OSCEs for the uninitated

September 24, 2008 rooroo

OSCEs stand for Objective Structured Clinical Examinations and they usually start to happen when a med student hits clinical medicine. It involves a series of 5 minute stations and you get to do things like take a history, something practical or cry while an examiner marks you. When it’s the first evar OSCE, it’s daunting and terrifying, especially as you can be ‘pink slipped’ for a number of things i.e. hurting a patient, wearing inappropriate dress etc. Out of everything, I was more anxious about getting all flustered or going into a panic, so my get out clause was just to say calmly to the examiner, “I need to take a minute.” I did this several times.

Rather like a wedding day, you have to assume that somewhere down the line there will be a cock-up. Here were mine:

Station 6, fluid balance (permanently etched into my subconscious). I do the usual, inspect the patient, look for any obvious signs of dehydration or fluid overload. Then came the blood pressure check. I have checked blood pressure more times than I can count. Only on the day of my OSCE, the universe decided this was the time I was to be tested. The cuff wouldn’t inflate. In my nervousness I started to fiddle with the metal adjuster hoping that I hadn’t tightened it enough, then the examiner (who I’d like to add, was completely deadpan and unfriendly, unlike hip examination man) said, “You’ve got it on the wrong way round,” with no attempt to mask the contempt she had in her voice. 2 minutes to go, and I turn the cuff around, thinking internally, “Fuckity fuckity fuck,” then started fiddling with the adjuster again. And with stunning, effortless timing, almost in slow motion, the little metal screw flew off the monitor and landed on the floor, as if it’s entire lifetime ambition had been to live for that moment. I accept that I may have failed that station.

My medical school told us there was *always* an opthalmology station, and that we would have to examine the eyes of a plastic dummy. I walked in and read the instructions: “Please examine this patient’s ear.” Thanks a lot!

Airway management: it takes me about a minute to realise a patient was in cardiac arrest. I say rather too loudly, “Oh… riiiiight!”

Hip examination: the patient looked exactly like one would if they had been doing the same thing at least 50 times previously that day. My examiner was a dream, Eastern European good looks and eyes which seemed to twinkle everytime I answered a question correctly. I’m sure I giggled like a schoolgirl every time this happened.

Ethics and Law: Rather than stipulate what the law was, I just told a patient what they wanted to hear. Oops.

Taking a patient’s basic obs and recording them. Most bizarre station ever in terms of the dynamic of the examiner and patient.

Examiner: Right, that’s the O level stuff over with, now lets do some medicine, it’ll be like cricket!
Me: I don’t really watch cricket *WHY DID I SAY THAT?!*
Patient: I like football
Me: The patient’s respiratory rate is 14 breaths per minute
Patient: Ok, you need to write it down here *points to part on paper*
Examiner: Excellent! Ok, now take the patient’s temperature.
Me: *reading instructions*
Examiner: Now tell me what you are doing
Me: Erm… I’m going to take the patient’s temperature

Examiner: Excellent! One mark!
Patient: *takes thermometer out of my hand and puts it in her mouth*
Examiner: If she was pyrexic what could you do?
Me: I could give her paracetamol, fluids and…
Examiner: … yes? And?
Me: erm
Patient and examiner (looking at me wide eyed): turn around!
Me: *thinking what the hell upon seeing a fan* erm, there’s a fan there?
Examiner: Yes! Well done!

That night I fell asleep before B did. He said I was out like a light as soon as my head hit the pillow. I got 10% over the pass mark which I was pleased about, I’m just about getting to grips with the fact I will be doing this again in just over 10 weeks…

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1 Comment Add your own

  • 1. elle&hellip  | 

    I briefly had a job as a pretend patient for these kind of things, down at Guys. Had my bp taken >70 times one afternoon.

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