Tuesday, 26 January 2016

Year 2 OSCE's

Nightmare.

So some bright spark thought as well as introducing two new stations and giving us the vaguest / unclear information about them, they've decided that we should have 8 (both anatomy, all of physiology / pharmacy and communications) on one day and the two new one's on another.

Today was the holy-mother-of-god 8 station day.

Phys / Pharm 
Just like last time we had the run down of what the physiology/pharmacy stations would be the night before. I've not refreshed my e-mail so many times in quick succession since I was waiting for track to update.

The stations were decent - I was dreading an audiometry station or EMG but neither of those came up. So like last time i'll run through what they were and everything I fucked up on.

Station number. Station type: whether I think i've passed or failed (how confident I am that I passed / failed)

1. Otoscope / Ophthalmoscopy: Pass (60/40)
So this station was in three parts, had to look inside the ear of the patient, inside the eye, and then match up the inside of the plastic eye with the picture.

Wiped hands, introduced myself to patient, checked name and DOB, explained procedure, gained consent.
- Putting on a new speculum on the otoscope after lubing your hands up turns out to be a lot more difficult than you think but I managed it eventually!
- Almost forgot to pull the ear up and back but I remembered! Also remembered to comment on the outside of the ear
- Saw the tympanic membrane for the first time in my life hoorah!

Think that bit was OK!
The opthalmascopy bit was a frickin nightmare. So firstly it took me forever to switch it on, and when I did, the light was green! I couldn't understand why and proceeded to shine this green light into the patients eye. Obviously wasn't getting a red reflex and eventually managed to get the white light on!

Got a red reflex eventually, moved on in. Commented on what I could see.

Next had to do the same on the plastic eye and match it to a picture. For a start all I could see for a while was grey - as in the grey plastic on the inside. Eventually managed to find what I was looking for but I literally had to take a wild guess in terms of matching the picture up.

Picked one and as I had another minute left I thought I would double check; double checked and changed my mind. Then as soon as the buzzer went off I realised I made an error by changing my answer. Too late. Had to move on.

Points definitely lost:

  • Shining a bright green light in my patients eye
  • Not selecting the right picture
2. Blood Pressure and Pulses: Pass

A) Washed hands, introduction, checked patient name and DOB, explained procedure, gained consent
This time around I actually managed to find the pulse, put the stethoscope in my ears the right way around and got a blood pressure! Although the blood pressure I got was bizarre (like 110 / 92) and I have no idea if my systolic estimate was right...


B) Had to find carotid pulse on examiner! Managed it.

C) Had to find dorsalis pedis pulse - think I got this one too!

Points lost:

  • Did not say mmHg for the blood pressure measurement
  • Who knows if my BP was right
3. Cranial nerves: Pass?
So I had to pick two nerves from pile A (the "easy"pile) and one nerve from pile B (the "hard" pile) but all the cards were face down and perform tests for them explaining why I was doing them.

I got CN I and CN VI from pile A and CN II from pile B.

A) Started with CN I - again solid intro. 
Remembered to smell the thing myself, remembered to tell the patient to close one nostril while smelling it, however I did not change the fucking smelly pot for the other nostril. Why didn't I do this?! Of course you change the smell or the patient could just say the same thing twice!!!

B) CN II -
i)Acuity
Got her to cover one eye
Said I should be 6m away
Got her to read down
Asked her if she normally wore glasses

Mentioned near vision testing
Isahara plates

ii) Then did visual fields. Was sat really frickin awkwardly where the bench was in the way. Should have moved! No idea if I was doing this right.

iii) Then did accommodation reflex - said I was looking for convergence of the eyes and constriction of the iris

iv) Then did light reflex, said I was looking for direct pupillary constriction and consensual reaction

C) CN VI
It took me ages to remember this was the abducens nerve. Once I had remembered it, I talked about how innervated the lateral rectus

Asked patient to keep head still but follow the tip of my finger with her eyes
Said I was doing the H test but paying particular attention to whether the patient could their eyes from left to right

Examiners question: And what would you see in a normal patient?
Me: er. they could move their eyes from left to right.
Examiner: ...
Me: oh i mean they could move their eyes laterally
Examiner: laterally! yes.

Had a very very lovely examiner for this station. Love her, cute little lady.

4) Drugs calculation. Failed. 100% failed.

So you may recall me moaning about not knowing how to do a drug calculation for the life of me and getting really fucked off with it and resigning myself to not knowing how to do it.

Well 10 minutes with a friend of mine in a bar and taught me exactly how to do it. We did some practise questions the night before as well to remind ourselves (and thank fuck for that too because we kept fucking up) and I knew I could do the calculation.

A) Got in there, did the calculation in under a minute.

Great. Got the right concentration of the drug. Great.

B) Open the caps of both the water on the drug. Put bleed needles in them both. At this point I'm thinking I cannot believe I have never done a drug practise before and yet it's going so well and how mighty impressed I am with myself for managing to do the calculation right on the first try.

It's 3.4 mills so I know I need the yellow needle. Gotcha. Put needle into my 5ml syringe. Fab.U.Lous.
So as i'm thinking about how great this is going, I suddenly notice that I've pulled out 5ml of water. not 3.4. Shit. Start again. Put that to one side.

Luckily got another solution at the ready. This time accidentally used a 10ml syringe. Fuck I say, out loud. Put that to one side. Pick up the other 5ml syringe. This time manage to pull out the 3.4ml. Now I need to take out 3.4ml of the drug and put into my water solution.

"Er. I've used up all the syringes."
Yes. I've used up both the 5ml syringes. There isn't another one.
"Here use this one," my examiner squirts back out the water.
30 seconds left
"And now I'm going to take up slightly over 3.4 ml of the drug!" I say
I don't get a chance to. Move on.

Points lost:

  • everything related to doing the actual drug dilution
5. CPR: 50/50 
Now I would have said I had passed this station but last time I was on the boundary and today I realised why. 

I failed to get breaths right because I was forgetting to pinch the nose. Eventually remembered.
My CPR rhythm was all. over. the. place.


Did my DRS ABC - but forgot to check for obstruction of the airway.

Points lost: 
  • hand placement
  • failing to do proper respiratory breaths till third try
  • rhythm
Anatomy

Firstly this will be an extended rant as I am confident I have failed both of these. Firstly, my anatomy demonstrator didn't register me till 30 seconds into my 5 minutes. Next she told me to take my time because I had plenty of it. Then she told me to speed up. And then she didn't even ask me all of the questions because she was so slow asking me the questions. 

The next anatomy station, quite frankly it would be a miracle if I got more than 2 marks. Had to pass on 2 questions and I actually replied "don't know" to about 3. "What nerve innervates the anterior thigh?" Apparently, in a moment of sheer panic, sciatic nerve which i fricking know runs down the back of the leg fucks sake. 4 features of the fibula. Just about managed to pick up the fibula. Basically couldn't find a single thing on this prosection because it was shredded to pieces. Didn't even know if it was the left or right leg, and that's when you know it is pretty bad.

You also know it's pretty bad when you can't actually hold it together and instead break down on your way out of the anatomy room. Had to be comforted by a close friend who kept hugging me and telling me it was going to be OK and that I needed to pull myself together because I had another 6 stations to do...

Communications
Whatever. I stopped caring by this point.

Did ICE. 
Did a solid intro. Hope the rest was fine. 

My best case scenario here is that I failed one anatomy and the drugs.
My worst case doesn't even bare thinking about.

Next up: 2 integrated OSCE's.




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