In her latest diary installment, Physician Associate Studies student Aimee takes us through her first ever Objective Structured Clinical Examination.
Until very recently, the whole process was completely alien to me, but I am pleased to announce that I survived my first OSCE experience! So, what actually happens at an OSCE?
You go into the exam room, which is set up like a hospital ward: lots of beds with the curtains drawn around them. You begin by standing outside the curtains of the first bed, where there is a simple sentence telling you what you are being asked to do e.g. Mr Hughes has come to the emergency department with chest pain and you have been asked to carry out a cardiovascular examination. A buzzer sounds indicating that you can open the curtain and attend to the patient (this is a real person, either an actor or a patient with a known condition).
The tasks in each station come under four categories: history taking, examination, procedure and explaining.
This station is much like the kind of discussion you would have with your GP. You have 6 and a half minutes to take a medical history (the current problem, previous medical problems, family history of medical conditions, any medications they take and any allergies etc).
At the end of the 6 and a half minutes, a buzzer sounds and you have 90 seconds to present to the examiner the results of your history taking; you introduce the patient and explain why he has come to the GP surgery/ emergency department today. You present the most significant points and tell the examiner what you think the possible diagnosis is, what other things it could be and what tests you would like to do to confirm or rule out your diagnosis.
For the examination station you will be asked to carry out a full examination of a particular system e.g. A cardiovascular examination, a gastrointestinal examination or a respiratory examination. Again, you have 6 and a half minutes to examine the patient followed by 90 seconds to present your findings to the examiner and state what further tests you would like to carry out.
For the procedure station, you are asked to carry out a procedure which can include doing an ECG, inserting a cannula, drawing blood or inserting a nasogastric tube. Some procedures can be carried out on actors, for example with ECGs, but invasive procedures are carried out on dummies and models – it would be a little unethical to allow a whole cohort of students to keep pushing tubes up an actor’s nose!
The explaining station is a test of your ability to communicate medical information in a patient-friendly way.
This station is different to the others in that it has two parts: 8 minutes are spent reading information and 8 minutes are spent with the patient. The information you are given tells you why the patient has come into the clinic, for example to discuss test results, a new diagnosis or a change in treatment. You must then talk to the patient, find out what they understand already and then explain anything that they do not understand. This can be quite hard as you have to explain quite complex information in a simple way by breaking it down into smaller chunks of information and by using analogies.
Sounds pretty straight-forward, right? So how did my first OSCE go?
During the examination, I forgot to ask the patient’s name, during the explaining station I finished early and spent about 3 minutes sitting in awkward silence with the patient, in my procedure station the patient’s ECG flat-lined but the history station went ok, at least. The OSCE was the most anxiety-provoking exam I have ever taken, but I have learned from my mistakes and I now feel prepared for the next one.
Until next time,
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