All 4 entries tagged Osce
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May 04, 2021
Apologies for radio-silence since my last blog which was just before my final exams of medical school. The last couple of weeks have passed by in a bit of a blur, a kaleidoscope of exams and anxious waiting for the results.
First of all, the exams. Written exams came first, with 2 papers of multiple-choice questions. I found quite a lot of the questions in these papers tricky – there is a definite step up from Phase II of the course to Phase III (final year). The patients in these questions have more complicated medical histories and the questions require you to think and reason why it can’t be one condition as much as it requires you to know what condition it might be. Overall, I found paper 2 the easier of the two, although I know most of the year found paper 1 easier. I think this is probably just dependent on what we’ve read over in the weeks before the exam. It’s always difficult to gauge how well an exam has gone after sitting it, so I simply tell myself, ‘once it’s done, it’s done’, and keep moving forward. I think I could drive myself crazy if I devoted too much time to going over each question in my mind and casting doubt over my answers. Besides, there was no time to sit on my laurels after completing the written papers as OSCEs were imminently upon me.
OSCE day arrived, and it was an equally daunting, intense, stressful and exhilarating experience. There were 10 ‘stations’ (clinical scenarios) to work through and I felt a definite lull in concentration towards the end. The OSCE scenarios are 7 minutes each and the station usually requires some sort of clinical examination and then you are asked questions by the examiner. It always surprises me that, no matter how much practice you get, there is still something that catches you off completely off guard! However, I think this is good practice for life as a qualified doctor – patients always surprise you, no matter how experienced you are. By the end of the OSCE, I could definitely feel my energy waning, but there was still (just) one exam to go – the OSLER.
I have practiced many of these during my placements but of course nothing compares to one under exam conditions, as the stakes are far higher. An OSLER is a ‘long-case’, where you have to take a full medical history (10 minutes), then discuss tests you want to do and how to manage the patient (10 minutes). The exam usually ends with a communication aspect – so explaining how to take a drug or what a certain test involves to the patient. We have to complete 4 OSLER cases for our finals, all on one day with a short break in between each case. This exam tests everything, from your clinical knowledge to your history taking and patient communication skills, as well as how well you can integrate your knowledge and put it all together. The written exams test what you know, the OSCEs test what you can do, and the OSLERs test how well you can function as a doctor, a healthcare professional. The OSLER day was very long but actually flew by because of how busy it is.
So that’s it – finals done! I then had a week wait until results…and I passed! It still hasn’t really sunk in, but I’ve passed medical school and will be starting my first doctor job come august. In my next blog I will go through some more details about applying for my GMC registration and what my first doctor jobs will be. Don’t miss it!
February 24, 2021
I had my Prescribing Safety Assessment (PSA) last Monday and I would be lying if I said I didn’t find it tricky! It was a weird experience sitting the exam at home, made more difficult by the lack of the adrenaline of the exam hall to really get you into exam mode. However, I sat it and it’s done – results pending. No-matter the outcome, I’m simply happy to move on and get stuck into revision for real.
Last week was my final official week of medical-school placements as my surgical block came to end. Whilst it was a milestone moment I felt it was all rather anticlimactic as I have spent much of the last fortnight revising for my two prescribing exams instead of at the hospital. However, we did have a mock-OSCE on Wednesday which was arranged by the block lead and some of the doctors involved in teaching the block. Just to remind you of what an OSCE is, is a clinical-style exam where you do activities and have a discussion with the examiner. This was just a practice but actually it was really useful for getting back into the swing of doing timed OSCEs and also for gauging where we are in relation to the level expected of us for finals. It feels strange to say, but I quite….enjoyed the exam! It involved various stations including one station where we had to do a suture whilst being observed. We were given marks for each station and then the highest scoring candidate gets a certificate. I’m proud (and very, very surprised) to say that I got the highest mark! I have to say that I probably struggle with confidence generally, but receiving this good news gave me a little boost and definitely makes me slightly more confident going into finals revision. Added to this is the fact that the surgical block has re-ignited my passion for medicine in general. I do think that in my surgery block I have seen the best of what medicine can do for people – seeing people at their worst moments, their moments of pain and tragedy, but also seeing how medicine can improve people’s lives.
What will I be doing now placements have ended? The next 8 weeks are a revision block called Advanced Clinical Cases (ACC), which is largely self-directed in nature. This means that the medical school and hospitals are putting on activities (such as examination practice), but it is totally up to us what we decide to go to depending on our own learning needs. I’ve booked in a couple of ward sessions to practice my examinations and history taking and also a couple of procedure practice sessions (so practicing taking blood on mannikins) – as these procedural skills do come up in finals. Warwick uses the ‘spiral’ curriculum method, which basically means that essential topics are visited several times throughout the course. The topics we learned in Phase I and Phase II come up again in finals, just in more depth. This means that we go over the basics several times and become really confident at managing common conditions such as heart attacks, lung infections and diabetes, because we’ve learned the principles of these conditions throughout the course. The next 8 weeks are sure to be tiring, but I’m excited to learn and improve. Bring it on!
February 12, 2014
OSCE is done and I'm happy to say it went quite well (I won't get ahead of myself too much yet). I managed to enjoy it even though there were a few hairy moments, so I'm definitely feeling a bit better about the real thing in the summer. Recently we've started seeing real patients in the hospital. So far all of the patients I have met have been so nice, and really keen to help us out, and it feels good to strut around the hospital with your stethoscope around your neck pretending that you know exactly what you're doing. After all, you've got to fake it until you make it, right?
I saw a really nice man last week that came in with shortness of breath. He was happy to have a chat with us and even talked me through my respiratory examination - "I think you're supposed to have a listen now, on both sides of my chest and my back" - at least one of us knew what we were doing. I suppose it's a bit like learning to ride a bike. In the first week we had our clinical tutor guiding us through the history, helping us to ask the right questions, a bit like having stabilisers on. Now we've had them taken off but we're wobbling a bit, still asking what we should do next and how we might make things better in the future. Before we know it we'll be flying solo, bothering patients all on our own.
I really like my tutor and I learn a lot from him. I've also found that a lot of the theory makes much more sense when put into real life, clinical context. Every week though my tutor says "I'll show you this now and you'll never forget". Thankfully, he hasn't remembered that he has had to show me the exact same thing three weeks in a row. He recently tricked us by instructing us to take a history from a man who was completely aphasic and a woman who didn't speak any English at all. I suppose it's all part of the learning curve!
It is quite uplifting meeting people who think that you're an important person and are absolutely entitled to know their deepest, darkest secrets. I'm amazed at how forthcoming patients have been with letting us talk to them, prod them and poke them, even though they have gone through the motions countless times before. People are generous and encouraging. The whole experience definitely fills me with optimism for the future, however naive that may be. I like the idea that one day I can do something to help the people who have helped me to learn. Hopefully though they won't remember that one medical student who palpated them a bit too aggressively or made them sit for ages in the cold without a top on. I hope it has been as positive an experience for them as it has been for me. It can only get better with practice.
See you soon,
January 24, 2014
The dreaded formative OSCE has arrived.
Even though I know that the purpose of the formative is to help me assess where I am in my learning and to identify any areas of weakness before the scary summer summative, and in the grand scheme of things, it doesn’t really matter if I fail; I can’t help but feel absolutely terrified. A few blog posts ago I said that I was really enjoying the clinical skills sessions and optimistically I said I thought I was quite good (really just not absolutely abysmal). I take it all back. It’s funny how you go along thinking “actually I’m alright at this stuff, I can do it” and as soon as you get close to an exam time, you forget everything. It’s like I never practiced at all. My fingers are no longer able to unscrew the valve on my sphygmomanometer, my hands aren’t big enough to support an elbow and my stethoscope is definitely broken, hence the lack of clear Korotkoff sounds. Of course - a poor workman always blames his tools.
Despite my sheer terror, practicing has actually been quite fun. Our front room has been turned into an examination room, the sofa providing a more than adequate substitute hospital bed. We’ve been doing practice resuscitation on a borrowed dummy, disrupting a silent BioMed Grid, with calls for help and had endless blood pressures taken, never having the same reading twice. Have you ever practiced walking in to a room and introducing yourself before? It’s so frustrating that we do it every day and it’s so simple but because the context changes and we feel under pressure, saying your own name - “Hi, I’m Amy Barrett”, becomes quite a significant achievement. Usually I get at least part of my name right and sometimes I remember to identify the patient, so really I’m about half way there. A few more hours in front of the mirror and I should nail it.
I’ve enjoyed practicing history taking the most. My housemates seem to have made it their mission to come up with the most ridiculous back stories and ludicrous set of symptoms no clinician has ever seen. Then again, anything is possible when it comes to patients. I’ve spoken to a few people now who have done their OSCE and all have had completely different experiences. A couple said it was “the worst thing ever”, some said “ahh it was alright” and one person actually said “it was really good” so well done them and thanks for that little bit of positivity! I would guess that most people will have done a similar amount of preparation. We’ve all had the same clinical skills sessions, and have plenty of people around us to practice with. I think the greatest variable is each individual’s confidence on the day. It’s horrible when you’re nervous and when it gets too much, that’s when things start to go wrong. I think we just need to learn to laugh at ourselves (when appropriate of course) and move on from our mistakes. I’m sure the OSCE examiners have seen the most ridiculous performances over the years*. It’s much better to do something silly now, with the opportunity to ensure it’s right for next time, than sit the summative and end up looking like a Chuckle brother.
So - I’ll try not to be too nervous and hopefully, with a bit more practice, I’ll be in a pretty good position. I’ve decided I’m going to enjoy my OSCE - at least maybe once it’s over.
I’ll see you on the other side.
*There was a rumour of someone actually hitting a patient on the head with a tuning fork, though I cannot verify the authenticity of this claim! It can’t be any worse than that can it?