Post-OSCE

Hi,

I had my end-of-year OSCE (Objective Structured Clinical Examination) on Wednesday, and found out today that I passed it. There were 11 stations, which we rotate around every 5 minutes (or 10 for the communication skills station) when a bell sounds.

I started off with breast examination, where a model was tucked up in bed and in the 5 minutes I had to examine its breasts and lymph nodes and present my findings. Next, I was given a post-op fluid balance chart to interpret and answer questions on. Following that, I moved on to a practical skills station, where I was asked to insert a nasogastric tube into a model, and then to another data interpretation station with a chest X-ray to discuss. Then there was 10 minutes of explaining catheterisation to a patient (well, an actor pretending to be a ridiculously over-concerned patient) to assess my communication skills, followed by 5 minutes to take a history from another actor complaining of leg pain on exertion and answer questions about his symptoms. Although most of the examiners were very friendly and encouraging, the surgeon in charge of this station seemed to have got out of bed on the wrong side. Fortunately, discussing the OSCE with other students afterwards revealed that he was equally unpleasant with everyone. ECG interpretation came next, where I had to identify signs of a heart attack affecting the inferior part of the heart and discuss management of the condition, and then interpretation of a set of blood results showing chronic renal failure. Then came a cranial nerve examination and ophthalmoscopy, basic life support skills on a dummy, and finally an abdominal examination of an actress with the most over-the-top abdominal pain I've ever seen!

The OSCE wasn't quite at the end of the year, as we still have another week left, allowing those who have failed to resit. Next Friday we've got a written exam, but this one is formative (meaning that it is designed to help us see how we're doing rather than to test us, so our marks don't actually count for anything) unlike the OSCE which was summative (has to be passed and marks are recorded). There wasn't a lot of point in going back to Reading for one day so I'm just taking the opportunity to read up on some rheumatology ready for going back next week. Hopefully the complicated fiddling about with various drug regimes in rheumatology clinics will make a bit more sense next week than it did last week when I was more concerned about preparing for the OSCE than mastering rheumatology.

Bye.

OSCE preparation with added interest from the cardiology ward

Hi,

Yesterday, whilst looking for patients to practise my examinations on, in preparation for my end of year OSCE (objective structured clinical exam), I came across the first person to ever have a permanent artificial heart, or ventricular assist device. He had the pump implanted 7 years ago in Oxford and it's still going, although he did once have the camera bag in which he carries the power supply stolen - fortunately an alarm that went off when the batteries disconnected frightened the thief and made him drop the bag, and the temporarily heart-free man was able to quickly plug his pump back in. A house officer suggested I examined his cardiovascular system without telling me why, but when I saw the power lead coming out his head, felt his lack of any pulses, and heard the continuous whir in his chest instead of heart sounds it soon became clear what was going on. Unfortunately, not all patients are that obvious - the next one I examined had three different heart murmurs all on top of each other and was a retired chest physician who added to my difficulties by quizzing me on the physiology of haemoglobin while I tried to decipher the plethora of sounds coming from his heart (needless to say, I didn't get them all!).

As well as examining various body bits (abdominal, cardiovascular, vascular, respiratory, neck, breast, lumps, cranial nerves, peripheral nervous system and general examination) in the OSCE, we'll be asked to take a history from a patient, demonstrate our basic life support skills, and other practical skills (like nasogastric tube or IV line insertion), and interpret results (from ECGs, chest X-rays, blood tests, etc). We rotate round the stations, each of which is only 5 minutes long apart from one ten-minute communication skills station. All the "patients" are actually just actors so there shouldn't be much to find on examination - it's just to show we're confident with all the routines really. It's a good practise for 6th year when we have real patients in the finals OSCEs.

As well as finding any willing patients, housemates, etc, to practise clinical examinations on, and looking at as many ECGs and chest X-rays as possible, I'm still doing the usual ward rounds and clinics with the rheumatology firm I'm on at the moment in Reading. Most of the patients on the ward are general medicine rather than specifically rheumatology patients, but there have been some interesting cases to see in clinics - rheumatology encompasses a lot of autoimmune and other conditions that affect many body parts as well as the joints. Because they can affect so many systems, these conditions (things like lupus and vasculitides) pop up on lists of differential diagnoses all over the textbooks and it's interesting to see them in real life. A few have added interest because of their very descriptive names, like the "stiff man syndrome" affecting one of the rheumatology patients!

So it's a busy week ahead spread between rheumatology in Reading and OSCEs in Oxford. With tendon hammers, pentorches and stethoscopes at the ready to practise on any volunteers!