So the written exam is all over and it feels like the summer holidays should be starting except there are still the dreaded OSCEs to go...These are the practical exams - the bit where you have to actually know how to use the stethoscope dangling round your neck.
Putting that bit of kit on when you start the clinical placements is terrifying. If your hospital has no scrub uniform for doctors they all just wear smart clothes so a stethoscope = doctor to many patients and often to other staff. If you are a grad student with a few extra wrinkles its not uncommon to be mistaken for a registrar or even (horror of horrors) a consultant... So after one placement of nurses constantly asking you to assess breathless patients or to amend drug charts you'll see quite a few students hiding their stethoscope in bags and pockets! To begin with I wasn't really sure when I would need one anyhow and although it seems obvious to me now I do recall bringing one to a plastic hand surgery outpatient clinic. They must have thought I was a total idiot :) In order to help you avoid a similar embarassing fate here are some tips:
Stethoscope Rules
- Bring if its Respiratory, Cardiac, General Medicine, Acute Medicine, General Practice, Pre Surgical Assessment (for those pesky new heart murmurs), Care of the Elderly (virtually everyone has COPD or pneumonia)...
- Don't bring if you are going to Surgery, Outpatient clinics unrelated to Cardio or Resp, Psychiatry...
- If you need one unexpectedly there will virtually always be one with the doctor or on an obs trolley
- Do get your own! Buy the best model you can afford - cheap ones are usually still £60 or so but if you can afford a bit more I'd say it helps. I was fortunate enough to get an expensive one as a gift and I have found that I can hear murmurs etc more clearly with it. Sometimes other people ask to borrow mine because the sound quality is better so its not just me! Of course it doesn't help you interpret what you hear - that's all down to the user!
- If you have an expensive stethoscope you will look more stupid when you can't use it. Murphy's Law.
So, assuming you've survived the clinics and wards and actually got to practice using your shiny new toy the big moment really comes when you have to demonstrate it...
Of course stethoscopes are only a small part of the examinations you will do. They do get used in abdominal exams, as well as the obvious respiratory and cardiac stations. Plus blood pressure of course... and if you do get a BP station don't be surprised to find a terrifying double headed stethoscope with the examiner able to listen in so there's no faking what you hear...(not that you would ever do that of course...)
OSCEs
OSCEs fall into three main categories - (i) practical physical examinations, (ii) history taking/information giving/advising "chatty" stations and (iii) procedures like taking blood etc.
"Stations" refers to the OSCE task and usually last 10 - 15 minutes.
In my experience the usual set up is a mock ward with cubicles with curtains drawn. There is a chair outside every station with an instruction card face down. Everyone lines up outside their start cubicle...
BUUUUUUZZZZ!
The alarm sounds, your heart pounds, you snatch up the instruction card and try to read. You have one minute to grasp what the station task is about.
BUUUUUUZZZZ!
You yank back the curtain and rush in trying to look casual. You begin your introduction to the patient and start trying to follow through the task. This can be easy or awful. Chatty stations can be a gift or a nightmare depending on your inter-personal skills and whether or not your simulated patient is meant to be psychotic.
BUUUUUUZZZZ!
And it all starts again....
Top tips for OSCEs
- Practice your skills well in advance. You can't rock up on the day and hope to wing them all. Its a recipe for disaster.
Confidence is key. If you think you have heard something or seen something on an xray, say so! Present your finding fluidly and concisely using proper language and you will look professional. Saying "um, the xray has a cloudy bit on it over at the edge" is not going to win you many marks whereas "loss of the right costophrenic angle and a meniscus suggest the patient has an effusion" comes across much better. You've seen the same thing but a lot of it is in how you get the information across. Caveat to this is NEVER make stuff up. If you don't know something admit it rather than lie or say something like "I'm not sure of the detail of that so I think its something best checked with my senior colleague". That's honesty not failure and you can probably still pass the station if you have done everything else properly. Lying is a sure way to fail...
Always introduce yourself to the patient, explain what you are doing and get permission. Don't say you are a student and that the examination is for your learning unless it says that on the scenario instructions!
Get a group of friends and write OSCE scenarios for each other. That way you will be examining each other and can get feedback and see how you cope when you don't know what the scenario is in advance.
Rope in friends and family to be your mock patients. Many will find it quite fun (for a while anyway!)
Practice your skills with the real patients you see everyday - this is the closest thing to an OSCE - they have real signs and are often happy to help you learn.
Offer to do the ward jobs. When you have to do a mock ABG in the exam you will ace it because you have done it lots of times for real!
Know the kit. I've heard people say they had to put a speculum together and they had no idea how that was done...
Try to keep calm. If you totally mess up one station push the feelings and memory of it into your inner box of doom and move on. You can agonise over it later...
Expect the unexpected. Examiners seem to throw in the odd scary station to differentiate the best students. Try to think logically and work your way through it the best you can!
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