Thursday, November 18, 2010

Nice Article (OSCE Exam)

Source : here

Today, I would like to share an article with all of you.. enjoy reading huh!


This is what you might call a “walkthrough” to the day of the exam, what happens inside the famous GMC building, from the minute you go inside, filled with tension and anticipation, till when you walk out, hopefully happy and confident! 

First thing make sure that you arrive on time, it’s better to come a bit before the time stated in your booking confirmation, because if you arrive later than that time, you might not be allowed to enter, so it’s better to be safe!

If you are coming from eastham (as most people would be), then the easiest way might be to take Hammersmith&city line, as it goes directly to Great Portland Street station, which is the closest station to the GMC centre, when you get out of the tube station, you will see the GMC building in front of you, it’s a HUGE building with big glass fronts, so you can’t miss it (this is the new GMC building in 350 Euston road). 

Once you get in the building, the receptionist will ask you to find your name in the list of candidates for that date, and you have to write down the time when you arrived, then you will be given a ID card on a neck band, but it will not carry your name or anything, then you will be instructed to take the lift to the 1st floor, which is where the GMC is. 

So now you are in the GMC, someone will come to you shortly, they will check your booking letter and check your name with a list they have, then they will tell you to get in one of their offices, where your documents will be checked, your data will be entered into the computer, and your photo will be taken for your ID card, then you will be asked to go back to the waiting area. 

Shortly after that you will be given your ID card and you will put it in the neck band, it will have your name, your photo, your GMC number, a color for your batch, and a number, which will be the number of your first station. 

After that you will enter the assessment centre, usually in groups of 4 or so, you will go to the locker room, where you will be given a locker key, where you should put EVERYTHING, you can NOT have anything with you in the exam, other than some tissues and your locker key and ID badge! We had our exam in the afternoon, so we were allowed to have the books until 11, then you will be asked to put all books in the lockers. 

Now comes the tough part, you will have to wait from 11 until 2, where your exam starts!! You will have a vegetarian sandwich lunch at about 12 or so, then you will be shown a short video about the exam and what to do in it at about 1:30. After that you will be taken to the exam rooms! 

The exam hall is made of 16 rooms, where you will have your stations, there are monitors that show how much time is left and there is a voice telling you to enter and leave the stations. 

Outside each room there is a bottle of alcohol gel, you will be asked to use it before you enter the station, you will be doing that in the 1 minute while you read your instructions, before entering the station. 

Usually, stations 8 and 16 are rest stations if there are no pilot stations, and most of the time station 7 is the CPR station, but it could be 15 as well! The main thing is that you will get CPR before a rest station. 

So what was my exam? Let’s go through it station by station! 

1- My first station was a rest station, not a good start after a 3 hour rest huh?? Anyway don’t worry if you start with rest as well, just relax, try to listen to the station next to you, maybe you can get a hint about it and you have 6 minutes to think about it!! As there are no instructions for the rest station, so you actually have a 6 minute break!! 

2- Then came the cervical smear station, it went fine, I started with the usual introduction, there was a light source turned off and positioned above the manikin, I told the examiner I would position it appropriately but he said that’s ok, the light we have is adequate. There are gloves there and you have to wear them, so it might be a good idea to be comfortable with gloves. The speculum you will usually get is the disposable plastic one, you should mention that you would throw it in the clinical waste bin, but the examiner said just leave it as we will use it again, same thing for the spatula as they will use it again, but mention that you will dispose of it anyway! It was a simple station with no problems at all 

3- Next station was a child diagnosed with meningococcal septicemia, talk to the mother, the mother was very concerned, basically you just have to tell her the usual things, but one common mistake is to tell the mother she can’t see her child, but actually she CAN!! This is very very important, as the mother was very happy when she found out that she could see her baby, and I confirmed that with several course tutors and paediatric registrars, all of them agreed that there is no reason whatsoever not to let the mother to see her child, it’s quite the opposite, the mother should be encouraged to see her child, but you will have to mention that she will be given a tablet (prophylaxis) to protect her, also ask if she has any other children, in this case she had another boy, so don’t forget to say that she should bring him as well just to have this tablet to protect him, but it’s nothing too serious, just a precaution, so that the mother won’t be too worried about it, at the end the mother was satisfied and had no questions. 

4- Then was a station about multiple sclerosis, the patient had a discussion with the consultant but forgot some parts of it, in the past he had an episode of optic neuritis and was given dexamethasone for it, and also had an episode of leg weakness which resolved as well, talk to the patient. He was a young man, he said that he knows what MS is, and he read many things about it, but he has some questions, like the medications, so what I told him was that there is for example dexamethasone which he already had before (this shows the examiner that you read the notes well, and it’s like a gift as it’s already mentioned in the instructions!!), so we can give him that if needed, there is also interferons, which will help reduce the relapses and increase the durations of remissions, other than that there is the physiotherapy, occupational therapy, leaflets and all these things, he asked if he would end up in a wheelchair in 10 years’ time, so give him the “different people react differently” answer, but also say that for now we will start with these lines of management, and if any problems occur we will take care of them and take it from there! Finally he said that he read something about cannabis and that it might help people with MS, so I told him that I don’t know about that, but I would ask my consultant and get back to him on that, he was happy and we finished right on time! 

5- Next was chest examination with peak flow meter. The patient had taken his top off already, so after the quick introduction do a quick general examination, just the hands, mention that you would do the pulse and respiratory rate, but you don’t have to do them, check the tongue and JVP, then move to the chest. I did the inspection, palpation, percussion and auscultation of the front and axilla, then I asked the patient to sit up on the couch to examine the back, half way through the back examination the 4:30 bell rang, so the examiner said “ok doctor, the patient is normal, what would you do next”, so quickly I took the peak flow meter, talked about it and demonstrated its use to the patient, but by then the 5 minutes were over, so I said quickly that I would come back to ask him to demonstrate it, thanked him and the examiner and went out. 

6- After that was a station about testicular examination, now I have never seen this station before, and until then I have never seen the model of the scrotum before, I was told after that that Swami has this manikin, but I don’t know for sure, anyway it’s a model of the scrotum only, not a full manikin, it’s lying on the table in front of you, and you have a torch as well. I think the examiner was very good in this station as he guides you with his questions, maybe because many people get scared and don’t know what to say! So he asked about the patient’s position when you inspect the scrotum (standing), then what would you do, then the spermatic cord and it’s contents, after that he moved to the palpation of the testicles, there was a hard mass on the right side, after that you do transillumination, finally he asks you about your diagnosis, I was mentioning the tests that I would do when the bell rang, so I had to leave, but I think the examiner was nice and he probably gave most people good marks. 

7- My next station was history taking, you are the doctor in GUM clinic, take history from this patient, the instructions also said do NOT council the patient, and do NOT discuss HIV. That was a bit confusing, you will know why very soon. The patient was a 60 year old man who had SEX with a prostitute in paris 2 weeks ago, and the condom came off during that, so he is worried, basically everything was negative!! So at the end of my history taking I was confused, I wanted to say that we would do some tests and examine the patient, and that he should practice safe SEX till we have the results, but I was afraid this might count as councelling, so I asked the patient if he had any questions, he said that he is worried he might have a venereal disease, all what I said was that from the questions I asked him seems that he doesn’t have any problem, I should have mentioned the tests and everything, but the instructions confused me, but I think it’s ok just to mention the tests and antibiotics, don’t go into too much details! 

8- Now it was time for my second rest station, which was nice and a welcomed relaxation for a few minutes, waiting for the rest of the exam to be over!! 

9- Then came one of the most difficult stations!! Primary survey!! The scenario was that the patient fell from some height (I think it was 2 meters or so), do an initial assessment. So I entered the station, the patient was wearing a neck collar, he was conscious and talking as well!! (Now before I start I don’t think I did well in this station, so I’m not giving advice, I might have failed this station, but I’m just saying what I did in it). So what I did is that I introduced myself to the patient, asked the patient if he has any pain, he said he had some pain around his pelvis, so (and as all courses say), I asked him if he wants a pain killer, he said yes, so I told the examiner I would offer the patient pain killers, and much to my surprise he asked me “which pain killer would you use??” Now I was really scared, but I said diamorphine, and even more to my surprise he asked “what dose?”, so I said 2.5-5 mgs (as it is in MI and the rest of emergencies. And to add to my shock he said “well doctor is it 2.5 or 5 mg?”, so I said 2.5 mg, after that he asked about the route of administration, so I said IV, finally he said ok, proceed!! Now that was a minute gone, and my nerves shattered!! So I was told in one course that if the patient is talking and breathing normally then the airway and breathing are clear, and that you should start with circulation. So I mentioned the usual investigations and everything, then checked the heart, the abdomen, and moved to the pelvis, I said I would expose it properly, inspect for bruises, deformities, bleeding, blood on the tip of the urethra, the examiner said that there isn’t anything, then I said I would check the parameters (pulse and BP), and he said BP is 110/70 and pulse is 80, so I was confused, I suspected that I should have mentioned the pelvic spring test, but I didn’t as there was nothing positive about it other than the pain!! Anyway I moved to do the rest of the survey and time was over when I was checking the pupils! I think this was my worst station in the exam!! 

10- After that I had venous sampling, which was plain and simple, no twists whatsoever, just the basic venous sampling that all of us can do blindfolded. 

11- Next was history taking from a patient with panic attacks, this was actually said on the instructions!! And as soon as I asked the patient what was her concern she said everything basically, that she has these attacks where she feels she can’t breathe, her heart pounds and her hands shake and sweat, and that they started when she was on the bus or the market, but now they are occurring whenever she tries to go out!! Anyway it was very simple and no complications at all. 

12- The next station was paracetamol poisoning, talk to the patient about management, but don’t assess suicidal risk, it was easy too, you have to talk to the patient about the management in simple terms, you also have the graph in the room with you, so you can use that as well, the patient seemed happy and just asks when she can go home, so you can say that you will repeat the test for her blood thickness (INR) the next day, and if everything is fine she can go home then, she was happy! 

13- Then I had a station about a patient who was diagnosed with left ventricular failure, form a management plan and talk to the patient. The patient was a lady who loves to talk!! She wants to know what she has (LVF in simple terms), the medications (water tablets), she said she goes to the toilet often now! So she doesn’t want to spend all day in the bathroom, so I said we can give it a try to see what happens, and if she is not happy we can switch to another medication. Then she asked what other medications, I mentioned ACE inhibitors for example, and I mentioned the cardiac rehabilitation team, the follow up appointments, and the leaflets, she was happy but we ran out of time by then! 

14- My next station was upper abdominal examination, the instructions said that the patient has pain in the right upper quadrant, related to meals, and other details basically telling you its cholecyctitis! When you enter the station the patient is lying on the couch, wearing jeans but has taken his top off, the examiner surprised me as he was a bit pushy, I wanted to do a quick general examination, but he told me “just stick to what the instructions say”, then he actually took me to the foot of the bed asking me “can you see any abnormality?”, so I said no and mentioned what you look at on inspection, he asked then what next, I did superficial palpation and deep palpation, the patient had positive murphy’s sign, then percussion (all through the examiner was asking about what I can find and what I’m doing although I was giving a running commentary!), so after that he asked me what I think, I said the usual “I need to do some tests but seems likely that he has acute cholecystitis”, and he seemed happy. However I was shocked after the exam when I remembered that the patient was lying in 45 degrees and not completely flat, and that I did my examination in that position!! It was mainly because the examiner took me by surprise!! Now I have 2 explanations for that, either the examiner was trying to trick us to miss the correct examination position, or that it was done for the comfort of the actor, and he was pushing just to get everything done in time and because they have been there probably from morning and it was almost 4 by then!! And I think the second option seems more likely! 

15- Then I had blood pressure, the patient was a young thin guy, you have the 3 cuffs and the sphygmomanometer with the rounded dial, just choose the adult cuff, explain the procedure and get on with it, I got the systolic pressure as 90 on palpation, then I got a reading of 88/64 sitting (the examiner is listening too as you know), write it down as soon as you do it, then I asked the patient to stand, and repeat it again as you all know by now, I got a reading of 90/72!! Time was over by then, I thanked the patient and removed the cuff quickly before leaving, I think I might have got one of the readings of the diastolic pressure wrong, and I also think that I forgot to support the patients arm on standing, so I don’t know if I got a D in that station or not! 

16- The last station was the CPR, it was a child in a hospital ward, very basic and very simple CPR, nothing out of the ordinary, and as soon as you call the crash team and come back to do one more cycle the examiner says ok doctor, that’s fine! 

After that the exam is finally over, you go to your locker room, get your stuff, hand your locker keys and ID tags, then go down, sign in the reception that you are leaving and hand out the neck band and leave!! Then you only have the horrible wait for 2 weeks till you get your result!! 
Hope you have enjoyed this trip to the GMC, and hope that it gave you some idea about what to expect, the main thing is to try and be confident, this is the toughest part of the exam, but believe me if you are confident and sensible, you will do fine in the exam, even if you mess up one or two stations, just try to stay focused and concentrate on the rest! The most important advice I could give anyone is: be confident, try to relax, appear confident and professional, and be nice to the patients, this is not an exam of knowledge, it's an exam of presentation, and if you can present yourself in a good way, then you will pass this exam! 


Belle' : I like the ADVICE! and To All Phase 2 RCMP..Gud Luck for our becoming exam!

1 comment:

Sharkyra Kid said...

tak link kat fb ke? utk dak2 phase 2. huhu. ade mase ke dorg nk bace? ;p