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One the most important parts of a postgraduate course is the assessment. Assessments can come in all manner of varieties, from standard exams and essays to more innovative and intricate activities. Being prepared for them is key to succeeding, so it’s always wise to try and find out in advance how you will be assessed on a postgraduate programme. To give you a look behind the scenes of Physician Associate Studies assessments, Swansea University student Aimee takes us through her first ever Objective Structured Clinical Examination.
Physician Associate and Medical students are evaluated on their clinical skills via OSCE assessments. OSCE stands for Objective Structured Clinical Examination, and until very recently, the whole process was completely alien to me. However, I am pleased to announce that I survived my first OSCE experience!
At the start of an OSCE, you go into an exam room which is set up like a hospital ward – lots of beds with curtains drawn around them.
Outside the curtains of the first bed, you’ll be presented with a simple sentence telling you what you are being asked to do. For example, it could say ‘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. You then have four tasks – history taking, examination, procedure and explaining.
You have six and a half minutes to take a medical history of the patient, going over the likes of the current problem, previous medical problems, family history of medical conditions, any medications they take and any allergies they have.
At the end of your time, you’ll have 90 seconds to present to the examiner the results of your history taking. You introduce the patient and explain why they have come to the GP surgery or emergency department. You present the most significant points and tell the examiner what you think the possible diagnosis is and what tests you would like to do to confirm or rule out your diagnosis.
You will be asked to carry out a full examination of a particular system at this point, like a cardiovascular examination, a gastrointestinal examination or a respiratory examination, for example. Again, you have six 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.
You will be 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.
Finally, you'll be tested on your ability to communicate medical information in a patient-friendly way. This task is different to the others in that it is divided into two parts.
You’ll first get eight minutes reading information why a patient has come into the clinic, which could be to discuss test results, a new diagnosis or a change in treatment, for example. You’ll then get eight minutes to talk to the patient, find out what they know already and then explain anything that they do not know in a way that they can understand.
The OSCE was the most anxiety-provoking exam I have ever taken. During the examination stage, I forgot to ask the patient’s name. At the explaining stage I finished early and spent three minutes sitting in awkward silence with the patient. In my procedure task the patient’s ECG flat-lined. The history task went OK, at least! Despite the stress, I have learned from my mistakes, and I now feel prepared for the next one.
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