are examining, and covering them again before moving on might seem like a small detail when you are focused on remembering the exam sequence. But those small moments communicate something much bigger: I see you as a person first, not just a patient.

Clinical skills has reminded me that the little things are rarely little. A calm voice. A warm smile. Explaining what you are doing before you do it. Asking if someone is comfortable. Respecting their privacy. These moments do not take much extra time, but they can completely change how someone experiences their care.

Medicine will always involve science, protocols, and physical exams. But I have learned that it is also about being a warm presence in what can sometimes feel like a cold clinical setting. If a patient leaves an encounter feeling respected, heard, and safe, then I think you have done something just as important as performing every step of the exam correctly.

It is easy to remember that you are being evaluated. It is much more important to remember that your patient is having an experience.

Communication Is Harder Than the Physical Exam

Before starting clinical skills, I was convinced the physical exam would be the hardest part. Memorizing every maneuver, remembering the correct order, and learning what "normal" actually sounds like felt intimidating enough.

Then I started talking to patients.

It turns out that communication is so much more than asking the right questions. It is learning how to ask them in a way that makes someone feel comfortable enough to answer honestly. It is noticing when someone hesitates before responding or when their body language tells a different story than their words. It is resisting the urge to interrupt because you are already thinking about your next question.

As someone who tends to be very Type A, I have noticed that my instinct is to keep the conversation moving. During an OSCE, especially, your brain is constantly reminding you that the clock is ticking. You are mentally checking off questions, thinking about what comes next, and trying not to forget an important part of the history. But I have learned that patients do not experience the encounter as a checklist; they experience it as a conversation.

One of the biggest lessons clinical skills has taught me is that listening is not simply waiting for your turn to speak. It is giving someone the space to tell their story, even if there is a pause. Sometimes those few seconds of silence feel incredibly long, especially when you are worried about time. My instinct is often to jump in with another question, but I have learned that if you wait just a little longer, patients will often continue talking on their own. And more often than not, that is when they share the details that matter most.

There is a saying in medicine that if you truly listen, the patient will often tell you what is wrong. At first, I thought that meant listening for the "right" symptom or the clue that would lead me to the diagnosis. Now, I think it means something much bigger. Patients do not just tell us where it hurts; they tell us how their illness has changed their lives, what they are worried about, and what matters most to them. Those details may not always show up on a lab result or imaging study, but they are just as important in understanding the whole person sitting in front of you.

I have also realized that how we ask questions matters just as much as the questions themselves. Open-ended questions invite patients to share their experience in their own words instead of limiting them to a simple "yes" or "no." Sometimes the most valuable information comes from the answer you were not expecting, the one you only hear because you gave the patient the space to keep talking.

Clinical skills has taught me that medicine is not just about finding the right diagnosis. It is about making patients feel like they are being heard. Sometimes the most meaningful thing we can do is not say anything at all. It is listening with patience, curiosity, and the reassurance that, for those few minutes, they have our full attention.

You Do Not Have to Know Everything to Care for Someone

If I am being completely honest, one of the hardest parts of medical school is not the endless lectures or the mountain of information we have to learn. It is feeling like you should already know more than you do.

When I first started clinical skills, I put a lot of pressure on myself to have the "right" answer for everything. I thought being a good future physician meant never hesitating, never forgetting something, and always knowing exactly what to say. Looking back, that is an impossible standard to hold yourself to, especially when you are still learning.

And if you have ever done an OSCE...you know there is a very real chance you will walk out realizing you just gave your standardized patient the most wildly incorrect diagnosis imaginable. Somehow, the second someone starts watching and the timer starts counting down, your brain decides to pack up and leave. That textbook answer you knew five minutes ago? Gone. Suddenly, a straightforward case feels like the world's most complicated medical mystery, and somehow you have convinced yourself their tension headache is actually something you would only ever see on a board exam.

Then comes the walk back to your apartment, where you replay every single question in your head, mentally grading yourself and wondering how you forgot something you absolutely knew. If you have ever walked out of an OSCE thinking, "Well...that was definitely not my finest moment," welcome to the club. I promise you are not the only one.

As funny as those moments become in hindsight, they have taught me something I was not expecting. Patients are not looking for perfection. They are looking for someone who listens, treats them with respect, and genuinely wants to help. OSCEs do not just test your medical knowledge; they test your ability to stay present when your inner monologue is absolute chaos.

There will always be moments when we do not know the answer. Medicine is simply too vast for any one person to know everything. What matters is how we respond in those moments. Saying, "I'm not completely sure, but I'll find out," is not a sign of weakness. It is a sign of honesty, humility, and a commitment to providing the best care possible.

I think there is often this misconception that confidence comes from having all the answers. Clinical skills has taught me something different. Real confidence comes from being comfortable enough to admit when you do not know something and trusting yourself to learn it. That is how medicine works. We ask questions, we collaborate with our colleagues, we continue learning, and we come back with the best answer we can.

As students, it is easy to feel like we have to prove that we belong in medicine. But every clinical encounter reminds me that my job is not to know everything today. My job is to keep learning so that tomorrow, I can care for my patients a little better than I did yesterday.

Patients do not expect us to know everything. They deserve to know we will do everything we can to find the answer. And I think that is one of the most important lessons clinical skills has taught me so far.

Confidence Comes After Repetition, Not Before

If there is one lesson I am still actively learning, it is this: confidence is not something you magically wake up with one morning. It is not something you either have or you do not. It is something you build, one patient encounter at a time.

I used to think the confident medical students were the ones who walked into every clinical skills session completely calm and knowing exactly what they were doing. Now I have realized that most of us are just doing our best, learning as we go, and hoping our face looks a lot calmer than our internal monologue feels.

Because if I am being honest...I still get ridiculously nervous.

I still get the anxiety stomach aches before a clinical skills assessment. I still replay the checklist in my head on the walk to the exam room. I still wonder if I am going to blank on something I have practiced a dozen times before. As someone who likes structure and wants to do well, being evaluated while trying to care for a patient at the same time is probably one of my biggest challenges. In many ways, clinical skills is my worst nightmare wrapped up into one exam...and feels kind of like a humiliation ritual.

And yet...I keep showing up.

Most days, it feels a little like "fake it until you make it." I take a deep breath, smile, introduce myself, and remind myself that the patient does not need to know I am mentally running through a checklist in my head. What surprises me is that each time I do it, it gets just the tiniest bit easier.

I have noticed the small victories that I probably would not have appreciated a few months ago. My movements do not feel quite as robotic. My conversations flow a little more naturally. Instead of focusing so much on what I am going to say next, I find myself paying more attention to the person sitting in front of me. Those changes did not happen because I suddenly became confident; they happened because I kept practicing, even when I felt uncomfortable.

Clinical skills has taught me that confidence is not the absence of nerves; it is choosing to walk into the room anyway. It is trusting that your preparation will meet you when your anxiety tries to convince you otherwise. It is accepting that you will most definitely make mistakes, learn from them, and come back a little stronger the next time.

I am still very much a work in progress, and I think that is okay. Every physician was once the student nervously knocking on the exam room door for the very first time. The difference is not that they were never scared; it is that they kept showing up.

So if you are waiting until you feel completely confident before believing in yourself, let this be your reminder that confidence usually comes afterward. It grows quietly through repetition, persistence, and the willingness to keep trying, even on the days when you would rather turn around and go home.

The Physical Exam Starts Before You Ever Pick Up Your Stethoscope

One thing I never expected to learn in clinical skills is that the physical exam actually starts long before you ever place a stethoscope on someone's chest.

It starts the moment you walk into the room.

Before a single question is asked, you are already observing. How did the patient walk into the room? Do they seem uncomfortable? Are they short of breath while speaking? Do they avoid eye contact because they are anxious, or are they smiling and eager to talk? Even the way someone sits on the exam table or moves from a chair can provide valuable information before you have performed a single maneuver.

I used to think the physical exam was simply a sequence of steps: inspect, palpate, percuss, and auscultate. While those skills are incredibly important, I have realized they are only one piece of the puzzle. The real challenge is learning to put everything together. You are constantly gathering little clues, not just from what you hear through your stethoscope, but from what you see, what you feel, and what the patient is telling you through both their words and their body language.

I also love that no two encounters are exactly the same. You can practice the same examination a hundred times, but every patient brings a different story, different symptoms, and different experiences. That is what keeps medicine so fascinating. You are never just completing a checklist; you are solving a puzzle with a real person at the center of it.

Clinical skills has reminded me that medicine is as much about observation as it is about examination. Sometimes the most important clue is not something you find during the physical exam at all. Sometimes it is something you noticed before the exam even began.

Every Patient Has Something to Teach You

One of my favorite surprises from clinical skills has been realizing that every patient teaches you something different. Before medical school, I assumed I would spend most of my time learning from textbooks, lectures, and professors. While they have given me an incredible foundation, I have quickly realized that some of the most meaningful lessons come from the people sitting across from me.

Every patient walks into the room carrying so much more than a chief complaint. They bring their own experiences, fears, priorities, and perspectives. Two people can have the exact same diagnosis and experience it in completely different ways. That is something no textbook can fully prepare you for.

Some patients teach you how important it is to slow down and truly listen. Others remind you that a little reassurance can go a long way. Some teach you resilience in the face of chronic illness, while others show you just how much trust patients place in the people caring for them. Even the briefest interactions have the potential to change the way you think about medicine.

One of the things I have come to appreciate most is that every encounter is an opportunity to grow, not just as a future physician, but as a person. Every conversation challenges me to become a better communicator, a better listener, and hopefully one day, a better doctor.

I think that is what makes medicine so special. We spend years studying anatomy, physiology, pathology, and pharmacology, but some of the most valuable lessons cannot be found in a lecture or on an exam. They come from the people who trust us enough to share a small part of their story.

As much as I hope to help my future patients one day, I have a feeling they will spend just as much time teaching me.

It Is Okay to Be Awkward

If there is one thing clinical skills has taught me, it is that awkwardness is almost a requirement for learning.

I used to think I had to look confident before I actually felt confident. I wanted every patient encounter to go smoothly, every transition to feel natural, and every physical exam to look polished. Instead, there have been moments where I have fumbled with my stethoscope, forgotten what question I was supposed to ask next, or stood there thinking,"...wait, where was I going with this?"

And honestly? That is okay.

As someone who has always put a lot of pressure on myself to do well, being awkward is not something that makes me feel very secure in the situation. I like having a plan. I like knowing the right answer. I like feeling prepared. Clinical skills has challenged all of that because there is no way to become comfortable without first being uncomfortable.

The truth is, every physician you admire has probably had moments just like these. They were once the student who forgot part of the physical exam, stumbled over an explanation, or walked out of an OSCE replaying every mistake in their head. The difference is not that they never felt awkward. It is that they did not let those moments convince them they were not capable of becoming great doctors.

I have also learned that patients are not grading us the way we grade ourselves. They are not keeping track of every pause or every moment we have to gather our thoughts. More often than not, they are looking for someone who is kind, present, and genuinely trying to help. That perspective has helped quiet the perfectionist in me, even if only a little.

So now, instead of expecting perfection, I try to celebrate progress. The conversation that flowed a little more naturally than last time. The exam that felt a little less intimidating. The moment I remembered to slow down instead of rushing through the checklist. Those small victories add up.

I still have plenty of awkward moments, and I probably will for a long time. But I have stopped seeing them as evidence that I do not belong. Instead, I have started seeing them as proof that I am learning, growing, and becoming the physician I hope to be.

Because the goal was never to be perfect on day one. The goal was always to keep showing up.

The Biggest Lesson of All in Clinical Skills

As I reflect on everything clinical skills has taught me so far, I am realizing that the biggest lessons have not been about mastering the perfect physical exam. They have been about slowing down, listening with intention, protecting a patient's dignity, embracing the awkward moments, and learning that confidence is something we build, not something we begin with.

I am still learning. I still get nervous before assessments. I still walk out of an OSCE replaying every little detail in my head. But with every encounter, I am becoming a little more comfortable, a little more confident, and a little closer to the physician I hope to be one day. And I think that is what this journey is really about.

Thank you so much for joining me for another week here at Forensic Fashionista. I hope you enjoyed this week's post and that, whether you are a fellow medical student, a future healthcare professional, or simply someone curious about the journey, you found something that resonated with you.

As you head into this week, remember that growth rarely feels graceful while it is happening. It is okay to feel nervous. It is okay to make mistakes. It is okay to be a work in progress. Keep showing up, keep learning, and give yourself the same kindness and patience that you so freely offer to others.

I hope you have a wonderful week, and I will see you next Sunday for another blog post. Until then, take care of yourself, keep chasing your goals, and remember, you do not have to be perfect to be making incredible progress. 💗

XOXO,

Kenzie

The Forensic Fashionista

In perfect timing with having just taken my PE assessment this past Friday, and OSCE is next Saturday!! (yay finals week...not)