End of Year 3 Recap | Adaptability is the name of the game| OSCE Tips

This year presented an interesting paradox in which time seemed to fly by yet stand still in moments where it felt like we'd never arrive at this point. The race wasn't for the swift but for those who endured with fortitude and perseverance. I will admit it was without a doubt the most mentally taxing year which required a holistic perspective at all times. After all it is easy to have tunnel vision but because you have so many components simultaneously you cannot afford to dedicate all your attention to one thing at a time or you'll definitely be unprepared for many upcoming course assessments, quizzes, clerkships and PBLs. And let's not forget OSCE or OSPE! 

Adaptability is the name of the game. It can be confirmed that our entire experience for Year 3 was done online with the exception of two in person Skills practice sessions, one each semester. The practice sessions were really just that --practice. In my experience you had to be quite familiar with the list of skills that will be done on that day and demonstrate whatever knowledge you had from the reliable resources you used. Your demonstration was executed at timed stations just like the actual OSCE exam which only had a few modifications which I will discuss further. But essentially during this practice is where you have the opportunity to ask tutors, in the room, to clarify any aspect of the clinical exam that you are unsure of. You won't be able to do everything perfectly at this point but it is a wonderful opportunity to expose your weaknesses and reinforce your strengths. For me, I incorporated practicing skills in the first semester strategically to be ready for the main clinical exams in the first semester without it clashing and/or  taking away time from End of Clerkship (EoC) exams, pharm quizzes, PBL, and course assessments. The first practice was more like a demonstration of what to do and what's expected where the tutors really walked you through most of the station. Having an idea with what to expect helped it be more cemented in my opinion and allowed me to recall specific steps that they were looking for as well as areas you can be penalized. There was less focus on what you didn't know  and more on what's expected. 

The second practice couldn't be more different though. I'm not sure if its because of the experience being very new in comparison to the flow and execution --which was now all on you to do in the midst of your tutor and another student simultaneously. Whatever the reason, needless to say it didn't go as I expected even though I dedicated much more time to practicing each exam on those in my household religiously.  I went blank for almost every station and realized I was missing crucial aspects in specific examinations such as Tactile fremitus in the Resp Exam. Before going into that practice, I prayed a prayer that asked God to allow this experience to prepare me for the actual exam and reveal the areas I need to work on to be prepared for the final examination. At first glance one may be uncertain as to if this prayer was in fact answered-- it was. This experience allowed me to clarify exactly where I needed to refocus and how to move forward to truly be prepared for OSCE in precisely three months. I will summarize tips I applied below. 

These sessions preceded the in person OSCE which comprised 13 stations in which 10 were active stations and 3 were rest stations. It's important to note that there WILL BE a history taking session i.e. thyroid history, chest pain, shortness of breath, diarrhea, abdominal pain, etc.  and at least 2 PECH stations that can address a few main areas like; ethics, breaking bad news and/or dealing with difficult patients (note: you don't get to practice any of these before the final exam with a tutor). Your other stations MUST have at least two core exams such as Cardiovascular, Resp and GIT. Basic Life Support (BLS) is a station that ALWAYS comes and in some cases requires the use of the Bag and Mask to administer rescue breaths. Other filler examinations can come but are not limited to these include; Suturing, Venipuncture, Urinary Catheterization (male), Thyroid exam, Digital Rectal, Intramuscular Injection, Hernia Exam, CNS Lower Sensory and CNS Lower Motor Exam. Please note there WILL BE radiology stations so be acquainted with different imagery techniques such as CT scans, MRIs and X-rays at different anatomical sites such as the hand, wrist, foot, arm, mediastinum, abdomen, head/brain, etc. in different views such as sagittal, coronal, etc. For radiology you will get one Skills session that will shed better light on what is expected including aspects which may be tested such as the identification of blood vessels in the mediastinum, etc. 

Tips for OSCE Prep:

• Practice on family members or nonmedical friends in the beginning - I have a relatively large family and what I did was dedicate specific examinations to specific family members so whenever I thought of the exam, that person came back to my memory and I recalled the steps I did on them. It allowed me to compartmentalize the exams especially in cases of a lot of overlap and specific differences in what to look for amongst exams which all look at the hands. 
• Understand what you're looking for and why- There's many aspects of each exam and without understanding the principles at hand it will just be you trying to memorize or cram in some cases- which is a recipe to forget.
• Make a checklist and have the prompts in your own words- Do this in the form of running commentary. This style helps you demonstrate to the examiner that you know what you're doing and minimizes the chances of them missing any of the steps you're taking. BONUS: You don't have to say every single detail i.e. when looking at the hands, just saying two major details with the palms down and palms up is sufficient. These details will of course be based on if it is a CV, Resp or GIT exam. 
• Leverage your resources- There's many online resources that shed light on specific exams for OSCE so see which lays everything out best for your learning style and ALWAYS put it in perspective with what's required from your university at your level.  BONUS: Look at marking schemes that's available online and do the same. Ask upper class peers to clarify what's expected vs what's not if you don't have the opportunity to ask any of the tutors. 
• Look at videos online which demonstrate the exam in the way closest to what's expected of you- Not every video will be beneficial to prepare you for the final exam, in fact some may confuse you more than help so it's important to not take everything as gospel and compare to the recommended text Macleod's Clinical Examination. Disclaimer: even some of the things in this text is not recommended by tutors so try to double check with your tutors and peers what was expressed to them. BONUS: Watch the video while doing the steps and pause and playback when and where needed to master the maneuver. Let your patient watch it too because you'll be surprised how helpful they can be!

Now that you've done these tips, it's time to...

• Practice with medical friends- I recommend you do this after you've established your own routine. Try to use a medical student as the simulated patient versus a family member or non- med student. I volunteered to be the patient a few times and this really helped me know what to look for and by extension what to do especially in cases where I wasn't fully prepared with my routine. Friends can also help you refine your technique and modify things based on feedback from their practice or tutor interactions. 
• Time yourself- Know the time for each station and practice sticking with that time. In some cases you will realize you may need to leave out some extra things to stick within the time frame and cover the major aspects that the examiners are looking for with your running commentary.
• Clarify if you need to summarize/conclude, answer questions and/or state further investigations- For us we didn't have to do any of these things because we only had 5mins to do each examination but I recommend still being prepared for any of these categories but ensure that you do the clinical exam within the 5mins and anything else can come after. 
• Make sure to verify which maneuvers require the use of the bell versus the diaphragm of the stethoscope- Know how to adjust and switch between them based on the stethoscopes available or on your own while practicing. 
• Know your COVID-19 Procedures- Based on SARS-CoV- 2, there are some aspects of the exam we were not permitted to do i.e. those which produced aerosols- coughing  and the patient was not allowed to remove their face mask at any time - you could not look into their mouth or nose. Notably some maneuvers of the eyes required you to ask the patient to perform them on themselves and you would comment on the findings i.e. when inspecting the conjunctiva, you will ask the patient to pull down on their eyelids then assess if any  conjunctival pallor was noted.   

Equipment necessary:

• Stethoscope
• Tendon hammer 
• Measuring Tape (to measure the liver)
• Gloves (percussion with gloves on is very different compared to gloves off)
• 128 Hz Tuning Fork (practice setting in vibration)  
• Suturing Kit/ Sutures & Sponge 

Online resources I used: 

• Checklist- https://oscestop.com/ and https://geekymedics.com/
• Videos- Skills Department Videos and Geeky Medics
• Radiology- https://www.radiologycafe.com/ and https://radiopaedia.org/  
• History taking- Geeky Medics

I'd  especially thank my family and friends for all the support they gave me throughout this year.

All praise to Jesus! 

" I thank and praise you, God of my ancestors: You have given me wisdom and power, you have made known to me what we asked of you..."- Daniel 2:23 (NIV)  

Now time to prepare for Clinical Years...