Results Are Out...

So, results came out today.























I guess you're going to want to know how I did right?





















You're going to have to keep scrolling.

























Click here to find out:
http://thelittlemedic.blogspot.com/

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 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.

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.

OSCE Fun (not really sure those words go together)

Tomorrow brings with it the 3rd Year OSCEs, now they’re not real OSCEs, in the sense that they’re summative rather than formative (maybe that is the wrong way round?!). That basically means they don’t mean a thing with regards to progressing through medical school. Its more of a practice for the summer 3rd year OSCE which is important.

You won't be surprised to hear that I'm again modelling tomorrow which means I get to lie on a bed all day and be prodded and poked by the 3rd years. I wonder what my station will be this time. I've got a pretty good idea but again I'm not going to share any details just in case any 3rd years are reading.

I enjoy being a model for the OSCEs, I get £20, I get to revise something I might not have done for a while and I get free drinks and biscuits - shitters - no biscuits - stupid new years resolution! Probably for the best, last time I ate my way through 2 boxes (admittedly only stealing the best ones).

If you've not already done so, read the latest about PBL at the real little medic.
If you're new and need an invite just drop me an email to imamedicalstudentgetmeoutofhere[at]hotmail.co.uk

Of course you can prod and poke me

Today was the 4th Year OSCE for which I've spent the day being a patient. Yesterday I was informed that I should bring shorts, this was a surprise as I'd guessed that I'd be on the shoulder exam station (there is ALWAYS a shoulder exam - well there used to be!). From this I could deduce that I'd either be doing hip, knee or lower limb neuro examination.

As it turned out, I spent the day having my hips examined. It has been a very long day but despite that, it was good fun. I rotated with another volunteer but I must have had 25+ hip exams today, (my hips now feel far worse than they did this morning). It was actually quite exhausting, I don't know why, and I've lost count of the number of times I've confirmed my name and date of birth. By the end I was struggling to remember my own date of birth, at one point I confused one poor girl by telling her I was born in 1895, oops.

The quality of the students differed quite significantly, confidence seems to be the main differentiating factor. Take for example one guy who was very confident and whose knowledge was adequate compared to a very nervous but exceptionally knowledgeable girl. The girl's mark suffered as a consequence of her nervousness whereas the boy gained significantly by being confident (even though it might well have been false confidence).

I was there all day but at lunchtime the examiners changed. I was surprised just how much difference this made. This morning's examiner was quite harsh, he kept putting people off their rhythm with silly questions. The afternoon's examiner, was comparatively lenient, and he let the students get on with it. I suppose it all evens out over the whole exam, but still, they are VERY subjective.

The majority of students wanted to remove my shorts for the examination! Fortunately the first examiner explained that I was adequately exposed but when it came to the afternoon, even the examiner thought I should remove my shorts! Luckily one of the admin staff overheard and saved me. I did get poked in some awkward places though!

It was very interesting to see the exams from the other side of the fence, it was good experience (I could do a perfect hip exam now) and it was good fun. I've lost count of how many biscuits I ate throughout the day. Most of which were to make up for the awful free lunch we were given. Honestly the canteen could do with a visit from Gordon Ramsey, their food tastes like its come out of the wrong end of a cow.

I'm sure there was much more that I wanted to say about today but it escapes me, and right now I'm going to spend some of my hard earned cash from today on takeaway for me and missbliss. mmmmm tasty!

(There is one bit of extra gossip but that is suitable for reallm eyes only)

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!

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*

Children Down, Vaginas To Go.

I didn't think 'one down, one to go' was quite right for this post.

My paediatrics OSCE is done, to be honest I'm disappointed in myself, I know I should have done better, it was a relatively fair exam, I just didn't fulfil my true potential. Its worse when that happens. I could just about cope if it was a horrible exam or if I didn't know anything but when you know the stuff but it all just goes a bit tits up, its fucking annoying.

I hope the uni won't get mad at me for explaining the stations (they shouldn't because everyone has done the exam by now)

PAEDIATRICS: (excuse the dodgy numbering, its the order I did them in)

Station 3 - Scenario: Young boy admitted previous night with exacerbation of asthma, comment on his vitals and examine him.

So, I looked at his vitals, but I wasn't exactly sure what comment on them meant so I just remarked that they had improved and took a few guesses at normal ranges of peak flow for children. Then disaster struck, I flunked the respiratory exam, Fuck knows why, I've done it a million tomes, maybe it was nerves, maybe I'm just stupid but I completely fucked it up, I did stuff in completely the wrong order, I forgot to even bother to do most of the stuff and the stuff I did do was rushed and messed up. What a waste, a fair and easy station but I flunked it.

Rest Station - Great, 5 minutes to reflect on my disastrous first station, just what I needed, I took a drink and a jammy dodger before carrying on.

Station 4 - Scenario: Mother attends GP because she is worried about her 7year old daughter who is putting on weight. Take a history.

Probably my best station, my history was good, I almost froze at a couple of points but I bought myself some time with open questions and managed to cover as much as I possibly could in 5 minutes, which again is ridiculously little time to take a decent history. (even GPs have longer than that) I addressed the mothers concern, I even summarised, and started to make a plan before the buzzer went.

Station 5 - Scenario: Mother has just a baby which has been diagnosed with Downs syndrome. She would like some more information on the condition. Discuss it with her.

A strange and somewhat unexpected station although it was fair I suppose. I could have talked about the signs and symptoms of Downs, even discussed the genetics in depth but I was much less sure of this station. I managed to waffle a lot and managed to elicit and address most of the mother's concerns but I'm not sure I did what was expected of me. Goodness knows how I did in this station, hopefully my blagging was enough.

Station 6 - Scenario: 2 brothers have impetigo, calculate their doses of antibiotics using BNF

Another fair, if rather unexpected station, I don't think I did too badly here either but I couldn't for the life of me think of some contra-indications for penicillin, obviously I got allergy but apparently they were after renal impairment. I got half way there by waffling about metabolism. I also tried to give one of the children, a baby the wrong dose until I used my eyes to bother to actually read the BNF.

Station 7 -Scenario: 14yr old boy in a+e after mother became increasingly worried about symptoms of paranoia. Viva station.

Ah yes, the obligatory child psych station, I don't if I shafted this station big time or if I just misread the examiner. I mean, its a waffle-y topic at the best of times and I answered her questions but I was ridiculously vague and waffled like never before. I still don't know what I was actually supposed to say but hopefully I did ok, psych isn't my strong point but I had a vague idea about schizophrenia and I tried to satisfy the examiner.

Station 1 - Scenario: Young girl in clinic complaining of facial weakness, examine her cranial nerves.

My heart sank at this station, for 2 reasons, a) I hadn't really expected this to come up as it came up in neuro last term, I hadn't revised it but I had vague idea., and b) All 12 cranial nerves in 5 minutes? In fact, more like 4 minutes with traveling between stations and a bit of admin work. Are they having a fucking laugh? Oh well, I launched in saying "I'd also do this, and that and t'other" Whilst trying to be quick but rushing made me forget things, I got into a muddle and ended up having no idea what nerve I was up to. 5 Minutes is just too short, if it had been a 10 minute station I could have gone thorough it all slowly, systematically and properly. I was also bamboozled at the presence of orange quarters on this station, I didn't know whether to eat them or to use them to test taste and smell. In the end I chose the latter, although I could have done with refreshments at that time. I fucked up my diagnosis at the end too but he said I did ok so we'll see.

Station 2 - Scenario: mother accompanies child to a+e, child has a mark/rash on his bottom. Take a history

Now I thought this was a bit of a silly station, I mean it would have been ok as a viva or discussion but as a history it didn't make much sense. It was ok, I managed to deal with the mothers worry about the possibility of meningitis and asked her about the possibility of non-accidental injury (NAI) It turned out that the child had recently stayed with its father who had a new girlfriend. But just as I was discussing the NAI aspect of the case the buzzer went and that station ended. 5 minutes just isn't enough.


And that was the end of that, time flies when you're having......fun? (hmmm, not too sure about that). In summary, my histories were good but 5 minutes is way too short to get anywhere, my examinations were crap and overall I should have done a lot better. Bring on obs and gynae tomorrow, hopefully I'll make up for today's semi-disaster.

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.

North and South

I have returned alive from the South. Devon was lovely, the weather was beautiful and a good time was had by all. I even made friends with missbliss's cat which usually runs at first sight of me. I've actually had a very full and enjoyable Easter holiday I'm sad to say its coming to an end. I could have done with another week but c'est la vie.

If you give the South a chance its actually quite nice, although I'm thoroughly fed up of walking up hills. Exciting southern pictures can be seen below. We saw dolphins in the sea, (albeit from the top of a very high cliff.) Even the journey wasn't bad, a 4 hr drive each way with very little traffic. What more could I ask for?

Sounds almost too good to be true...Oh shit...I seem to have forgotten about the 2 OSCE exams I've got in a couple of days time... It's going to be an interesting weekend... watch this space.

OSCEs

Its that time of year again, as we approach the end of the module, examinations loom. Yes ladies and gentlemen its OSCE time (well it will be in a few weeks.)

I made my revision timetable at the weekend and I'm already a couple of days behind. Oops, I could do with some motivation. As it happens I don't mind OSCEs too much, in fact, in a sadistic kind of way I enjoy them although this time round it includes obs and gynae which automatically makes me want to shoot myself.

So 15, 5 minute stations, over 2 days, on paediatrics and obs and gynae. Simply by looking at previous years its easy to predict that there will likely be a few recurrent examiners favourites; breast exam, vaginal exam, family planning and various paediatric histories to name a few. At the top of all my revision notes is the phrase "WASH HANDS, INTRODUCE SELF AND OBTAIN CONSENT" I work on the proviso that if I do that in every station everything else will just kind of follow.

Maybe I should be more scared than I am about this OSCE, especially as I havn't exactly been enthused by obs and gynae and as a result have spent most of my time avoiding work. I can't wait till its out of the way and that post-exam feeling of having fuck all to do for a few days. The best thing about an upcoming OSCE is the fact that I can avoid the last 2 weeks of obs and gynae by attending as many revision sessions as possible. WOOOOOOO!!

Just for the record psych is still marginally ahead of obs and gyane in the 'firms that suck' league table.