Thursday, 3 January 2013

OSCEs

Barely 48 hours after my New Year's Eve moan about how much I hate the run up to exams and all that it entails (insomnia, more insomnia and even more insomnia - and the occasional feeling of total stupidity and utter ignorance) I was launched into what will be the first of many examinations throughout my medical career. That is, assuming I still have a medical career to look forward to - lately I have to keep reassuring myself during moments of uncertainty that "people pass, so I will too if I work hard enough because I am a person too". That sometimes works, but occasionally I still have these blind moments of panic where it feels like it's all going to be a total write off.

So, OSCEs. For the non-medics these are exams which test your practical skills. The bread and butter of being a doctor, as it were. This ranges from relatively simple things like taking a blood pressure to more lengthy processes like examining a "patient's" abdomen or whatever else. The inverted commas are there because the people were examining were actors who were hired to pretend to be ill or to generally be poked and prodded by us. There were six stations to go through, and like the two written exams I will sit next week, it's all formative, but damn it all, I still want to do well. I hate feeling like an idiot, and I do (on the whole) try and work quite hard...so I'd like to see some pay off. But I've long since realised that it's not all about working hard, it's also about working smart - and that's something which comes with experience, and experience of medicine and med school is something I'm severely lacking at the moment, but unfortunately I don't have all that much time to gain experience either on an accelerated course. You need to be pretty good from the outset. Anyway, here are the stations I went through today:

Station 1: Medline

Medline is a database with medical journals and such. Searching this thing is a pain and I do wonder whether it's something which doctors and med students need to use everyday. I prefer Pubmed anyway. So I walk in and there's a computer terminal and an examiner and a task i.e. you wish to find out more about this particular subject, find the relevant article. Well...to cut a long story short, I just couldn't find the damn article. When my time was up I had managed to find some articles on the general subject we were looking for but not the specific one we needed. The examiner noted that I did manage to identify the key search terms and so on well, but I needed to refine my search technique. On the other hand, I did manage to answer her follow up questions well, so hopefully I may have scraped a pass in this. But obviously I didn't find the sodding article, which was the whole point of the exercise, so it's all a bit hit and miss really.

Station 2: Blood pressure and BMI

Right, so, not the best first station, but never mind, we persevere. Or not. I'm still feeling nervous and slightly disappointed after a rubbish first station. Anyway, I enter the room and there's a patient and an examiner. Smile, introduce self, ask patient to stand next to wall to be measured. Ask her to take a seat. Remember that I haven't taken her weight. That's kind of crucial to do a BMI. Apologise and ask her to step on the scales. Work out BMI. Fix bp cuff on too low. Realise this after a second and re-adjust it. Much better. Take blood pressure. Answer the examiner's questions. Get told that I didn't remember to wash my hands. Fuck! Definitely not feeling happy with myself after this.

Station 3: Taking a history

So, I move on to the next room feeling like a prize idiot. How the hell could I have forgotten to wash my hands? Really hope I won't be hung out to dry for that. So in this room there's a patient with chest pain. I take a history and keep things friendly, the patient's nice and so it all seems good. Go through the SOCRATES mnemonic, make sure to ask her for her own ideas, concerns and expectations. Finish up and thank the patient. Comments from the examiner: generally good but too many closed questions in some places. Also seemed to jump around a bit from topic to topic. Feel marginally less awful after this station but still wish I could simply get something right for once.

Station 4: CPR

Pretty simple really, the only station where you don't have to introduce yourself to the patient or bother with the social niceties. Mainly because the patient is a plastic dummy and supposed to be in cardiac arrest. They're probably not too fussed with giving consent at this point, they just want to be resuscitated. I'm able to do that, reasonably well I think, and I time my chest compressions to the tempo of Another One Bites the Dust. How appropriate. Answer the examiner's questions well for the most part. I didn't know what should be done with C-spine patients i.e. the "jaw thrust", but I did know about shockable rhythms, how deep you should compress, when you should stop CPR, etc. Hopefully passed this one.

Station 5: General examination

Feeling slightly better as this weird experience trundles on. Go in, introduce self, get patient to lie at 45 degrees on the examination table. Take her pulse. Realise that I've forgotten to rub hands with alcohol gel, so do that, and the examiner smirks - hopefully this will still count, but I'm not optimistic. Is it better to do it later than never? Get back into it and do the general exam. Examiner's feedback is that it was generally okay, but he gives a few points for improvement.

Station 6: Abdominal examination

Feeling slightly heartened by the not totally awful experience of the previous station, I go in for the last one. I remember to wash my hands with the alcohol gel (first thing I do, whilst I'm introducing myself to the patient) - congratulate self on finally beginning to remember to do this at the right time. Decide to go out drinking later to celebrate. Remember that I still have revision to do for the written exams. Crap. Carry on with the exam. Inspection, palpation, percussion, auscultation. All over within a few minutes. Examiner seems happy and remarks that I "percuss and palpate better than most, most students are very timid". Surely something to be happy about? Hey, I might have given you some awful germs when I was taking your blood pressure, but at least I can tap on your belly like a boss, that surely counts for something! He asks a few questions...they're alright but I flounder when he asks what else I would do after the abdominal examination. The answer is hernial, genital and rectal examinations. I actually DID know this and had revised this particular bit multiple times, but for some reason I drew a blank and started rambling about cardiovascular examinations instead. Slightly disappointed that it wasn't as amazing as it could have been, but otherwise this is the only station I'm genuinely reasonably happy with.

Final thoughts

I have no idea when we're getting the result from all of this, but I imagine it will be in a few weeks or so. We need to pass 4/6 to "pass" overall, but since it's a formative there are no penalties for failing. However, if I have failed, I think I'd be very disappointed with myself. I've wanted to be a doctor for so long and if I stumble at the first hurdle that's not exactly promising is it? I've looked over my notes and (Medline aside which was totally FUBAR) I've managed to remember to do most things the way they should be done, so I hope I've passed. Though even with Medline I still managed to get the follow up questions right, I think. That might count, mightn't it?

However, I'm rather worried that little (but important) things like forgetting to wash my hands with the gel at station 2 will see me being failed despite managing to get the blood pressure to what the examiner said he expected was the correct value. I feel this way because he stressed that handwashing is important and "could be the difference between a pass and a fail". I'm not feeling particularly encouraged by that, was that a subtle hint that I've screwed up and that's the reason why? Or simply good advice for the future? Never mind, it's all a learning experience I suppose. Anyway, now I need to revise for the two written exams which will be next week. Over and out.

6 comments:

  1. Lovely to read your last few posts! I'm sure you did better than you think you did! Keep going, remember this is only the beginning. Happy New Year :)

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  2. "tap your belly like a boss" that made me laugh.
    Sounds like the OSCE went well grumpy, they're a little bit daunting to start, but you sort of start to have fun after a while ...and don't worry about washing your hands.. if im not mistaken, you should get a mark for that so long as you mention you realised you forgot to do it at the start and actually do it before carrying on.

    Good luck revising for the written papers!

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  3. You have a "medline" station???

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  4. Yep, we had a Medline station - what a pain. The truth is that I'm actually not bad at searching databases, I frequently got firsts and distinctions for my essays before med school, so clearly I know how to track relevant articles down, but when I was put on the spot I assume I just got the yips or something. Never mind I guess.

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  5. Don't consider it 'the first hurdle', but rather (as you deftly pointed out) a learning experience. You're not expected to get everything right in your first year, or what would be the point? You are guaranteed to get better with practice and time, and boy, will there be lots of both in your career.
    Keep working hard, and always wash your hands!

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  6. Cheers Friend, the logical side of my mind tells me that it is all a good experience to learn from, but my ego still wants to do well, it'd show that the effort I've been putting in over the past few months has paid off somewhat :)

    Yep, will definitely remember about handwashing from now on!

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