Thursday, 15 May 2008

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.

10 comments:

Polly said...

Congrats on finishing!!!! Enjoy your time off - well deserved :)

Elaine said...

I echo that!

PhD scientist said...

Fascinating read, LM. Never heard a description of the contents of a 5th yr final OSCE before. Fingers crossed.

On the whole I think these sorts of OSCEs are pretty good way to assess medical students, although the "5 yrs into 160 minutes" must feel a bit daunting. The "stress factor impairs performance" sometimes evokes complaints, understandably, but the pat response tends to be: "well then imagine what happens the first time you have to do X on a patient without a more senior person standing behind you to advise / bail you out."

Of course, the professional (College) exams - MRCP, FRCA, MRCS (? - guessing about MRCS) have OSCE type bits, e.g. the FRCA part 1 used to have a "hyper-OSCE" that went on all day, w before and after lunch sessions, 4-5 hrs all told.
At least, that is what my anaesthetist friends tell me. And Mrs PhD always says the 2 hrs or whatever of the MRCP OSCE/PACES was a real grilling. I am pretty sure part of the philosophy of the final yr exams you are doing was/is to model them after cut-down version of the College exams.

The Manchester Medic said...

From your post, it sounds like the exam went pretty well. I bet you are pleased to get it over with. Enjoy the next four weeks!

Calavera said...

Well done, Little! You're done! I think from what you've told us there that overall, things went pretty well! Pat yourself on the back!

(Or rather, go out and get pissed!)

Noel said...

Who chooses these questions? I mean if I was setting an exam like this I would have dropped some of these questions. For example, Diabetes and Driving? Who dreamt that up?

PhD scientist said...

Re "diabetes and driving", well, it's real life, innit? The wider point is about "medical conditions that could affect driving or be dangerous if a sudden catastrophic incident occurred while you were driving" ...there are more obvious examples, like epilepsy, and less obvious ones, like not-well-controlled hypertension leading to strokes and MIs.

Insulin-dependent diabetics are at risk of hypoglycaemic blackouts, and are not allowed to hold an HGV licence... so they can't drive lorries, or buses.

Basically the DVLA and their in-house medical specialists have loads of elaborate rules about this, so "tell the DVLA" is a good message. Employers should (on the whole) already know via a medical questionnaire (at least) when people start work.

HM said...

We received a list of possible first year OSCEs for the exam in a few weeks, and I don't think I can do any one of them as it stands right now.

Stupid things like cardio exams or first aid, or guiding a blind person around a room. I doubt I could manage any of them as it stands.

Let alone any of the OSCEs you had!

Wistfully thinking said...

Congrats on finishing the exam! I was in the 2nd day cohort and it was pretty much as expected (with the exception of the query non-accidental injury station).

Good luck and roll on results day!

Anna said...

Oooo ouch! That is one long and painful-sounding OSCE. I am eternally grateful to have studied at a medschool with staged finals. My medicine OSCE this block was only 4 stations of 6 minutes, shortest one ever!

I have my fingers crossed for the results, but only as a safety net. I know you've passed!