Today was my first OSCE examination. It consists of six 5 minute stations and depending on the station you may or may not find a patient there. It's nerve wracking, heart pumping and all a bit of a blur. It is (and i'm sure all other medical students will agree) one of the most difficult examinations to be put under.
Station 1: Resuscitation 50/50
Person found collapsed, 25 metres from the nearest house by an electrical thing but no lakes or water nearby.
This one was quite straight forward.
D - Identified the danger. Made sure it was safe to approach.
R - Shook the patient for a response. None given.
S - Shouted for help.
A - lifted the head back, pulled the jaw down - got my airway
B - pressed ear against mouth, watched chest, no signs of breathing
At this point there is no point starting compression without getting help first. I go to the house, tell them to call an ambulance for an adult male found collapsed and to bring a defibrillator. I tell said person to join me.
C - Started compressions 30:2 ratio. And this is where it got a bit tricky - was I doing compressions right? Not a clue. Was I going too fast or too slow? A bit of a blur. Every time I did my respirations, I don't think I was holding the nose properly so I wasn't seeing the chest rising and falling as I should have.
Station 2: Fail.
1. Forgot to wash my hands.
2. Asked how I would find the 2nd rib. Said I would identify the jugular notch, palpate down to sternal angle, move lateral.
3. Successfully found 2nd rib on patient.
4. Was asked to find 3rd rib, 3rd intercostal space and fourth rib. Sort of just fumbled around hoping it looked like I was doing it right.
5. Pick a card, any card: auscultate upper lobe of left lung. I knew I had to use the bell of the stethoscope well done me. Made sure the bell was open, fabulous. Got patient to take several deep breaths in and out - could hear it well. Got the patient to raise arms and lock fingers behind head. Said something about c1 to t3. should have said c7 to t3 vertebra. Listened using diaphragm of stethoscope. Couldn't hear a thing.
6. Was asked to find mitral valve / apex beat - ran out of time.
Station 3 - Blood Pressure: Fail.
1. Washed my hands!
2. Introduced self.
3. Needed to estimate systolic blood pressure - failed and made it up. Tried twice.
4. Did not even get around to attempting full blood pressure as the valve was so fiddly, I couldn't get it to pump up right.
Apparently my lane number had this old guy who had a knack for messing around with the valve just before we went to the station. It happened to 2 other people I know!
Station 4: Blood Sample: Pass.
1. Introduced self, informed consent, confidentiality - tick tick tick. Explained procedure - tick.
2. Wiped fake hand using mediwipe. Then saw gloves. Put gloves on and wiped hand again.
3. Pricked fake hand, massaged thumb.
4. Got pipette, readjusted it to 20 microlitres, put pipette on, withdrew blood.
5. Got other sample tube, emptied pipette, discarded pipette
6. Inverted tube, wrote patient details tick tick tick. All smooth, really happy with how this station went.
Station 5: ECG and pulse - Fail.
1. Record ECG for one minute.
2. Forgot to wash hands. Introduced self, explained, hooked it up for 1 minute.
3. Find duration of P wave. I think I manage this, but my examiner looked very unimpressed.
4. Calculate heart rate. I got 72, and that seemed reasonable so I ran with it.
5. Find posterior tibial pulse - couldn't find it, ran out of time.
Station 6: Spirometry - 60/40 Pass?
1. Show patient how to use wright spirometer - think I did this well. Introduced myself, got informed consent, demonstrated, observed and gave feed back.
2. Calculate FEV1. I got 3.6L which actually was the same as the vital capacity that I got... not sure if I was actually asked to calculate tidal volume instead and just got confused. Can't remember a thing and quite embarrassing.
To be honest, the whole thing was so shambolic I'll be really really bloody chuffed if I've passed. I know I shoulda woulda coulda but why didn't I do better? I wasn't as prepared as I could have been in the end.
Another OSCE tomorrow - this time, anatomy and communication!
[NB: Sorry for the delay between posts. I've had a lot going on at home which has made it difficult to keep up with life stuff, never mind medical stuff. I'll may be post about it soon.]
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