Wednesday, 12 June 2013

Summer OSCEs

My first year of medical school finished with 10 OSCE stations of which we need to pass 7 to pass the OSCE component overall. Following written exams (which finished at the end of May), I took a few days off then began preparing for these clinical examinations which amongst other things involved me practising various examinations on my pillow over the course of several days!

My general thoughts are that the OSCEs went alright overall, however, similar to the written exams, I’m still wary of the fact that the pass mark is quite high and that I did make some silly mistakes along the way – i just hope these won’t prove to be fatal errors! Of the 10 stations, I feel borderline about two of them, and I’m pretty certain I’ve failed two of them. Most stations were 5 minutes long with two 10 minute history taking stations:

Male anatomy 

So this station involved quizzing me on various aspects of the male reproductive system (pointing to different organs/structures on a model), interpreting a histology slide, and finally a question about a clinical procedure (urinary catheterisation). I feel I’ve done well in this station and I’m pretty hopeful that I’ve passed as all of the questions were fairly simple and straightforward. Definitely a nice way to start the exam!

ECG 

A slightly trickier station came up next – I answered the first few questions about the principles of the ECG, how to measure heart rate etc well but became stumped when it came to actually interpreting the ECG readout – turns out it was a STEMI (a common exam ECG example which suggests a heart attack has occurred), but I totally blanked on this. Very annoying! However, I did manage to answer the follow up questions correctly i.e. which coronary artery and region of the heart are likely to be affected. The examiner looked pretty indifferent and impassive throughout the whole thing so that kept making me think I’d screwed something up, but on the whole I do hope I’ve managed to pass this station!

History taking – breathlessness 

Not a fun station at all – from the off my thoughts felt disorganised and I was acutely aware that I was taking the history in a fumbling kinda way. I really wish we had more opportunity to practice history taking during our weekly ward placements, since I really feel I’ve messed this station up, as proven by the fact that I totally forgot to ask the patient if they were a smoker – something very important to enquire about when someone comes in complaining of breathlessness!

Abdominal examination 

Next station was something practical – I’d had the chance to perform several abdominal examinations during my weekly ward placements and I passed my January abdominal exam OSCE fine, so this station was nice and straightforward. I remembered to wash my hands and I don’t feel I missed anything out. I’m pretty hopeful that I’ve passed this one.

Respiratory examination 

Again, another hands-on station: but unlike abdominal examination I did not have much experience of performing a respiratory exam on a patient. Luckily my brother had agreed to help me out so I was able to practice on him when I went home for a few days before the exam, so I didn’t feel unconfident during this OSCE station. I forgot to check for tracheal deviation, but aside from that I think I covered everything else on the list.

Cardiovascular examination 

As above, not something I had much experience of doing before, but luckily my brother was a great help during the past week of OSCE preparation. Again, I don’t feel I left out anything significant, I remembered to wash my hands, went through the sequence in a regular and orderly manner and it was over before I knew it. Really hope I’ve managed to pass this one too.

Mini-mental state examination 

Oops. This should definitely have been the most passable station since we were given a proforma with all the MMSE questions written on them, and our job was simply to ask the patient the questions and score their replies! Unfortunately I ran out of time and didn’t manage to ask the patient the final three questions. On reflection perhaps I spent too long introducing myself and explaining to the patient what I would be doing; maybe I should have just got on with it quicker. I’m not very hopeful of passing this station.

History taking – abdominal pain 

Well, this history taking station was much nicer than the respiratory history station – I felt rather more confident and my thoughts were better organised, but I still feel like I could definitely do with more history taking practice as it still didn’t seem like I was being slick enough. This is really something I hope to improve on in second year (if I’ve passed that is!). A few follow up questions from the examiner, but I feel I managed to answer them reasonably well.

Infection control 

Easy station – demonstrating how to wash your hands with alcohol gel using the 8 step technique, and then some follow up questions about proper waste disposal and infection control in a hospital setting. No problems here.

Breast examination 

The final OSCE station involved performing a breast examination on a manikin – I have mixed feelings about this station: since it’s a manikin (with no limbs) it’s easy to forget to ask it to raise its arms, place its hands on its hips etc – luckily I did do this eventually, but only after some prompting from the examiner. Palpating the breast and lymph nodes went well enough I think, but unlike the earlier respiratory/cardiovascular/abdominal examination stations, I don’t think I came across as confident enough in this station.

Summary 

I think I’ve probably failed the respiratory history station and the MMSE, and I feel ambivalent about the breast examination station and the abdominal history station. But I think I made a reasonable attempt at the other stations, and speaking with some of the other students afterwards, I took some comfort in the fact that it seemed like most people had made a few silly mistakes or left something out; the examiners clearly aren’t looking for perfection here, so I do hope that the good things I did will outweigh the things I forgot/missed out, so I can pass overall. The rest now lies in the hands of the OSCE examiners and whoever’s marking my written papers, but I really, really hope I can make a post on here in a few weeks time saying that I’m ¼ of the way to being a doctor. Here come the sleepless nights in preparation for results day!

Hope that everyone else’s exams/revision are going well!

3 comments:

  1. Best of luck! It sounds like you did pretty well...

    Next time around, there's a nice free ECG interpretation resource that you might find helpful here: http://www.emedu.org/ecg/

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  2. This is a really useful breakdown of OSCEs, what is expected in the exams, and how to approach them - really useful for other medical students IMO!

    Keep us in touch about how you did. When is results day? Best luck :)

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