Year 3 OSCE

So, i’ll do this the way i’ve always done it. Talk you through what I had and how I got on. Originally I tried to give myself a score out of 7, but quite frankly, that's too hard. 

Station 1. Data interpretation 4/7 - a scraped pass.

CXR + ABG. 

ABG showed low oxygen, low carbon dioxide, but pH was was within normal range (7.37), HCO3- was in normal range, and so was base excess. 

PMH: Asthma. 

There was some consolidation in the lower right lung but as far as I could see the trachea wasn’t deviated - apparently it was!! The pneumothorax was pretty obvious. But I basically spoke for about 5 minutes straight chatting complete shit and making one diagnosis and then changing my mind to the point where all I really wanted to say was JESUS TAKE THE WHEEL.

Station 2. History taking - Angina. Pass.

So there was I was, revising away, thinking you know what - there is no way that they are going to give me the same station I had in my mock and THERE YOU GO. Literally the exact same situation. She was a teacher that was getting chest pain on her way walking to school. 

At 6 minutes you had a buzzer for 2 minutes remaining and in this station, that meant the examiner had to stop and ask you two questions. I had only just moved onto the past medical history. Hadn’t got anywhere near the rest of the history.  “What do you think she has” - stable angina, of course. “What risk factors does she have?” - I reeled off 6. 

“Okay, you can carry on” - 

“Can I carry on with the consultation?”

“Yes, you have 1 minute”

Bang - I just turned back tot the patient - “Right, i’ve got several questions to ask you now, but i’m going to be quick and most of them will be yes or no. Do you have any drug allergies? No? Do you take any medication? Oh great, a prescription, thank you. (I turned, showed the examiner, and winked - she smiled right back. Yes, yes, yes) So we’ve already spoken about your family so now i’m going to ask you some questions that I have to ask all of my patients - do you drink any alcohol? how much? 2 glasses? OK. Do you smoke? No? OK. Any recreational drugs? No.” *The buzzer for the next station went*

I grabbed my stethoscope, “Thank you thank you thank you!” I shrieked as I went for the door, adrenaline pumping right through me. 

Did I get those extra marks at the end? Who knows.

Station 3:  Examination 1 - Abdominal Pass may be hopefully.

Forgot to do liver flap. Spoke at the speed of light. Think the patient and I had great rapport, there was one point me, the patient and the examiner were all laughing. 

I basically just whacked out the examination as quick as I could, forgetting some pretty major things. “Anything else you would look for in the legs?” he asked. 

“YES. SIGNS OF IBD. LIKE GANGRANOSUM!” I basically shouted with excitement when he asked. “Any abnormal findings?” He asked. “No.” I replied confidently.

Apparently she had the biggest spleen you’ve ever seen. Great. 

The examiner and the patient were both really lovely, but I have no idea if I did OK in this. The only sign I picked up and commented on was the corneal arcus. Can you still pass a station if you don’t find the abnormal findings??

Station 4: Sharing information - AF and warfarin. Pass if they're generous. 

So this patient had been told she had atrial fibrillation and was going to start warfarin. I mean I did a lot of waffling, and not much of it made sense here. Was I meant to explain atrial fibrillation? Wasn’t I?

Hilariously me and my best friend had spoken about how we would explain AF some weeks ago, and we used a demonstration with our hands. Bearing in mind we are in the same cycle of students - we both did the exact same thing. The patient must have thought - what an earth are these magical hand movements students have learnt?! 

I found this patient really difficult. She was a bit aggressive in her questioning and I made an absolute mess of explaining atrial fibrillation never mind the warfarin.

Station 5: Examination 2 for AS. Pass

My best station by a mile. I had the nicest, friendliest gentleman in there. The examiner was just as pleasant. I walked there, shook Johns hand, introduced myself and dare I say it - bossed it. And I say that with certainty because I had a minute to spare at the end where the patient gave me two thumbs up and said I had an excellent bedside manner and after I had answered the examiners questions she said, “Yes you can breathe again, very very well done. Excellent,”

HOORAH. 1 station out of 16!!!!

Station 6: History taking - Hyperthyroid. Pass

I went in with a strong differential. She was having palpitations, had weight loss and tiredness. I was going to rule out anaemia and diabetes within the first few minutes and I did.

Threw in some questions about periods as well to get some extra ticks. 

Station 7: Explanation. Metformin. Pass?

Oh my god, this guy was basically falling asleep. After the OSCE it did just seem like he had a completely different story for everyone he spoke to. One of the girls was saying he was mainly concerned about how he didn’t want to exercise, with me he was mainly concerned about family history and the likelihood of it being passed on.

Considering this should have been a really easy straight forward situation I missed the big worrying side effect of lactic acidosis and struggled to explain it well. I also said he would be taking this once a day and the patient literally had to correct me and remind me it was twice a day. For crying out loud, why can’t I just READ THE DAMN QUESTION.

Station 8: Data Interpretation: CXR Gas under peritoneum. Fail. 

So I spotted this one straight away. Why was there gas? GOD knows. I said a perforated bowel. That was all I had. He had back pain, but kidneys on ultrasound were normal. His urea was pretty high but that was the only thing abnormal.

He had been taking ibuprofen for back pain for weeks. 

One of my friends said she thinks he had a peptic ulcer which has ruptured. I think she’s right.

We had a 15 minute break now and oh my god, if there has ever been a time I had wished I had a severe hearing impairment it was right there and then. Everyone just had so much to say about what they thought each station was and what they found and I was like NONE OF YOU KNOW IF YOU ARE RIGHT STOP STRESSING ME OUT.

Half way, another 8 to go, CHRIST.

Station 9. Medication History. Pass?

Sneaky, sneaky, lil rascals. I checked the name of the patient and instead of giving me her date of birth she gave me her age 58. I didn’t think anything of it at the end - I thought she was literally just saving me from doing the math. Apparently on the sheet that you are meant to write down the medication history, in the corner where you check the name and d.o.b. the date of birth said 1958. 

Fucks sake. How sly! I remember seeing both of these things but then thinking that would be absolutely ridiculous surely. And to top it off she was wearing  wrist band with her actual date of birth!!!

The good news is I think I asked all the relevant questions when it came to this, I checked with the prescription too, and even looked up one of the drugs in the BNF which i’m glad I did because I really wasn’t sure whether I needed too!

Station 10: Examination 3: PVE but exclude the head, the thorax, and the arms. Right so basically just the arms and the legs then, great OK. PASS

I don’t know what the situation was with the foetus child they brought in. Obviously she must have been older than 18 but she looked about 12 and I was really concerned about this. She also had the biggest fake nails on which made capillary refill a little more difficult?! 

I think I went through the motions of a PVE exam in an OK way, but obviously because we had to miss out 4 major parts of it I was just stood at the end chatting shit.

Her questions were what signs would you look for in an acutely unwell arterial limb and signs of arterial disease. I spurted something about how arterial ulcers and venous ulcers were different. 6p’s of limb ischaemia?! Who knows. Who knows.

Station 11. Sharing information - Ethical scenario. Pass, only just.

A patient had been referred for a colonoscopy as part of a two week wait - fine. The ethical situation was that he didn’t want any investigations. He’s had a good life, he’s lived long enough and healthy enough and he would rather not know. The key point of his question was when he asked you, straight - “What would you do if you were me eh?”. I replied I couldn’t possibly know, it was too difficult to say when i’m not in the situation. I think my arse began to hurt from sitting on the fence so firmly. “There you go! There you go you see! Exactly,” He said. “Look, investigation does not equal treatment. Just by having the investigations means you get to make an informed decision about what you want to do.”

“But what if I change my mind later? Can I do that?” - Damn, I thought. I should have covered this already. “Of course you can change your mind we will always remain open to what you want to do when you are ready to do that. Whatever decision you decide to make today, know that we will support that,”

“And what about if I want treatment for something else. Will you still treat me?” He asked. DAMN. JESUS MAN. WHY DIDN’T I THINK OF THAT. At this point, the 2 minute buzzer had gone off and I *knew* that this simulated patient was trying to help me out. He was giving it to me on a platter now, asking me the questions that I should have the mind to cover originally. I knew this SP well, I had worked with him for 3 years already. God dammit. “Of course we will always treat you indifferently, whatever decision you make here today, we will always treat you as well as we possibly …* The buzzer went off to move on. SHIT. 

I still wonder what I should have done. Was I right to sit on the fence? Should I have said I would absolutely have the test done? I just don’t know.

Funnily enough, on the next station I could hear what my colleague was saying to him and when he asked the question, my colleague said, “Look, I would have it done. If i’m being honest with you, that’s just me personally but I would have it done,”

“THANK you,” the SP said. “Thank you for being honest with me,”. 

Damn it.

Station 12. - Prescription review. Pass.

Now there has bene absolute outrage about this lol. It turns out a lot of people had been told that there was no way prescription review was going to come up because it was too difficult to do it well within 4 minutes. Where in most of the other situations we had about 6 minutes to do something and 2 minute for questions, in this one the timer was set for 4 minutes.

The station was you had 4 minutes to review the prescription and then 4 minutes to talk the examiner through what you had done and then answer the questions. I decided to basically not ever stop talking. I walked in there and from the word go, spoke through everything I was doing.

“Ok, so looking at the name and date of birth, looking at the prescription, yes that’s fine, let me look at the indication, going to look that up, yes okay, that’s good, okay so next…” 

So when that buzzer did go off at 4 minutes, she immediately turned it off and told me to just carry on with what I was doing. She said, normally i’d stop you but you are talking me through it as you go along so carry on.

“The nurse said the patient should be on two antibiotics. What do you do?” She asked.

I looked back at the sheets in front of me. Trust Guidelines!!! Give amoxicillin AND clarithromycin. Gotcha! I literally said to my examiner “HA, yes. Prescribe clarithroymycin also for review in 48 hours, etc” She nodded eagerly.

“Ok, the nurse has gone to give this medication to the patient but the patient has said she doesn’t normally have it today. What are you going to do?”

I looked at the prescription. It says start today… it’s for osteoporosis… let me look it up. OH. It says once / week. I looked back at the examiner. “What are you going to do?” She repeated. “Find out what day she does normally take it, write the dates in the prescription, mark them with an X excluding the day she should be taking it!”

“YES. Well done. Okay.”

I raised both my hands in the air. “JESUS THANK YOU” I screamed in my head. Praise to de lawd. Another one.

Rest 

One of the staff came up to me. “You might need to control your eyes,” she laughed, “You look like a complete deer in the headlights!” Offering me a biscuit. “I bloody well feel like one!” I said, trying to breathe again.

Station 13: Examination 4 - Respiratory. Fail.

So for this one I had to do it focused for a pleural effusion. Obviously, I just walked in and bulldozed straight through. Should I just be looking at the chest? I don’t know. Should I bother with the hands?? Who KNOWS. I just completely ran out of time, never even getting onto the back of the chest and barely managing to vocalise what I was thinking.

“What are the two types of pleural effusion?” she asked. 

“ER. what.?” I blinked - and it was literally like that meme that is currently going viral of that bloke blinking. 

“TRANSUDATE AND EXUDATE” I basically shrilled. As the final buzzer went off.

“RIGHT now quickly GIVE ME 2 CAUSES OF EACH!” She squealed right back at me, willing me, begging me to get the answer.

……….. I got nuffin. “ARGH!!” I basically yelled. 

“Go,” She said. “Just go,”

I left. Tears in my eyes, outside my next station, I could feel myself welling up. I picked up both my hands and put them on my head and tried to breathe out slowly without crying.

Try and forget it. Please, I said to myself, forget it. The buzzer went off for the next station, my final one. Come on, hold it together I pleaded to myself blinking away the tears and pulling the curtain back for the final time.

Station 14: Data interpretation. Fail.

WHAT IS GOING ON. U’s and E’s. Blood and protein in the urine. Glomerulonephritis????

What is this ASO thing??? The questions began at 4 minutes. “What do you think is wrong with him, how would you manage him?” - ER. I HAVE NO FUCKING CLUE.

Look, I don’t think its a UTI. I think it could be glomerulonephritis, nephritic syndrome - no wait, nephrotic, no wait nephritic?! wtf. I’d like to, er , i don’t know Google what the hell ASO is. 

i think one of my friends managed to nail it - it was some anti-streppwto-something or other, and the guy did present with a sore throat. He’s had an infection, it’s spread to his kidneys. 

Station 15: History - bowel cancer. 
Quite straight forward symptoms; weight loss etc - I got it fine. I went a little bit crazy with the investigations and all I really needed to say was a DRE and a colonoscopy!

Station 16: Explanation - COPD. Pass??
Oh look, another one that I had in my mock. Do you think I revised this? Nope. Just as much of a shit show as when I did it in my mock, but I sort of scraped through it then so I hope I can scrape through it again.