Final exams of medical school – 4th year OSCEs

November 22-23, 2014

As you may recall from my last post, we had our Surgical Specialties (orthopaedics and ophthalmology) exam on Nov 13. Following that, we had a week to prepare for our final exams of medical school – the dreaded OSCEs!

These are a set of clinical exams that test all the skills we’ve learned and honed throughout medical school. A variety of skills may be tested, including history taking and examination, clinical reasoning, basic/advanced life saving, investigation interpretation and response, procedural skills (venepuncture, blood gases, etc) and more.

We were told ahead of time that we would be rotation through 8 stations, each with 2 minutes perusal (to read your stem and collect your thoughts). 6 of the stations were 8 minutes long and the other 2 stations were broken down to 2×4 minute stations with related tasks.

Needless to say, we were stressed. We were incredibly stressed! The entirety of our medical school could be tested in 1.5 hours. Not only was there so much to know, but 2 of the most important rotations (paediatrics and obstetrics & gynaecology) we had completed first in the year, which seemed like so long ago.

My OSCEs took place on the morning of Saturday, November 22nd. The group of us sat in nervous anticipation waiting to start, trying to pass the time by chatting with our colleagues or doing some last minute reading.

I was allocated to the green team with 7 other students and we were soon escorted to our first stations. Facing away from the wall, the buzzers soon went off, signaling the start of our OSCEs. Everyone turned to the walls to read the stem (taped to the wall) of our first station.

Once the OSCEs started, they passed by in a whirl. Time flew and you were in and out of each station in what felt to be a blink of an eye. There was no time to rehash or even think about how you did in the last station because you were too busy giving it your all in the next. In less than 1.5 hours, it was over. The wonderful ladies coordinating the exam for my green team gave us big smiles and congratulated us before ushering us out to join up with the rest of the group.

The room was a buzz with students discussing the stations and their performance. Lots of happy smiles to have one last hurdle behind our backs, however, not without some caution that our performance in one or more stations may have been lacking. The director of the MBBS program shook our hands on the way out and asked everyone how the OSCEs went for them, a nice comforting gesture!

And since I might forget what my stations were in a few months time, I am going to record them here.

In no particular order unless specified.

1) This was my first station, which was a 2×4 minutes. Was given an ECG to report, which was SVT. Then also given some bloods to interpret (hypochromic microcytic anemia, likely due to iron deficiency). After interpreting the bloods, we were given pathology forms to request the blood tests we thought appropriate. This was almost a ‘gimme’ station as it was very similar to previous years, however, I was so nervous it definitely took away from my performance!

2) My second station was an 8 minute one. A few weeks prior to our OSCEs, we were asked to submit a clinical & procedural skills log – a report of the things we accomplished and to what level. At this station, the examiner looked through my log and asked me questions seemingly to verify our stated level of competency. I was asked a number of questions, including, “Talk me through how to do an IV cannulation. What complications could arise? How do you do an ECG? What gets printed out on the tracing? What are leads V1-V6 called? If you walked into a room and someone was unconscious, what would you do? And how do you do chest compressions? How do you perform ophthalmoscopy?” Nothing the examiner asked was out of my comfort zone and I just continued to answer his questions until the bell rang.

3) A young male fainted while gardening. Tasks are to take a history, examine and manage. Was greeted by the examiner as I came into the room playing the role of a nurse, with an unwell patient on the bed. Turned out he was in anaphylactic shock and required acute resus and further management once he was stable.

4) An expected death in a patient with advanced bowel cancer. Had to do a death certification, talk to the spouse and write up the paperwork.

5) Preadmission talk to a patient for an anaesthestic assessment. The main finding in his history is a mechanical valve on warfarin therapy. Would need heparin bridging and antibiotics.

6) Giving a distraught lady the results of her hysteroscopy D&C, which was thankfully not cancerous but endometrial hyperplasia. Talk to her about the risks of endometrial cancer and treatment options for endometrial hyperplasia.

7) Taking a history and presenting a mental state exam of a patient experiencing acute psychosis, likely schizophrenia.

8) My last station, another 2×4 minutes. First task was to interpret a chest x-ray which demonstrated lobar pneumonia and then to write up the medication chart.

Overall, the OSCEs went well. At every station, I can still to this day, think about things I forgot to say, things I should’ve done and things I could’ve done better. I just hoped that the examiners felt I performed well enough to pass overall!

Paediatric Medicine: End of Rotation 1

Hi friends 🙂

Today marked my last day of Rotation 1 – Paediatric Medicine, which I completed at a large tertiary hospital.

8 weeks on a variety of teams, soaking in as much as possible, in as little time as possible.

  • 2 weeks in General Paediatrics
  • 1.5 weeks in Emergency Department
  • 0.5 weeks in Neonatal Intensive Care Unit (NICU)
  • 1 week in General Surgery
  • 1 week in Gastroenterology
  • 1 week in Oncology
  • 1 week in Respirology

I definitely enjoyed some placements more than others, for a variety of reasons including: personal interest, consultants and senior staff more interested in teaching, and the learning opportunities provided.

For this rotation, we had a number of assessments, including 3 mini clinical examinations (mini-CEX, each worth 10%): neonatal (well-baby check), short case, and long case.

My well-baby check was performed an adorable newly born girl and her lovely parents. She was a little hungry and crying during my examination but was perfectly healthy.

My short case was a respiratory exam on a 1 year old girl who presented with noisy breathing. She was recovering from bronchiolitis and by chance also had a number of neurological findings with associated developmental delays.

And lastly, my long case was a young adolescent girl who presented with fevers on a background of complex mastoiditis leading to the severe complications of intracranial abscesses and venous sinus thrombosis. Incidentally, she had many features consistent with Cushing’s which led to additional discussion points.

The feedback I received from all 3 of my assessments were positive, so hopefully my grades will reflect that!

And today was the big day. A multiple choice exam of 75 questions worth 50% and 2 OSCE stations, each worth 10%.

The written exam was overall fair and very representative of our teachings this rotation.

The clinical exams each had 2 minutes perusal followed by 8 minutes of discussion:

  • Case #1: A 5 week old girl who came in with signs of sepsis.
  • Case #2: A 5 year old girl with acute exacerbation of asthma.

For each case, we had to discuss what additional information we would like on history and examination, what our differential diagnoses were, what investigations we wanted to perform, and how we’d like to manage the patient.

Those 10 minutes go by in the blink of an eye, and I always walk away thinking, “Should’ve said that, could’ve done that, forgot to ask about this, didn’t mention that.”

Only time will tell how I did this rotation! Hopefully hard work paid off.

In the meantime… I would love to catch up on my sleep. However, before I do that, I need to catch up on my blogging! Thanks for reading! 🙂