UWS OSCEs

[Matt]

I thought I'd start this thread to make a record of OSCEs at UWS for revision and interest purposes.

Year 1 Formative OSCE, 2007

1. Perform a basic abdominal examination

2. Take Chest pain history

• Ask on risk factors
• Make a differential diagnosis of unstable angina

3. Perform a basic respiratory examination

4. Take a dysphagia history

• Identify oesophageal dysphagia (as opposed to oropharyngeal)
• Differentiate between mechanical obstruction and a motility disorder

Year 2 Summative OSCE, 2008

1. Explain the rational for performing a routine spirometry and guide the patient through this procedure

2. Take a Dyspnoea history

• Identify relevant risk factors
• Take a brief smoking history
• Make 3 differential diagnoses

3. Perform a basic examination of the knee

4. Take a palpitations history

• Identify 3 factors that indicate a serious cause
• Identify precipitating factors

5. Perform a basic abdominal examination

6. Take a menstrual history (irregular periods)

• Ask on menopause and possible pregancy (patient was 45yrs old)
• Take a brief reproductive history

7. Perform a basic neurological examination of the upper limbs

8. Take a pain history (wrist, knucles, phalanges)

• Differentiate rheumatoid vs osteoarthritis
• Identify one other possible cause

 

[Matt]

It was really a pretty easy OSCE this year >_> not much more difficult than year 1, to be honest.

 

[Matt]

Year 1 Formative OSCE, 2008

1. Perform a basic examination of the respiratory system
2. Take a palpitations history
   • Identify 3 factors that indicate a serious cause
   • Identify precipitating factors
3. A patient presents with syncope take the patient's vital signs excluding temperature
   • Remember to first take the blood pressure lying down and then standing up
4. Take a history from a patient presenting with abnoral bowel movements (constipation) and abdominal pain
   • Identify three differential diagnoses

 

[Matt]

A little difficult for a year 1 OSCE, I suppose.

 

[torchlight]

Lol! I'm glad you found it easy Matt, I had a heart attack and a half with Katelaris (no pun intended), the patient gave me NOTHING. And Connie had her iron faced stare. *death* But I didn't get one of Frankum's dreaded e-mails, so I guess I'm right?!

 

[Matt]

Haha, Connie's OSCE glare has become something of an OSCE icon right? I wonder if anyone did fail though. I guess someone must have because they wouldn't go to all the trouble this email business if someone hadn't.

 

[torchlight]

Yeah, that's true isn't it, I hear they're going to hold them like a week or so after exams... I hope everyone does well, our year just keeps getting smaller.

 

[Matt]

Year 3 Summative OSCE - 30% of final year's grade

1. A postoperative patient on the ward develops fever, chills and hypotension. Perform and ABG (on a model hand) and explain the rationale and procedure to a patient (volunteer)
   • Remember to performs Allen's test
   • Remember to check ID
   • Remember to label specimen
2. A 57 year old women is concerned her mother is becoming increasingly forgetful. Take a history
   • Develop 3 DDx
3. Examine a patient with Diabetes and present your findings as you go
   • The patient has incredibly severe diabetic disease of the foot and probably of other places too but I was too slow to find much of it
4. Perform an examination of a patient's cranial nerves
5. Take a history from a lady presenting with recent weight gain, cold intolerance and fatigue
   • Develop 3 DDx
6. A 67 year old man with a significant (>60 years or something) pack history mentions recent haemoptysis, weight loss, loss of appetite, and lethargy on a routine visit for ear syringe. After he says "I think it might be lung cancer, doc". You invite him into your room to talk about the possibility.
   Communicate effectively with this patient.
   • The patient has had a friend die recently (of lung cancer) with the same symptoms who's quality of life suffered with chemotherapy/radiation therapy
   • The patient believes his friend was given false hope and is adamant that he does not want aggressive treatment
7. Perform a Cardiovascular examination and present your findings in the final minute
   • The patient has a couple of signs to find. I only found digitial ischaemia and a systolic murmur. The jury's still out on what the murmur actually was but I haven't asked many other people. There was also abdominal distension and expiratory wheeze but I didn't finish the examination in time to properly assess the distended abdomen.
8. Take a history from a patient presenting with right flank pain
   • Develop 3 DDx

 

[Matt]

All in all, probably quite a fair OSCE, without and really horrible stations... 'Cept maybe the diabetes one. Still, while I think I performed adequately on all stations, I don't think I nailed any of them and there are at least two where I'd be surprised if my grade wasn't borderline.

 

[Kyle]

I felt really good coming out of there, but in retrospect now feel like I missed major stuff on almost every station.

1.) forgot to check patient ID and simply mentioned that I'd label the specimen, didn't do it.

2.) Feel like I nailed this one. Clinically it sounded like alzheimers, but had some vasc path history and hypertension so potentially vascular as well. Also mentioned withdrawl, possible decreased affect so depression was on the cards. Had UTI recently, and gets them often, so delirium was in the differential. No disinhibition, hallucination, concrete thinking etc. etc.

3.) Diabetic one was lonnnnnng. I missed out heaps, what I did get was

- Sensory loss to sharp touch, vibration and proprioception in feet up to about knee level.
- Decreased pedal pulses
- Acanthosis nigracans
- rubeosis iridis
- tendon xanthelasmata (not diabetes per se, but relevant)
- asked for BP, UA and BSL

4.) Did ok, only tested sensory trigeminal in one domain though

5.) Did well on this one too, pretty cut and dry hypothyroidism. For the last few years has noted weight gain (10kg), cold intolerance, hair loss, dry skin, fatigue, increased sleep, occasional depressed mood, growing lump on her neck. Mother had underactive thyroid. No past thyroid investigations. Diet she described has lots of iodine. Most likely hashimoto's thyroiditis or incidental goitre + depression or mix of the two.

6.) I have no idea how I did, it seemed to go ok, once we cleared up that it was making a false choice to say "yes" or "no" to treatment and was a spectrum instead, made some good headway, but lots of people described asking and saying lots of things I didn't which sounded really good in the quarantine holding after.

7.) Stuffed it, was going really well but ran out of time, again diabetic, but had very little in the way of cardiac pathology. I called an ejection systolic murmur, a lot of diabetic signs, nail pitting (couldn't for the life of me remember what this meant, but he didn't ask), nail clubbing.

8.) Stuffed it. Textbook nephrolithiasis case (I mean bleedingly obvious, literally) I called as pyelonephritis, had nephroithiasis as my very next differential though which may have salvaged me some points. To be fair she'd had sweating and a history of urinary reflux as a child though, so it wasn't an entirely stupid mistake to make (just 99% stupid).

Was feeling really good when I walked out of there. Now as the night rolls on I'm progressively feeling worse and worse about my prospects as I remember and read more and more stuff I missed.

 

[Hayden]

Is there a minimum you have to pass?

 

[Matt]

I felt really good coming out of there, but in retrospect now feel like I missed major stuff on almost every station.

1.) forgot to check patient ID and simply mentioned that I'd label the specimen, didn't do it.

2.) Feel like I nailed this one. Clinically it sounded like alzheimers, but had some vasc path history and hypertension so potentially vascular as well. Also mentioned withdrawl, possible decreased affect so depression was on the cards. Had UTI recently, and gets them often, so delirium was in the differential. No disinhibition, hallucination, concrete thinking etc. etc.

3.) Diabetic one was lonnnnnng. I missed out heaps, what I did get was

- Sensory loss to sharp touch, vibration and proprioception in feet up to about knee level.
- Decreased pedal pulses
- Acanthosis nigracans
- rubeosis iridis
- tendon xanthelasmata (not diabetes per se, but relevant)
- asked for BP, UA and BSL

4.) Did ok, only tested sensory trigeminal in one domain though

5.) Did well on this one too, pretty cut and dry hypothyroidism. For the last few years has noted weight gain (10kg), cold intolerance, hair loss, dry skin, fatigue, increased sleep, occasional depressed mood, growing lump on her neck. Mother had underactive thyroid. No past thyroid investigations. Diet she described has lots of iodine. Most likely hashimoto's thyroiditis or incidental goitre + depression or mix of the two.

6.) I have no idea how I did, it seemed to go ok, once we cleared up that it was making a false choice to say "yes" or "no" to treatment and was a spectrum instead, made some good headway, but lots of people described asking and saying lots of things I didn't which sounded really good in the quarantine holding after.

7.) Stuffed it, was going really well but ran out of time, again diabetic, but had very little in the way of cardiac pathology. I called an ejection systolic murmur, a lot of diabetic signs, nail pitting (couldn't for the life of me remember what this meant, but he didn't ask), nail clubbing.

8.) Stuffed it. Textbook nephrolithiasis case (I mean bleedingly obvious, literally) I called as pyelonephritis, had nephroithiasis as my very next differential though which may have salvaged me some points. To be fair she'd had sweating and a history of urinary reflux as a child though, so it wasn't an entirely stupid mistake to make (just 99% stupid).

Was feeling really good when I walked out of there. Now as the night rolls on I'm progressively feeling worse and worse about my prospects as I remember and read more and more stuff I missed.

And this, ladies and gentlemen, is a textbook case of someone who obviously did really well but insists on acting like they did poorly. Which really helps no-one and just makes others, who perhaps didn't do so well, feel bad about themselves.

Of course you're going to realise you missed a whole heap of stuff if you read over the station content in your textbook. No one remembers everything. Zomg, Kyle.....

[offtopic]PS though, are we going costume shopping today?[/offtopic]

Hayden, the school has been very secretive about just how many stations we're allowed to fail, or how many borderline grades we're allowed to receive. We think this is because they want to gauge the overall student response before they make any definitive decisions. Which, considering we're the first cohort through probably makes a bit of sense.... but it's not so great for the students.

 

[Kyle]

We did get told by the Professor of Clinical Education/ Clinical Dean for that clinical school that we could fail one or two stations and "it won't be the end of the world".

 

[kloudsurfer]

So is the year 1 OSCE formative? I thought it was summative but someone said its formative...?

 

[woozy]

Formative, but you still need to pass! Overwise you have a date with Dr Carl/Ian

 

[kloudsurfer]

Soooo, technically its not formative, its pass/fail? Thanks btw.

 

[Kyle]

Does your unit outline say if it's a barrier?


"(25) The University reserves the right for it to be necessary for a student to pass a particular assessment task or tasks in order to pass the unit (even if the total mark amounts to more than 50%). Where this is the case, it will be clearly stated in the documentation approved through the Courses and Units Approval process for the unit and on the information provided to the student in the unit outline."

 

[woozy]

Not to sure, a few students even managed to fail PPD last semester (not because of attendance) and had to front up to Dr Carl, etc and explain themselves.

 

[Matt]

[offtopic]The meetings with your year coordinator after failing a piece of assessment are not about "fronting up" and "explaining yourself'". They're a discussion for year coordinator and supervisor to work together in identifying why the student was having problems and what can be done to fix them. The aim of medical schooling is to develop competence after all.[/offtopic]

 

[rusty_rouge]

OSCE was, I think, fair overall. The stations were good, and reflected things we have learnt about. I just tend to get hung up on the '7 minutes' thing, because I take a lot longer to interview and examine patients, haha, and I like to think that I do it thoroughly! So some exams I didn't get the opportunity to finish, only say what I would do if I had more time.

Oh, and I had major stage fright (which several attendings commented on). Sucks to be scared.