Saturday, 3 December 2011

End of firm OSCE


I panic, worry, and get so nervous just before it, but once the first 2 stations are done, i start enjoying it and just have fun!

Radiography interpretation
ECG interpretation
Cardio exam
Respiratory exam
Thyroid exam
PNS exam of upper limbs

First station: Cannulation
- Okay..this was not expected....i just didn't expect there to be a cannulation station! I walked into the room, and was greeted by a nurse stood next to a plastic arm on the bed, and with a tray of random things right next to it (i think some things were there to confuse us.. or er.. i just didn't know what i was meant to do with it!).

I was given the instructions, and off i went to gather my equipment.... and there was a lot to choose from.. i didn't really think much of it at the time, and just picked up what i knew was "the normal stuff".

I was rather lucky with this station, as i've just cannulated 2 patients recently (one patient just the day before!), so i was feeling confident with it. It was a bit of a weird artificial situation, talking to a plastic arm and gaining consent, but i got on with it.. and finished well within the time limit.

Then came a few questions which were quite straightforward.. "what else would you do now?" "how long can the cannula stay in for?", "why did you choose that cannula size", "what is the flow rate?"

Second station: REST station
- This was definitely a lucky draw, i had an easy first station, and my second station just involved me sitting on a chair, reading magazines in the waiting area... !

Third station: Radiography Interpretation
- Again another station i didn't quite expect. I've never had to do this in an OSCE before! I just walked in, and there was a familiar FY1 sat at the desk and a 5th year medic in the corner who was going to record my answers.

I was faced with a computer screen showing a KUB with contrast compared with one without contrast (calculi in the ureter), then one of a pancreas with several calculi within, and lastly a pretty obvious chest radiograph with a huge pneumoperitoneum. I just had to sit there and talk about each radiograph, and i'm sure they've made the exam easier for us, by choosing pretty obvious abnormalities...because i've had to do the same thing on a ward before and never been able to spot anything!

Fourth station: ECG Interpretation
This was a question paper sort of station. I just went in, sat on a desk, and had a list of questions, a pen, and a blank piece of paper to record my answers on.

Thankfully, there were more questions on management of the patient than anything on the ECG in particular, the questions sort of eased me into it, and gave me clues on what to do.. and following from my last post.. the first ECG and set of questions were for a patient with AF! - okay this wasn't so bad, i had a PBL on AF last year, so the management side of things just came from some 2nd year regurgitation...

But with 2 minutes left.. i was stuck with the 2nd set of questions... with an ECG where i couldn't even identify what was wrong >.< .... this went badly. I could only work out the rate and that was about it......... i later found out it was an ECG of a patient showing a complete heart block.. i wasn't going to get that!

Fifth station: Cardio Exam
Everything was going smoothly, until i got to the murmur. I finished off the exam and when presenting my findings to the examiner (one of my favourite FY1s) i just panicked and got so confused. This wasn't helped by the fact that the bell had gone.. and i had to move on to my next station....

examiner: quick quick, tell me your diagnosis
tofu: err errr... er... its an ejection systolic murmur.... er.. er..
examiner: so what is it? quick quick!
tofu: errr ... *first thing that comes into my head..always a bad idea* mitral stenosis?
examiner: are u sure?
tofu: errrrrr errrrrrr errrrrrrrrrr.... no? i dunno!
examiner: so what would you do?
tofu: an echo!

...and then i had to move on!

mitral stenosis is a diastolic murmur, and from what i gather.. it's pretty uncommon >.
eeks! I know this.. but under pressure, it all goes out of my head :(

Sixth station: Respiratory Exam
This was a relatively straightforward station, the patient had a right sided pleural effusion... BUT i found the exam so so so scary, simply because my FY1 was the one marking me! I just got anxious before i started examining the patient!

Seventh station: Thyroid Exam
I walked into the room, and before the examiner explained the station to me, i was pretty confident that it was going to be a thyroid exam. It was probably the first time i've seen exopthalmos in a patient, other than in a textbook.

This was a pretty good station, and i finished well within the limits, and even had time to discuss the findings with the examiner (FY1 from my ward!), investigations and management with time to spare!

Eighth station: PNS exam of upper limbs
This was the first time i've actually done a complete PNS exam on a patient with signs, with slightly reduced tone in all aspects, slightly reduced power, co-ordination was fine, was able to elicit the supinator reflex, but unable to elicit the bicep and triceps even with augmentation. Sensory was fine (tested DCML and spinothalamic tracts).

I gave a list of differential diagnoses.. and the examiner kept asking for more..this was when i mentioned inclusion body myositis.. and then remembered.. i should never mention anything i don't know a lot about!!! Thankfully i was saved by the bell - and didn't have to look stupid again!


The OSCE was purely for our learning purposes, and after that OSCE i definitely feel a lot more confident now, and know what i need to work on before i hit the real end of year OSCEs next summer!

One more week left!


The Graduate Medic said...

Just wanted to say that I love the blog. I was reading over your "firsts" post, when you describe the moments when you finally find something abnormal on an examination. I can't wait to start on the wards for this very reason :D

Tofu said...

Hi Grad Medic!

Thanks for your message, and definitely, the feeling of feeling "abnormal" for the first time is a really hard to explain.. but you'll know what i mean pretty soon when you hit the wards too!

I was really excited about starting clinical years, and it's not let me down at all so far!