Part 4D: OSCEs

Okay, so its 5:48am in the morning, and the fact that the results are out in 9 hours (!!) have nothing to do with why i'm still awake at this hour.

I blame the stupid painkillers i took before bed for my headache, the combination tablets where you get your dose of paracetamol with added caffeine. Having detoxed from the brown stuff for 4 weeks, this little dose has kept me awake through the evening.. and reluctantly i have given in to my insomnia, and now have resorted to writing down what i remember from my OSCEs.

This is going to be a pretty long post, seeing as i've left it a little late after my OSCEs to give a day by day recall, so i will just go all out and post about them both in one sitting. Prepare yourself for a very long and possibly quite boring read.




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Monday - 4Di: 10 minute stations 

As i walked into the examination room, i gathered instantly that this was going to be a pretty intensive communication skills OSCE day, with 4 sets of actors and only one examination station behind a dividing screen (i could just about make out a bed behind the screen).

Station 1: Psychotic patient 

So this was a rather tough station. The fact that the patient seemed to have only one symptom and pretty much denied having anything else, made it really difficult to lead one question onto the other. Perhaps i didn't ask the correct questions to get the history out of him, but as the buzzer sounded for 1 minute remaining the examiner turns to me and asks me what sort of delusion i thought the actor had. Well, it wasn't a difficult decision for me to make, seeing as I could only identify the one thing!! - i went for persecutory delusions. 

Station 2: Explaining Citalopram

It was heavily hinted out to us that SSRI prescribing is a hot topic to revise for during the revision sessions, and having actually done a lot of reading and practice, i was pretty relieved when it came up! The actress playing the patient was also very easy to please! She had no questions and literally wanted me to tell her EVERYTHING, and so i just blabbed on about how to take it, when to take it, how long she will have to take it for, all the very obvious things, and checking now and then she understood everything and didn't have any questions. Again the 1 minute buzzer sounded, and out of nowhere she suddenly has a question for me. A common theme was emerging, Buzzer = question time! 

Station 3: Rest station

Headphones on, sipped 3 glasses of water, and sat on the chair waiting for time to pass. 

Station 4: Collateral Paeds History 

This was pretty much taking a general paeds history from a mother, and then homing in on the few symptoms that the kid had. The actress had to play a concerned mother, but she seemed rather uninterested, and would smile at me randomly throughout the interview. Again there were only a few symptoms, and the history was a very clear type 1 diabetes picture. As the buzzer went.. well you guessed it.. question time! The examiner then asked me for my diagnosis, and then asked for the compliance issues for children with type 1 diabetes, i listed those i could think of, he smiled and nodded.

Station 5: Suicide History

This was another biggy hinted out at the psych. revision lectures, and well it didn't really have to be hinted out, as it's an OSCE favourite. Knowing this, I should have really nailed this one, but the 10 minutes went by quicker than I expected, and i made this biggest of all fails... i didn't have time to ask the golden question.... "Are you going to commit suicide again". Nope i completely forgot to ask that, and yep, pretty sure i flopped this station.

Station 6: Smear and Bimanual examination 

This was a surprising station, as having spoken to upper years, this has always been a 5 minute station, so when i walked behind the dividers and was faced with a rather odd set up.. i was a little surprised. A woman was lying in bed fully clothed, and a pelvic model was placed approximately 1 metre on from her, and i had to speak to her whilst examining the pelvic model. What perhaps threw me off a little bit more, was the fact that the examiner was my obs and gynae rotation consultant (!!), and i remember how demanding she was. 

Having practised this station as a 5 minute station, and purposely slowing down to fit it into the 10 minute station, i still managed to finish rather early. This time, the examiner asked me a few questions on cervical screening, and that was it. 

Day 1 of osces over! 

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Wednesday - 4Dii: 5 minute stations 

So thankfully i had the whole of Tuesday to revise for these exams - last exam of the year... i couldn't wait to finish!

Station 1: Explaining spacer technique

This was a simple station, explaining how to use a spacer to the examiner, and demonstrating it on a plastic paeds model, followed by questions on acute asthma management. 

Station 2: Knee examination

Another pretty straight forward examination, where I was told not to do a few tests and instead had to describe them, and give specific names to the tests i was allowed to do. The station ended pretty quickly, as all the cruciate ligament tests were no to be performed, and I couldn't quite remember the name for one test i did perform. I finished the station with what sort of investigations i would do, and stood there in silence waiting for the buzzer signalling us to move on to the next station. Luckily however, at the end with time remaining, the name of the test popped into my head, and i asked the examiner if i could still tell her, she nodded, i named it, and i saw her give me the tick on the mark sheet. Another good station. 

Station 3: CNS examination

Again, another straight forward station, where i had to perform a CNS exam. I haven't read back on my pass years OSCE exams, but i'm pretty sure ive had this at least twice before! It's an OSCE exam favourite! I finished in time, only for me to move on to the next station and realise i had forgotten to check for accommodation reflex. meh. 

Station 4: GALS and Hip examination

I was a little worried about this station. Each year a GALS + joint exam comes up, and well, whilst practising for this OSCE i was struggling to complete the GALS exam in 5 minutes let alone fit in the examination of any joint. However, as soon as i read the candidate instructions, I was very relieved to find out that we didn't actually have to comment at all on what we saw on the exam, so rather than commenting on all the normal muscle bulks, spine curvatures etc, i just made it really obvious i was looking.. and moved on very quickly. 

Station 5: Fundoscopy 

During the preparation for my data interpretation exam, i had looked over all the fundoscopy images at the clinical skills lab, and well, that put me in a pretty good position for this exam. As i peered into the eye, i've seen that image enough times at the labs, and so it was simply a matter of describing it. 

Station 6: SBAR - ruptured ectopic pregnancy

This was a very very very odd station! I was sat in a booth, with 3 bits of paper and a telephone. One piece of paper had the instructions, the other had the patient's history, and the last bit of paper was an ultrasound report. I was given 5 minutes to basically process all the information, call the consultant (she was actually hidden behind a divider), update her on the situation and get her to come down to see the patient. It was more a test of how quickly i could read!! 

Station 7: Large Breech Baby

This was purely a communication station, with a mother who wanted a natural delivery at home, and having to basically tell her about the risks etc. 

Station 8: Down's Syndrome 

This was another communication skills station where i had to explain down's syndrome to a worried mother, who believes her child has been born with down's syndrome. I listed out a few things, gave some supportive advise and gave her an imaginary leaflet on down's syndrome to take away with her, 

Station 9: Upper limb PNS examination 

This was a PNS exam with a slight twist. The patient for this exam had to pretend to have a right sided wrist drop, and the question that followed was - "where is the lesion likely to be?". I went for a mid humeral shaft fracture, and the exam finished with plenty of time to spare.

Station 10: Collateral History - Dementia

I didn't really know what to expect from this station. I asked a few questions, and was rather clueless to where i was meant to be heading with this history. With only 5 minutes to ask questions, i got a very brief history, had the chance to offer the patient a leaflet, and that was it. 

......... and that was the end of Year 4!