The Week After The Week Before

Wow, its now a week after my last exam. Doesn't time fly when you're having fun or, in my case doing bugger all.

What exactly have I done in the last week? Well, not a great deal really. My post-exam to-do list which was already as long as my left arm hasn't been reduced and now in fact stretches around my back and down my right arm too. Saying that I have been 'busy', after all I must have been too busy to blog right? Well, yeah, but then again, I've not had a great deal to blog about. There is only so much material one can get out of waking up, playing computer games, eating and sleeping.

My main objective for the week involved a great deal of football manager, for those of you who know, I need say nothing more. For the rest of you, it's a totally addictive, virtual football manager PC game, like a boy's version of sims according to missbliss. I also got a new gadget on Tuesday and have spent many an hour playing with it, and i've not even read the mahousive instruction manual yet (by far the most exciting part) and yes, every single page is in English - no being disappointed when 5/6ths of the book is in Japanese/German/etc etc.

Yesterday, an excursion took us to the hospital I'll hopefully be working at come August. It was the first time I'd been there, and the first time I'd even been to the city in question. The city is lovely, if slightly quieter and more serene than what I'm used to. The hospital reminds me of a hospital some of my clinical placements were at. It is relatively small, seems mainly modern, and has a few odd, but rather cool quirks. We went for a wander round, obviously to scope out the important places, those being a) the shop, b) the cafes and c) the chocolate machines, all of which, I'm pleased to say, were up to standard.

This week has gone ridiculously quickly, perhaps I should be grateful after all that we have to wait a month for results! Hopefully next week, I'll be able to tick a few things off my to-do list.

The End ........ (hopefully)

Yes ladies and gentlemen, it is over. My last exam on Friday went ok, it was certainly better than Monday's. I broke my rule of "never change your first answer" and that cost me a couple of marks I think but on the whole it was OK.

As I'm moving out of deanery I don't have to do my shadowing period now, in fact, I don't have to do it until the week before I start my job. This means that I'm now free, free to do whatever I want until the end of July!

I am now in a strange sense of limbo, I don't know what I am. I have a whole month to wait until results. Don't even get me started on that... honestly, how long does it take to put all the multiple choice papers in a scanner?

Hopefully I'll be able put results out of my mind and just enjoy my free time, sadly, I don't think it'll be that easy for some.

Wheeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee!

The OSCE

So now everyone has done their OSCE, I think I’m ok to talk about what came up. Especially as the information will be freely available here in a couple of weeks time. I’d advise anyone sitting finals to register and take a look at the section where feedback has been collected from students who’ve sat finals in the past few years at most of the medical schools in the country.

OSLERS – 15 minutes history/5 minutes discussion

Asthma
This wasn’t too bad; I’m not entirely sure what type of history you’re supposed to take from someone who has had their diagnosis for 30 years. It’s more of a chat about their condition than anything I hope. You’re supposed to consult with them for 15 minutes and then tell the examiner what you think their diagnosis is. Now for some things this is easier than others. It sort of gives it away when the patient tells you their diagnosis (I don’t think they’re supposed to do that). When you’ve finished the history, there is a 5 minute period for questions. The examiner was a little mean and impatient but I think I did ok.

MS
This was harder than the other OSLER, mainly because it wasn’t barn door MS. At first I thought it could be MND, then I thought it was some weird myasthenia problem but I eventually did decide it was MS (mainly because when I asked if he saw any specialist nurses – he told me he’d seen the MS nurse before). Again I think I did ok with the history part and managed to waffle my way through most of the questions.

5 Minute ‘Spotter’ Stations

Charcot’s joint
A strange station really, I was told to purely inspect a patient’s leg and not to examine it. There was an obvious amputation and slightly deformed ankle, I wasn’t entirely sure what else I was supposed to see/say. I guessed it was charcot’s joint and the examiner seemed quite pleased. I was able to answer most of the questions quite well too.

Parkinson’s
Not the most of obvious of Parkinson’s, must have been pretty well controlled on medication. I found that the patient had increased tone but I thought it was spasticity rather than the typical rigidity of Parkinson’s. I did spot the shuffling gait and managed to reel off and demonstrate a number of other tests for Parkinson’s.

Stoma
Probably my best station. I was asked to inspect a patient’s abdomen, he had an obvious stoma. The rest of the station was questions. I managed to answer them all confidently and completely. We finished in about 3 minutes and spent 3 minutes talking about politics.

Dupryten's cotracture
Another barn door diagnosis, I was slightly unsure what to examine in terms of the patient’s hand, but the station was mostly question based and I think I coped with them pretty well.

Psoriasis
What annoyed me most about this station was the examiner; I felt she was rather mean. I managed to spot the diagnosis of psoriasis and answer the questions well, if not perfectly but the examiner still didn’t seem particularly happy for some reason. Maybe she was bored as it was my last station and she’d been there all day long

Heart Murmur
The only 5 minute station I really didn’t like. I was asked to examine a patient’s heart. I was told to go straight to auscultation and at first couldn’t even tell whether or not the patient even had a heart. When I finally found it, I could hear an obvious murmur and I tried to time it with the pulse and decided it was a diastolic murmur. I then decided that it was loudest in the tricuspid area and so decided on a diagnosis of tricuspid stenosis. God knows why, patients with that must be as rare as hen’s teeth. Anyway, the examiner told me that it was in-fact systolic and atrial stenoisis. Oops! I managed to answer the questions though so I’m hoping that brought my mark up for that station.

10 minute stations

Abdominal examination
I made such a hash of this potentially easy station. It is because I was told to go straight to the abdomen. If I’d had to examine the whole system it would have been the easiest station of the lot. Anyway, the ‘patient’ was simulating that she was in a lot of pain which put me off completely. I didn’t want to cause her any more pain by examining her. I royally fucked up the order of my examination but did eventually mention most things in a haphazard manner. I gave a decent differential diagnosis and mentioned just about every possible test under the sun.

Testicular examination
This was my first station, and I was well chuffed. It was a nice easy start. I’m pretty sure I had my testicle examination down to a fine art. And apart from a question on the cause of painless epididymitis, I also did quite well with the questions.

Hearing tests and hearing aid viva
I wasn’t impressed with the examiner in this station. I knew exactly what I had to do and I had it perfectly clear in my head about Rinne's and Weber's tests. Unfortunately the examiner decided to take me round in circles and completely confused me by twisting what I’d said. Anyway, I managed to get the other questions right so I’m hoping to have only dropped a mark for getting slightly confused.

Diabetes – Driving DVLA
My worst station, I didn’t have the faintest idea about diabetes and driving. The scenario was; “a patient has come for his routine diabetes check-up”, here was me expecting to have to examine him but no. He had actually come to ask about driving as he’d just got a new job. Would he have to tell work and the DVLA about his diabetes? I didn’t know, I said I’d have to look up the details but I told him to notify the DVLA and encouraged him to tell work. I don’t think he as the patient was particularly pleased with the outcome of our discussion so god knows what the examiner thought. Here’s hoping I got a mark for washing my hands.

Child psych – mother concerned about daughter losing weight
I haven’t a clue how I did in this station because I’ve no idea what it required us to do. It was difficult to take a history from the mother as third person but I got in most of the important questions. I presented a decent differential diagnosis and made a vague effort to explain to the mum about the possibility of anorexia.

Explaining bad news and consenting a schizophrenic with cancer
This station had come up before, just as the other scenarios I asked about had. Again I’ve no idea what was expect of us and how I did depends entirely on what the mark scheme asked for. The simulated patient who kept hearing voices during my consultation first of all declined surgery but was happy to consider it by discussing with his parents by the time we’d finished so that has to be a good thing. I think he had capacity but I found it difficult to get this point across to the examiner who didn’t say a word to me throughout the whole station apart from “you have 10 minutes to use as you please” as I asked her a question.

Pill counseling
Hope I did OK in this station, in hindsight (AKA talking to missbliss) I could have done better but at the time I think I mentioned most things that I needed to. My mind went blank with regards to the side effects but I remembered the other things. The simulated patient was annoying in that she kept asking me questions about things I’d already told her about, but I suppose that made her an accurate patient!

Death certificate
One of my better stations, don’t think this was too challenging though I think I spelt pneumonia wrong. They were sneaky in trying to catch us out with a particular detail which I wasn’t sure about but said I could check. I was able to answer most of the examiner’s questions. There was a fair amount of spare time in this station during which I sat there like a numpty trying desperately to think of more answers to the questions.

So there you have it, 5 years of medical school condensed into 2 hours 40 minutes.

4 weeks to wait to find out whether or not I passed.

Finals Update

Following a rather disastrous start to my finals on Monday(although it seems most people feel the same), yesterday was the OSCE. This is the big one, the most important one, the one everyone is most worried about. I'm usually quite calm around exam time but OSCEs bring out the nerves in even the calmest of us.

It is the waiting that annoys me most, we reported to the hospital about 12, only to be forced to sit and wait for an unknown period of time, a period where minutes feel like hours. I imagine it is like waiting for an execution, only at least with that you know what is going to happen, with an OSCE, you never know if you'll come out dead or alive! In that final hour, some nervously flick through their notes aiming to cram those final few facts, others sit calmly contemplating what is to come. Only when we had to put all our belongings in quarantine did the reality of the situation hit me, I don't often get butterflies in my tummy but at that point yesterday a swarm of them descended upon me. I defy anyone to sit an OSCE without feeling those nerves. When we were finally marched upstairs and given a short briefing I knew this was it, 3 hours that could make or break my future.

Placed outside the first station by an unfamiliar but friendly face, I could feel my heart beating, in fact, it felt like it was about to explode. The time had come, my body responding with its fight or flight mechanism. As tempting as it was to run out of the door and never look back, my thoughts were interrupted by the first buzzer and the fight began.....

That I'm afraid is where the story must end for today. I will write about each station but as other students still have to sit the OSCE I don't think it would be a good idea to talk about it till Thursday.

All I will say is that it could have been much worse...

Just Friday to go.

What a Ridiculous Exam

- If you're going to insist on asking us a load of microbiology questions, please tell us in advance so we can learn it. Alternatively, you could, you know, actually teach us something rather than making us do it all ourselves in PBHell.

- If pt x has so and so wrong with them, my 'initial management' would probably include the answers a, b and e. Please don't make me guess what Dr Jones wanted as the correct answer, based on how he was feeling when he wrote the question, when all 3 are potentially correct.

- To all of those studying a PBL course, unsure what exactly you need to know, the answer is everything. Yes, absolutely every last possible detail of every conceivable thing. You must know every textbook inside out and be prepared to answer questions on everything.

- I've done this exam 5 times now, and this time was by far the hardest in my opinion. At least most people seem to have found it rather difficult.

- I pity the poor 1st years who did the same exam, they must have literally had to guess all but a couple of questions.

- I've got a headache.

- OSCE tomorrow.

- Onwards and upwards

Close To The End

3 years of life in hospital as a medical student hopefully came to an end today. Shitters

Exams Monday, Tuesday, Friday next week. Shitters

Then its all over. Shitters.

Results 1 month later (don't even get me started on that). Shitters

Argh shitters!

The next update will probably be Tuesday after my OSCE. See you then

Blogging Revision

Ok, so I'm not supposed to be blogging because I'm supposed to be revising but I had a wonderful thought - what if I combined the two?

What better way to revise ethics and consent than to discuss it. It's a grey area without a yes or no answer. It is more a matter of common sense and opinion so I'm asking for your opinions on the following scenarios:

1) You are the SHO on an upper GI surgery firm, you are told to explain a diagnosis of gastric cancer and start to consent a schizophrenic patient for surgery.

2) You are a new GP partner in a GP surgery seeing a woman who is going in for a elective operation, and she doesn't want the people in the hospital to know about her Hep C status... it turns out that she thinks if the hospital knows about her Hep C status, her social worker would find out and not let her to see her daughter.

3) A husband slept with prostitute in Thailand on business trip. Wife is unaware but attends GP with sore throat & demands to know what’s wrong with husband & wants same treatment.

So, how might you approach the above situations, go on, leave a comment and help with my revision.