1st and 2nd Years’ OSCE guide We know the feeling. It’s June, everyone else has finished exams, you’ve spent every waking moment since Easter with your head inside a book. It’s NEARLY summer. But it’s not. The last thing you want to be doing in the lovely weather is preparing for a rather daunting OSCE. So here are a few words of wisdom from a bunch of people who have all learnt from their mistakes!
Something to bear in mind… If you’re in the afternoon, they very rarely change the stations. Ask around! (But don’t blame us if it does change). Useful acronyms SOCRATES – it applies to everything. The OSCE big 5 – •Introduction •Informed consent •Wash hands •Ask if in pain anywhere •Relevant medical history Count them off on your fingers while washing your hands!
The Ethics station It’s very difficult to prepare for, so here are some pointers… •Apply the ethical principles to everything •Don’t forget to mention other factors – social, religious, financial, family, legal •Also don’t forget things like confidentiality, consent, understanding/language barriers, competence •Mention the extremes – doing nothing and running screaming to the Dean included! •Have a structure – e.g. main issues raised, the actions you could take, how the ethical principles apply, and how everyone would be affected and how they’d feel (showing empathy). •Be honest and keep talking! •Don’t worry about it too much. It’s so subjective. Practising •Practise throughout the year. Don’t leave it to the last minute (like we all did). •Practise choosing a cuff from a selection for blood pressure. This catches a lot of people out. •Practise using an otoscope enough times that you’re sure you won’t jab the patient’s ear and make them cry. •Practise with a lot of noise around you – you need to be able to shut out what everyone else is doing, including people yelling for imaginary ambulances in CPR •Practise on non-medics as well as medics. •Practise doing 6 stations back-to-back. •Practise under time pressure. •Practise practise practise!
Some definite DO’s •Take a reliable watch. With a second hand •Wash your hands. And wash them again. And again. And look out for the hidden soap. •Show the person empathy, actor or otherwise. •Always ask about pain before touching ANYWHERE. Or else you might just find out how melodramatic your patient can be. •Ask what the patient would like to be called. •Be prepared for the explanation station. It’s been known to have to explain a midstream urine test, complete with description of the labia. •Put anything used straight into the correct bin. Looking for it in the pile of other peak flow meters/needles is a nightmare. •Dress appropriately. No bow ties, and noone wants to know what colour bra you’re wearing, girls. •Talk through everything out loud so the examiner knows exactly what you’re up to •If in doubt, check with the patient for permission for EVERYTHING •If you forget a stage, keep going, you can always come back later. •Ask the patient to redress!
Some definite DON’T’s •Dripping blood all over your patient is not cool. Just ask for a plaster! •Don’t panic. You’re doing better than you think (if you’ve practised enough). •Don’t tell the examiner you’re lying when you give blood pressure readings. Sound confident! (And try not to lie in the first place). •Palpating the carotid pulse on both sides will leave you with a passed out patient. Not ideal. •Don’t try to do the hepatojugular reflex on the LHS. •Don’t be embarrassed. It makes you look silly. Be confident and you look great!
And don’t do any of these… •“I asked the man in the joint exam to stand up and walk without noticing the walking frame next to the bed! (luckily I spotted it in time, asked, and it wasn't even his!)” •“When performing infant CPR, I stopped midway to ask whether or not that was enough, and started to have a casual chat to the person on the station. I then had to be reminded to continue!” •“Nearly called a patient fat, instead said they were "abnormally distended"”. •“I attempted to get consent in CPR” •“When asked on CPR 'why might you not be able to feel the patient breathing' I said, 'because my hair is in the way'...” •“I laughed when the patient told me he thought he was having a heart attack in the first year clinical history...it was awkward for all involved.” •“I told the patient that I'd seen them before in my mock osce and asked them how they were.” •“I introduced myself as a 'first year medical school'...” •“I couldn’t find the bin on the peak flow station and so lost a mark for disposing of the rubbish, turned out the bin bag was on the chair on my left.” •“I picked up the tub of hand sanitizer and asked if it was the patient’s medication.”
Remember – they want you to pass. If you’ve done enough practise, you’ll sail through. Good luck! Compiled by Gemma Dracup – Welfare Officer