OSCEs over and now the wait starts

3 weeks ago, I mentioned my year 2 clinical exams (OSCEs) coming up.

Well, I’m happy to say they are finally over! As part of the first batch of students taking the tests, we were scheduled to be at the hospital by 8am today. I was so nervous and worried that I woke up at 5am to read through everything again… 5am! Very rarely would I wake up that early because I’m so stressed!

At 8am, we were ushered in a conference room in the Outpatient Clinic at RBWH. We were signed in, divided into groups of five and were notified of the station we would be starting with. After being given a lovely speech of encouragement from our program director Dr Schafer and once everyone was ready to go, we were directed to our respective hallway and proceeded to sit down at our first station.

There were a series of 5 stations. At each, we had 2 minutes to peruse (and make our way from the previous station), followed by 8 minutes to carry out the specified task. 10 minutes total per station.

I started with Station #3: Clinical Reasoning.

The blaring horn went off to signal the beginning of 2 minutes perusal. At this station, the patient presented with abdominal pain. I had to read through the complete history and come up with 3 likely diagnoses and support them with positive and negative findings. Two minutes flew by so quickly, I had barely read through the entire history and only had just written down my diagnoses. The annoying horn went off to let us know 2 minutes was up and it was time to proceed into the room. For this station, I get an additional 2 minutes to collect my thoughts before speaking. Before I knew it, it was time to start. This station overall went well for me, although it wasn’t until I stepped out the door that I realized my 2nd diagnoses should’ve been my first!

Next was Station #4: Clinical Communication Skills

Two minutes to peruse how I would facilitate a ‘behavioural change’ discussion with a cardiac patient who needed to quit smoking. Prior to today, this was the station I was most worried about but I think I did fine. Hopefully I addressed the patient’s concerns appropriately and explored the necessary details. I said the patient was in a contemplative stage but unfortunately, didn’t have time to completely wrap up the interview.

Station #5: Procedural Skills

A sigh of relief. I looked down at my sheet during perusal to see the choice of skill to be tested was a less complicated one. I didn’t have to do venepuncture or cannulation. All I had to do was take BP, RR, HR, and measure peak expiratory flow. This was the only station which I finished (comfortably) within 8 minutes. Thank goodness.

Station #1: History Taking

A woman presenting with fatigue and weight gain. It was a classic hypothyroidism case. At one point during history taking, my mind blanked and I had a long awkward pause followed by putting my hands over my face and mumbling, “Ah, I’m sorry!” However, I did pull it together and thought I took a decent history, even though I forgot a few specific hypothyroidism questions (ie. nail changes and thickened skin) I also ran out of time, so had to blurt out that I would also want to address the patient’s family/social history.

And lastly… Station #2: Clinical Examination

I was asked to do an examination on a patient with a suspected diagnosis of lung cancer. This was the station I was most prepared for but I don’t think practice can ever prepare you for an intimidating (almost rude) examiner. I felt he was really aggressive and didn’t let me finish anything I wanted to say. I started with asking the patient his age (check if hes oriented to person/place/time) but before the patient could answer, the examiner yelled, “Why would you ask that? You were told his age on the paper! It says he’s 48! … Oh, well his mental state is fine!” Every time I mentioned that I would be looking for ‘so and so’ and before I could actually touch the patient, he would cut me off and loudly say, “Normal!” … every time! As a result, I could barely ‘examine’ the patient. I was also told to move on to other parts of the body when I knew there were things I needed to mention but didn’t get the chance. By the end of the examination, I had only been allowed to do a few percussions and feel a few lymph nodes. One stupid mistake I made: not realizing I had said ‘hypertrophic pulmonary osteoarthritis’ rather than ‘-arthropathy’ and not cluing in when he repeated ‘arthritis?’ I am genuinely worried about failing this station because I felt like the examiner did not judge my ‘examination skills’. Instead I had to verbally stutter my way through the station because I wasn’t really given the chance to fully talk or examine the patient.

Even though we were told not to fuss if we didn’t finish a station, I can’t help it! Oh well, I guess all we can do now, is wait and see!

Things I enjoyed:

  • It’s nice to have the skills I’ve learned these past 2 years be tested. It’s obviously necessary if we want to perform well next year on the wards!
  • Very well organized and very grateful to all everyone (staff, examiners, patients) who made the day possible.

Things I wish could’ve been better:

  • 2 minutes perusal time includes leaving the previous room and settling into the next station. Then 8 minutes at the station includes entering a room and having a brief introduction with the examiner. The seconds are so precious and add up quickly… I would have liked to see more time allotted per station.
  • Perusal during clinical reasoning was quite distracting when you could hear the other stations through the walls!
  • I had mostly good experiences with examiners but also one particularly bad one. From comments on our FB page, it seems many other students felt the same way. Just as our patients are standardized, I wish our examiners were as well. I wish they had been specifically instructed on how to evaluate us. Discrepancy with examiners can lead to an experience like mine or like others who were able to perform (while verbalizing) an actual examination on the patient.
  • The alarm/horn was so nerve wracking! Please use a nicer sounding chime (like Westminster) next time, and NOT THIS – gives us mini heart attacks each time.
  • As examiners pass or fail us on the spot, it would be great if we could get our final P/F grade at the end of the OSCEs. But logistics makes it understandable.

The wait begins…

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