Wednesday, 16 January 2008

OSCEs From The Other Side

This is the second time I've written this entire post, stupid blogger autosave GRRRRR! (anyone who knows where the setting is to turn off word verification for posts will win lots of appreciation)

If you read my last post you'll know that today I volunteered as a patient at the 3rd year OSCEs. I've done this a few times now and its really interesting to see the way things work from the other side.

A new undergraduate centre has just been built at our hospital and by 'just been built' I mean its not actually finished yet. Despite that, for some reason someone decided that the OSCEs would be held in the new skills lab. I arrived early this morning to find the entrance covered in scaffolding, machinery and debris all around the building and a number of workmen sat doing not very much at all - perhaps that is why it wasn't finished yet. The building isn't officially open yet but today went ahead as planned, fortunately they'd just about finished the new skills lab but I swear to god they must have been working until about midnight last night. I arrived early and had a wander round the new building which is much larger than the old (but relatively new itself) one. The new skills lab is huge which is good, but many of the seminar rooms are rather small and won't be much use for group work. Someone with the eyesight of mole obviously picked the carpet, it is absolutely vile, the whole building is covered in these very odd looking carpet tiles which must have been acquired on the cheap from some dodgy bloke down the market as most of them don't even match.

Anyway, enough of that, onto the exam itself. My station was something like this "Please examine this patient for enlarged kidneys. He presented with abdominal pain and weight loss." So it was basically a focused abdominal examination concentrating on the kidneys. This seemed to throw many of the third years who were expecting to have to do a full abdominal examination. I'd forgotten just how young and fresh (that sounds wrong) the 3rd years are, they're all fresh out of pre-clinicals and all so gentle (well, almost all). So I spent the morning with my top off being prodded and poked all over the place. Oh, and it was bloody freezing in this new building, they've obviously not bothered to install the heating yet!

The difference between students was quite remarkable, there were some who were excellent, some who were awful and many in between. There were 3 who stood out, and they were well above the rest, interestingly they were from the same base hospital and my observations were that this hospitals students were significantly better than the others. The better students are easily identified even before they've introduced themselves. The reason for this, and the key to being successful at OSCEs is confidence, or even false confidence. If you approach each station confidently then you can do pretty much anything and still get a good mark. Of course there is a line, which if crossed puts you in the arrogant category, and then you're in trouble right from the start. You don't have to have exceptional knowledge to do well in an OSCE, its much more about confidence and even more about ticking the examiners own requirements.

Because it was really cold, the 30 or so students who examined me today all had freezing cold hands, which was just a tad annoying. Worse than that, having 30 people poke or ballot your kidneys is rather uncomfortable, by the end I swear both of my kidneys were probably enlarged. Some of them didn't actually know where or how to feel the kidneys, and on more than one occasion it was quite painful. In one case I actually winced involuntarily which the examiner noticed, this meant that the person in question failed the station, although to be honest, they were not very good anyway. Thankfully most people didn't bother to palpate my bladder, otherwise i'd have spent the entire time needing to wee. Consultants always say that it is obvious who has actually examined real patients and I always thought that was an exaggeration but today you really could see those who'd examined patients and those who didn't know their kidneys from their ribs. Some of them decided that I did indeed have enlarged kidneys, quite where they got that idea from I don't know.

I once again saw just how objective the OSCEs can be but I don't suppose there is much that can be done about that. On one occasion I almost unconsciously tried to help one of the students by giving them hints (like nodding and shaking my head as they pondered the answers to some of the examiners questions.) I didn't mean to help anyone in particular and the examiner just laughed because he realised it was an accident.

Anyway, it was once again fun, interesting and useful experience. I don't know if I'll get another chance to do it before finals, if not, next time it'll be me. shitters.


Harry said...

We had a 5th year teaching us a basic chest exam on Monday, there was so much to take in and he certainly knew a lot but was very confident and stressed how important it was to be slick.

I've got a loooong way to go.

AMiB said...

heh...abdominal exam. 2nd year skill for us ;-)

i get to be a SIM patient as well for the 2nd years next monday. i will probably write a post as well, but i can never seem to write as well as you. oh well, i guess that's why your blog is more successful lol...

Rohin said...

I'm an OSCE examiner. Sure, slickness counts for the overall mark (AFAIK, all OSCEs are marked in a similar way - points for specific things, eg 20, and then a global grading out of 5. You need both above the passmark to pass. Thus a very knowledgeable student who ticks all the theory boxes but hurts the patient can still be failed) but generally don't worry about being nervous. Just concentrate on scoring the easy points (intro, consent, main parts of the exam) and you'll be fine. Plus if you have a kindly old examiner like me you might get the odd clue...

You think a third year thinking you had an enlarged kidney is bad? I examined a SECOND year who put the BP cuff around the patient's neck when I asked him to measure the ABPI. That's the first time I've had to physically stop a candidate.

I think OSCEs are a good form of assessment and fairer than any other system I've experienced/heard about.

Confidence said...

Great and interesting post on confidence building. Agree with you fully. However we have our own view on confidence building too. You can find out more at

the little medic said...

amib - thanks a lot for the link, i've requested that they remove it. Have fun in the OSCE

rohin - The mark schemes at out medical school seem to be rather different. There are specific points but they're grouped together under headings like "professional approach" which might include introducing yourself, checking the pt's name, not hurting the pt, etc etc.

The a final mark out of 7 is given where 3 is a fail.

I would rather there was a list of 20 or so tick boxes for different points as that takes away much of the subjectiveness. Obviously i've only seen this side of things on 3 different occasions but it looked very subjective to me (although this might be because of the way its done here).

BP cuff around the neck? Yikes, that is just slightly dangerous. It sounds like some sort of sadistic torture method.

Thanks for the comment.

confidence - argh SPAMMMMM!

PhD scientist said...

The keys to OSCEs being (reasonably) consistent are (i) all examiners having actually DONE the skill they are examining enough to be clear how it should be done; and (ii) all the examiners for a given station having met a day or two before to hash out any differences in opinion on specific points about how they would/should mark the station.

On the whole, (ii) usually works OK. Depending on who is available to examine, (i) can be a problem, although should be less so in clinical than in preclinical yrs as the skills will all be strictly clinical (I assume) and the assessors will all be reasonably experienced clinicians.

the little medic said...

phd scientist - both those ideas would be very good although in practice its often not the case.

Take for example this weeks exam, There were 2 cycles running at the same time so there were 2 examiners for each skill. I'm 95% sure that they didn't meet or even discuss the station at all before hand. As a result, both were using different criteria (I know this because the other student volunteering told me so). That is what makes it unfair - if they met and had some sort of standard even within one hospital it'd be better than nothing.

PhD scientist said...

'Tis often remarked that managing University academics is like herding cats, but I would venture that managing consultants - at least some of them - could be (on the same analogy) like herding rabidly savage cats.

What you report is really poor if true. Certainly where I work, and in the preclinical OSCEs I have been an examiner on, we would ALWAYS have a meeting beforehand to sort out the marking criteria for an OSCE station. Always.

jessica said...

Well that sounds like a relatively painless task!! It's nice that you get paid, and get to review your skills.

Anna said...

Gah. Now I'm even more depressed about my performance on Wednesday and Thursday...