OSCE

For those who doesn't know what OSCE is..it's an acronym for Objective Structured Clinical Examination..which is a method of medical student assessment..different med schools have different ways of running their own OSCEs...we have 12 active stations..in these stations, we had to perform a task which might involve us having to examine a patient, explain our diagnosis, investigation findings or management, take a history, or counselling the patient..apart from role-playing we also have to describe a photograph, videos or just whatever it is they could come up with..each stations last for 6 minutes and we have 1 minute reading time before we enter the door to each of the stations..this time, we were also given the information for our next 3 stations that we can work on during our rest station..in total we have 12 active stations and 4 rest stations...6 of the stations are for paeds and 6 for O&G..

I was among the 17 students from metro sites who had to sit our OSCEs at Traralgon (a rural hospital)...most of us were volunteers and the rest like myself were picked by the uni people to sit our exam there as there weren't enough enough examiners to accommodate us all here..I'm not sure if I should consider myself lucky or otherwise...the theory is, rural doctors are nice so they might be more lenient with marks-hence why some of us did volunteer to go there..Traralgon is 2 hrs away from Monash Clayton..thank God they also arranged a bus for us to go there!

I warn you this entry is gonna be lengthy and boring!as I'm gonna be talking about all of the stations...

Each station, the assessor will have to mark us according to the listed criteria and also provide a global score..a global score will be marked as clear fail, borderline and clear pass..

Station 1-6 are all paeds stations which I did badly..I doubt if I passed any of these...

Station 1
In this station we had to explain investigation findings of a child who presented with pallor and tiredness. FBE and ferritin revealed that she has iron deficiency anaemia. After explaining the blood tests, we also had to explain our management. We had one iron-deficiency anaemia when we were in 2nd year and I didn't do well then either..and now they're giving us a similar station?only this one is a child who doesn't eat meat and the one back then was a mother who is breastfeeding and sufferring from post natal depression(PND)...(I failed to pick that up...anyway, we were only 2nd yr students back then, how do we know there's such a thing as PND??and where they can get support from?)
This time, I was too nervous as this was my first station, I couldn't remember anything about the dose of iron that we should give and how to follow-up the patient..only when I have a chat with De'a at home I recalled answering a question in a book about the dosage and how much it is...
please doctor give me a clear pass anyway....

Station 2
We had to take a history from a mother who came in with her 10 week-old daughter who hasn't been putting on weight..her history doesn't reveal any obvious symptoms that I can put down to any particular causes...we then had to describe the baby's chest X-ray and propose our management..she had heart failure secondary to VSD...I only mention diuretics..I know there's another drug, it wasn't enalapril...when I'm on the way home, then only I recall it is captopril...

Station 3
This is a written station. We had to watch a video of a child who was born at 25weeks' gestation weighing only 697g..He is now 18 months corrected-age..our task is to comment on the child's fine and gross motor skills according to Denver Chart...I thought it wasn't supposed to be that difficult but it turned out 6 mins was too short to look at the video, Denver Chart and to write...especially for someone like me who hardly ever look at Denver Chart before this..when the bell rung and I was about to put my answer sheet on the box then only I realised, there were 2 other questions at the next page...without thinking I just wrote 3 month old for both fine and gross motor skills...that was definitely wrong!I think he is only around 1 month old according to Denver...

Anyway, can you believe a baby born weighing only 697g? I've seen a baby who was born at 26 weeks in the neonatal intensive care unit...she looked very fragile...I googled 26week baby and this is how they look like...imagine performing surgery on them...



Station 4
In this station we had to describe otoscope image of a child's ear who came in because of regression in his speech development...after that we had to explain the audiology results and propose management..it was very stupid of me not to know how does a left or right ear should look like when viewing with otoscope..from the audiology results, I know that it wasn't sensorineural loss but at that time, I can't recall what is the other form of deafness...if only I wasn't too nervous I should be able to tell them that it was conductive deafness...there are clues from the audiology results anyway..instead, I just kept quiet until the examiner gave me the diagnosis of bilateral conductive deafness and asked me to explain that to the mother..I bluffed all my way through the last part of the station, saying that the deafness was because of 'glue ear'..and I told her that her soon should have tympanostomy done...she asked if antibiotics would be useful and I simply said that it won't..honestly I don't know if it's gonna work or not but I just just tried to look confident and pray that I gave the right answer!
When the bell rung and I have to leave the room, I catch a glimpse of the assessment sheet and I can see that the examiner marked the global score as borderline...strangely enough I'm so happy to be awarded borderline as I expected her to mark me as clear fail!I guess I was right about the treatment...

Another stupid thing that I did was I said to the mother, "U have bilateral conductive deafness..."

Station 5
In this station, we had to explain our diagnosis to a mother of child who presented with polydipsia, polyuria, nocturia and lethargy...the blood test showed that he had high glucose and ketones...apart from explaining what Type I diabetes is we also have to explain our management for now up until the next 10 days..as usual, I stumbled all the way! I just hate hormones...I can assure you, I won't become an endocrinologist..

Station 6
This is another written station. We had to watch a video of a 2 year-old girl who came in because of coughing on a background of viral illness a few days ago...We had to write down what are the findings that we can tell from looking at her especially her chest...
Again,borderline, clear fail, clear pass??no idea!

I had rest station after this and I accidentally take the whole answers sheets that was for other students to fill up when they reached that station. Thank God I realised that soon enough or I might jeopardise other people's OSCE..I remember in our second year OSCE where we had to teach the patient how to use oral contraceptive pills and I actually took the pills with me to the next station that the examiner had to come looking for the pills from me...
there's always something funny happens to me in OSCEs...


The rest 6 stations are all O&G stations which I thought weren't as bad as the paeds ones..there was one station in which I ran out of questions to ask the patients..my task was to take a detailed and thorough history from a couple who came in because of infertility..they have been trying to get pregnant for the past 3 yrs...I don't know how much detail I should get into their sexual history(should I ask them how frequent they had sex??what position??-of course I didn't dare to ask such things)...it was frustrating that every questions I asked, the answers were all negatives...I focused most of my time taking history from the wife but I don't know what else to ask the husband that I asked him if he ever contracted mumps which he said yes.(how common it is that mumps was the culprit??ahahhaha..very rare I think)..I sat there in the room not knowing what else to ask until just before the bell rung that I asked the husband if he ever fathered another child!That was the most important question that everyone would ask in the beginning...I also didn't ask about the alcohol, smoking, drug and occupational history which would be relevant!
There was also another station in which the pregnant lady was diagnosed with Gestational Diabetes Mellitus..I just talked continuously but I have no idea if what I said was right..I told U I hate hormones and how come there were 2 types of diabetes examined in one OSCE!!!