Training a Bunch of Monkeys

Because a) I've got nothing better to do, b) I quite enjoy it and c) the £40 will pay for a takeaway, today I volunteered yet again as a patient for the 3rd year OSCE exam. It is the 5th or sixth time I've done so but each time I learn something new about the whole process. Today I had aortic regurgitation and 39 candidates did their best to impress the examiner as I laid there watching the ducks out of the window.

Now I should say that I think OSCEs are a very important assessment of a medical student's abilities. However, they aren't, certainly at my institution assessed effectively in my opinion. I recognise the difficulties in running a fair exam but when you're trying to do so simultaneously at 4 sites, with different equipment and different examiners in the morning and afternoon but supposedly the same stations it must be impossible! You might think that it all averages out in the end, and perhaps it does eventually but there are huge inconsistencies. I would have thought some methods are employed in an effort to standardise the marks but it would be almost impossible to do this for every conceivable variable. Blah, blah, blah, I could moan about this all day long.

Lets take today for example, admittedly I only saw a snap-shot of what went on, just 1 out of 13 or 14 stations. We started in the morning with one examiner, who's marking was rather erratic. There was one student who was a country mile above the rest who scored average to below average whereas others who were average at best were scoring higher. It doesn't help that the mark scheme leaves things very open to interpretation by the examiner but what can you do? An open mark scheme is too open to subjectivity but a more rigid mark scheme makes it more difficult for students to score consistently. Overall that examiner was fairly generous. In the afternoon, same station, different examiner. This time, a much more consistent marker but at the same time, much harsher with the marks (perhaps rightly so). Next we should consider the students, frankly, overall they weren't that great but I'll get to that in a minute. For no particular reason that I could see there was a significant variation between the morning lot and afternoon lot. The morning lot were on the whole, ok (remember they also had a generous marker) whereas the afternoon lot were, apart from one, not as good (and also had a harsher marker). I might not have explained that too well but what I'm getting at is that there was more than one variable affecting each group skewing the distribution of marks further between morning and afternoon.

As for the students themselves, let me explain what I thought was wrong. This might sound a little harsh and hypocritical (I was exactly the same when I was a 3rd year). Neither is it really the students fault. Every student was able to make a decent effort at completing a cardiovascular examination. But, you could teach a monkey to do a textbook cardiovascular examination. Very few students looked like they were actually looking to elicit signs. Perhaps the main issue here is that it is such a fake situation and the students are expecting a normal volunteer to examine therefore there won't be any signs so it doesn't matter. I spoke to the examiner about this and he agreed, he had previously examined a thyroid station where students had all done a textbook examination but 5cm above where the thyroid actually is. They are only 3rd years, perhaps it is unfair to expect them to elicit signs at such an early stage. You can clearly tell the students who've examined real patients and who are actually trying to elicit the signs from those who are just going through the motions, the former group generally score higher, I believe rightly so.

During finals for instance we had 6 stations of real patients, these were not only the most difficult but were the most interesting and dare I say it, enjoyable stations from my point of view. Why not have a few real patients for earlier years? Yes, it would take more organisation but patients are usually quite willing to spend a morning being examined. We're not trying to train monkeys, we're trying to train competent, dynamic doctors who're able to think on their feet so why aren't we assessing this properly?

My experience of OSCEs from both sides has led me to the following conclusion:
Performance = 30% luck in each and every station + 30% examiner subjectivity + 30% confidence (or false confidence) + 10% knowledge

Clearly, luck makes up a rather large proportion and this is what needs to be eradicated if possible. How we do this I'm not quite sure. Perhaps having more stations 30, 40 (as some other medical schools do I believe) to average things out, or improving the consistency of marking by reducing the subjectivity.

I love to get my hands on a chunk of results data to run some of my own statistical analysis on. Although the chances of that happening are about the same as winning the lottery.... 4 times. If I asked for it, I'd just be ignored.... again.

One other thing from today; what is with all the all black stethoscopes? At least half the students had them and yes they might look quite cool but they sure as hell don't make you any better at using them!

If you've not already done so check out my latest, and probably final post here: http://thereallm.blogspot.com/

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

Shingles Mingles

So missbliss has shingles, poor her, everyone who has had it seems to have oodles of sympathy. Unfortunately, nobody seems to be quite sure whether or not I've had chicken pox. I thought I had and was merrily poking her rash before she went to the doctors, but it seems that I might have just made up me having chicken pox as a child. I guess we'll find out in about 14 days or so (the incubation period) right before my finals start. Wahey.

On the plus side, the football rocked my socks. And so I've got the champions league final (no legs involved missbliss) after exams.

They Think Its All Over....

Well it very nearly almost is. I finished my last clinical placement on Friday. This signifies a couple of things, firstly that I'm supposed to know everything that I could possibly need to function as a doctor and secondly that finals are in 2 weeks.

2 weeks tomorrow, my first exam, then 2 more, spread out over the rest of the week and that is it. I'm free...at least for a month until results.

As a result of this, I'm not going to be writing, or reading blogs much over the next 3 weeks. Well that is the plan anyway. I know I've already mentioned my upcoming exams plenty of times and thanks to all those of you who've wished me luck.

Best of luck to all those readers who are also sitting exams as we come towards the end of another year.

The Final Push

A month from now it'll all be over one way or another. 3 more weeks until exams, I'm ridiculously fed up with waiting for them. I can't wait till they're over and I can spend my time doing bugger all/playing computer games/sleeping or a combination of the three.

4 more weeks and medical school is over. Shitters


Also want to take this opportunity to say hi to the people who've been reading through most of my archive. Some of you seem to have spent hours reading, considering exam time is approaching, I'm guessing you're all procrastinating!

Finally is anyone else having problems with blogger emails? I'm not getting messages about comments and other various emails.

A little bit of everything...all rolled into one!

Back from short trip to Dublin which was very welcome indeed. It rained lots...and lots...and again some more but other than that it was great! Plenty of Guinness was drunk, although not by me since I don't like it.

July is rapidly becoming the most hectic month ever, elective departure is just 26 days away with preparations for that in full swing. In the midst of all that i've a presentation to prepare and do, my research project to finish, a flat to move out of...arghhh where will it stop.

Exam results are out on Friday, whoop. Could be interesting. (I wonder if they'll surprise us too by telling us our academic rankings, I do hope so!)

My research project is apparently good and nearing completion however the database has been changed as a couple of mistakes were found which renders most of my statistics out of date. grrr. At least now I know what i'm doing it'll only take me 10 minutes to sort it out.

Off to Devon this weekend for more holiday goodness.

Also, only 16 days to Harry Potter book 7. Like cal I'm also uberly excited as is missbliss, wooooooo!!!! How exciting so I'll have that to read that amongst all the July craziness.

Finally a Response!

Just had an email about my appeal against a mark received in a recent exam, it was a very polite reply from the chair of the assessments committee.

He stated that the matter had been investigated and that no discrepancies in marking had been found. He suggested that as I had reached the required standard for progression to year 5, I should reflect and move on which is fair enough. Apart from the outcome, I'm pleased with the response. I couldn't have expected much more, it is a case of my story against the examiners and obviously his carries more weight in that he is the senior and I'm the student being assessed so am potentially biased towards myself.

I continue to feel an injustice has been done but there is little more I can do. I did suggest that the mark in question should be excluded from my grade which wouldn't change it overall but would be a moral victory for myself. We'll have to see what happens with that. I'm still offended about what the examiner wrote as feedback on my form. I remain oblivious as to how I could have improved for that station, and for that reason I've asked permission to speak to the examiner in question about my performance in that station (opinions on whether or not that is a good idea are welcome in comments?) and how the station should be performed. This was originally suggested to me by a member of staff.

I wonder if I'd be allowed a chaperone for my finals. :D

Anyway, poo to that!

Testing times....(NO MORE EXAMS TILL FINALS! - HOPEFULLY)

Well that's it, 4th year exams over and done with! Perhaps option d) wasn't the best option, Today's exam was atrocious, and it wasn't because I'd done too little work. The university say we should only do about 6 hours work before the exam.

The first time went through the paper, I answered the ones I was sure about, when I looked at my answer sheet, it was a mass of emptyness. I hated almost every single one of the 125 stupid questions.

Many of the questions are stupid and vague such as this one:

A 20 year old girl is admitted to hospital and undergoes an appendectomy. 3 Days later she finds out that she has miscarried her 11 week pregnancy which she did not previously declare. She has asked to speak to a doctor because she believes she lost the pregnancy as a result of the operation and would like to make a complaint. You are the house officer, do you:

a) Listen sympathetically and then tell her that the operation caused the miscarriage
b) Listen sympathetically and then call your consultant to speak to her
c) Listen sympathetically and then explain the fact that she had previously not disclosed the pregnancy
d) Listen sympathetically and then say that the anaesthetic caused the miscarriage
e) Listen sympathetically and then tell her that the operation and the miscarriage were not linked.

(these are not the exact answers as I forgot them but they're along these lines)

It is obviously not a, d or e, but it could feasibly, in my opinion, be b or c, I went with c, but I'm not sure it's right. It is an unfair exam in my opinion as many of the questions have two possible answers. (Don't even get me started on the questions about the 'best immediate management')

Anyway its over and done with now, results in a month. OSCE results this Friday, if I've passed both, no more exams till finals! Otherwise - resits next year...I'll keep you posted.

MCQ for You

The day before an MCQ exam, having done little work so far, which of the following should you do?

a) Read over as many notes as you can. (Well I don't make any notes so that's option a out)
b) Read "Medicine at a Glance" in the vague hope that you'll absorb the words intradermally as you turn the pages.
c) Spend the day doing practice questions. (I've already done the ones I've got about 5 times)
d) Forget about the exam by going to the cinema, gobbling roast dinner, then proceeding to watch two thirds of the Die Hard trilogy.

Answers here please

BLOODY PIGEONS!

I hate them, they are evil personified (or pigeonified,) what purpose do they serve? I can hear them right now, cooing evilness sat in my fucking ceiling. I usually slow down when they get in my way when I'm parking my car but in future I'm going to speed up squash the little monsters.

Yet again we've got no hot water, why? Because of those stupid, disgusting, waste of space little freaks living in our flue! The plumber is going to have to come and sort it out, hopefully good and proper this time by blocking them in. MWAHAHAHAH!!!

I've finally finished my SSC project on medical education (Obviously in true last minute style I was up till 3am the night before it was due.) I wasn't particularly happy with my final report. It didn't quite summarise my thoughts or all the stuff i've read. I was able to conclude that PBL doesn't work so I was happy about that (I'll write more about that tomorrow)

I've got an exam on monday :( I'd almost completely forgotten about it and i've done precisely NO work for it. I think I've written about it before 120+ multiple choice questions aka the Progress Test! Problem is there is no way i'm going to do as well as I did last time so it's going to be a case of backwards progress...if thats possible. After that I've got an 11 week orthopaedic research project to do which should be interesting and relatively easy once I get my head around statistics.

Elective Update: Its is booked and paid for!!! at last!
Departing the 30th of July for exactly 80 days of round the world fun and frivolity!
UK -> Bangkok -> Sydney -> Fiji -> Honiara -> Lata Hospital -> Honiara -> Fiji -> Los Angeles -> UK!

I love vaginas!

Ok, well maybe not, but obs and gynae has come to my rescue! (I never thought I'd hear myself say that)

Today's obs and gynae OSCE went really well, much better than yesterday's disaster so I'm happier now and hopefully more confident. Again it was a very fair exam but this time I feel I just about did myself justice.

OBS AND GYNAE (again, excuse the dodgy numbering, I did them in the following order)

Station 3 - Scenario: You have been asked to take a swab for chlamydia and perform a bimanual examination, please do so on on this model and talk to it as though it is a patient.

I walked in and I thought shit, there is no way I'm going to be able to do this in 5 minutes but I launched in and before I knew it I was finished. I'd done everything that was expected of me, even my communication skills were almost perfect (although its bloody strange talking to a plastic pelvis.) I had a spare minute at the end. Maybe I forgot something major, it seemed too easy...

Rest Station - This time I was able to reflect on my good start, and I got an orange slice and a drink to refresh me

Station 4 - Scenario: This lady has an embarrassing gynaecological problem, take a history from her.

Hmm, another full history in 5 minutes... it's ridiculous to expect us to do that really. But I did my best. I made sure my communication skills were up to scratch and I was fairly pleased but I didn't have time to discuss the potential treatments and or tell the examiner that I thought she had stress incontinence. That was more of a time problem than a problem with me though.

Station 5 - Scenario: GUM viva - Given results of various tests and had to give a diagnosis and treatment and talk about other aspects of the case.

It was a strange one but I kind of stumbled to the conclusion that the diagnosis was bacterial vaginosis and mumbled something about metronidazole as a treatment because I think that's what I read. But from then on I was back to waffling like I did yesterday. Hopefully I said some good stuff and got some good marks but I was a little unsure about this station.

Station 6 - Scenario: Counsel this simulated patient re. male sterilisation as a contraceptive technique.

I wasn't really prepared for this station but I think I came out of it pretty well, I don't think I emphasised the permanence of the procedure but I addressed his concerns and allayed some fears. It was all about communication really (at least I hope it was because I didn't know a great deal about the procedure itself)

Station 7 - Scenario: Comment on and discuss this partagram.

The only station that went badly. I've never really looked closely at a partagram before, yes I've seen them in books and on the ward but I've never studied one or seen exactly what is on one and why. I managed to bluff my way through explaining most of it although the examiner obviously knew I'd not really seen one before (thankfully other people said the same afterwards) I kind of messed this station up but the examiner was nice and hopefully I bluffed some marks somewhere along the lines. If only it had been a CTG.

Station 1 - Scenario: Examine this pregnant lady as you would during a routine ante-natal appointment.

Another success, again I'd learnt and practiced the procedure well. I knew what I was doing and what I was talking about. My communication skills where up to scratch and I'm fairly sure I didn't miss anything dramatic.

Station 2 - Scenario: Examine this plastic model of a breast, as you would a patient. Answer questions on your findings.

A nice easy one to finish off, I knew exactly what I was doing, I'd practiced well and I was slick at the examination. I found the two lumps in the fake breast and was able to give a diagnosis, how I came to that diagnosis and how I would confirm the diagnosis.



So, all in all, not a bad exam today, most of it I could have predicted and I'd revised most of it quite well. My examinations were good as were my communication skills, there were a couple of dodgy moments but aren't there always? Hopefully I've picked up a few more marks today to drag my mark up a little. The best thing about today was that post-exam relaxation feeling, although being in quarantine for a couple of hours soon saw me wanting to maim some of my colleagues. So...WOOO! Potentially no more OSCEs till finals *touch wood*

The day before...

I've been moaning about OSCEs and my lack of revision for weeks now but they're finally here. Tomorrow is paeds and Tuesday obs and gynae (at least it fucking better be because that's what we've been told, if its not then I'll be buggered and someone will get some abuse), 7 or 8, 5 minute stations per day. I'm not prepared, nowhere near in fact but I never usually am until right before we enter through the doors into the fiery hell that is the skills lab during OSCE time. I've not been as enthusiastic about revising for these exams than I have previously, maybe I'm complacent, maybe because I hate obs and gynae perhaps I'm just exhausted but anyway its too late to moan about that now.

I know my examinations, I can wash my hands, introduce myself and obtain consent, I can take a history, I can even counsel patients and parents. Ok so my subject knowledge is patchy but hopefully I'll be ok. *crosses fingers (and toes..and legs..and arms)*

OSCE day always makes me chuckle, it must be quite the logistical nightmare for the staff. But its also quite a ridiculous experience. The 'same' exam is run over 5 sites, how they can ensure this is standardised is beyond me. It can be interesting when you recognise the examiner at a particular station, perhaps its a consultant with whom you got on with well, or perhaps one who you didn't get on so well with either way, the fairness of using 'familiar' examiners is debatable, indeed the GMC didn't really approve. We get quarantined after the exam until everyone has started at all sites, oh yes, that lovely time when everyone dissects each station...point...by...point, over and over again. Just get the fuck over it, there is nothing you can do about it now! I don't want to know exactly what I've missed.

Roll on Tuesday afternoon and that lovely feeling of freedom.

P.S - Thanks to all who wished me luck in previous posts, I might just need it this time. By Tuesday evening all my OSCE moaning will be done and dusted and normal blogging will return.