This post is a bit premature, since next year's M1s have a full year to go until they take their first OSCE. But since I just took my first OSCE this week, I figure I might as well offer some tips now, while I still remember how to do the OSCE. OSCE stands for Observed Structured Clinical Examination. I gave an account of my personal experience during my first OSCE a few days ago in a previous post. Here are my tips on how to prepare for the OSCE:
Memorize all of the Review of Systems (ROS) questions for the pulmonary, cardiac, and gastrointestinal exams. You will be expected to complete these three ROS, and you're not allowed to take notes in with you other than what you write down there on your scratch paper. So be sure to memorize these questions before the OSCE if you haven't already done that.
Memorize the history of present illness (HPI) questions. You'll definitely be asked to take a history of the patient's present illness, so be ready.
Watch the Swartz video showing the pulmonary, cardiac, and GI exams. Swartz is the man. Do what he does, and you'll be fine with the exams.
Sign up for one of the optional OSCE review sessions and go there with a list of exams that you want to practice. They have standardized patients for you to work with, and this is a good time to review some of these exams that you haven't seen in six months.
Here are some tips for performing well during the OSCE:
When you write down the info that's posted on the door, don't forget to get the "patient's" name. Then when you walk into the room, make sure to look the standardized patient in the eyes, greet them by their "name," and shake their hand while you introduce yourself as a student. ("Hi, Mr. Smith, I'm John Jones, a medical student working with Dr. X....") The names are easy ones that you'll have no trouble pronouncing, and my observers all really liked that I greeted the patients by their names.
Make sure to wash your hands before and after you touch each standardized patient. Forgetting to wash your hands is apparently a huge faux pas that is rumored to make you flunk the OSCE. So definitely make sure you do it.
Pay attention to where you're standing when you perform the exam. I didn't realize this, but there are apparently "rules" about which side of the patient you are supposed to stand on while you perform certain exams. One of my observers commented about me examining the patient from the wrong side of the table. Just FYI, both the cardiac exam and the GI exam should be performed from the patient's RIGHT side. There does not seem to be any correct side for performing the pulmonary exam, as far as I know.
Try to group the exams together so that you do not have to keep moving the patient more than necessary. In other words, do all of the seated exams first, then have the patient lie down and do all of the supine exams together as a group. Don't do some seated exams, make the patient lie down, then have them sit up again. This requires some pre-planning, especially for the cardiac exam.
Explain briefly what each test you perform is designed to do. The observers really liked that I took some time to tell the patients why I was doing this or that. You shouldn't spend too long on patient education during the OSCE, but it's definitely helpful to do a minute or two of it for building good patient rapport. Actually, that goes for real-life patient encounters too. And along the same lines, make sure that you don't use medical jargon when you explain things to the "patients."
Don't forget to ask about ALL medications, including herbals and over-the-counter drugs, when you ask what meds the patient is taking. A lot of people won't mention things like alternative medicines or over-the-counter remedies that they only take occasionally unless you explicitly ask them. So make sure to do this. Again, this is important to do with real patients too, because sometimes these drugs can react with prescription meds. Also, make sure to ask the patient HOW they take their meds, since sometimes they do not take them correctly. Have the standardized patient tell you the doses of each medication and when they take them. Finally, don't forget to ask the patients whether they smoke, use alcohol, abuse prescription drugs, or take recreational drugs. If they use alcohol, remember to ask the CAGE questions.
If your standardized patient confuses side effects with allergies, make sure to explain the difference to them in a respectful way. A lot of people get confused about these things. But you have to let the patient know that if a medication has a bad side effect, that is NOT the same thing as being allergic to that med.
For a patient who has some abnormality or pain, examine the NORMAL side first. This is especially important for patients who are in a lot of pain, because otherwise they might clench up their muscles, and you won't be able to complete the exam. Also, remember that for the abdominal exam, you should always auscultate before percussing, unlike most of the other exams where you percuss first.
Try to be as gentle and sympathetic with your "patients" as possible, but still follow the exam procedures you learned in class closely. If the patient tells you that you are hurting them, apologize and back off a little. You can make some small modifications if you need to, but you still have to complete as much of the rest of the exam as you can. That's another good reason to always examine the normal side first.
Give a suitable closing statement before you leave the room. It's very bad form to just walk out of the room at the end without transitioning well or letting the standardized patient know what you're doing. I told the "patients" something along these lines: "Ok, Mr. Smith, I think that's all of the information I need for now. I'm going to go get Dr. X now, and we'll come back and talk to you some more. It was a pleasure meeting you, and thank you very much for letting me examine you."
Be aware that the OSCE will probably be filmed, and you will be asked to sign a release form giving permission for this. You may choose not to sign the form if you do not want to be filmed. Also, you'll be given food (we got sandwiches and chips). Try to relax and have fun. If you totally ignore the observer in the corner, it won't seem as awkward to be watched, and you'll feel less nervous. The time really does fly by. I felt like I had just started the exam, and then all of a sudden they were knocking on the door to tell us that time was up.