I’ve recently learned that the OSCE isn’t part of every medical school curriculum, but I believe every school has some variation of it. The OSCE is part of our Art and Practice of Medicine course (APM). APM is dedicated to helping us learn clinical skills, like history taking and physical exams. At OUWB we get exposure to the clinical atmosphere very early on by utilizing our clinical skills center in Troy, MI.
During my M1 year we had two OSCE’s, one that was ungraded at the end of semester one, and another graded at the end of semester two. Even though I was pretty comfortable taking a history, I was still really nervous for my first OSCE. I wasn’t sure if I had prepared enough and I didn’t want mess up any of my physical exam skills. After speaking with an M3 and some other classmates, I’ve compiled some tips for success below!
General tips for the OSCE:
1. Wash your hands, do not forget. When standing outside of the patient door I reminded myself to do this.
2. When you introduce yourself make sure to tell the patient your first and last name AND your title. AKA I’m a first year medical student and I’m here to do X today. This helps clarify any confusion and ensures that the patient knows you are not the physician.
3. Practice empathy. Standardized patients (and real ones) pick up on subtle emotional cues like a facial expression or body gesture. If the patient is in extreme pain, your facial expression probably shouldn’t be one of excitement.
4. Validate the patient. What’s worse than having someone who doesn’t believe you? I often tell the patient, “I’m glad you came in today to see me. I can see that you’re in a lot of pain (insert other word) and we will do our best to take care of you today.” This helps reassure the patient.
5. Tie your hair up and use bobby pins if needed. I made the mistake of having my hair in a low ponytail during my OSCE and small wisps of hair kept coming onto my eyes. Anytime you touch your hair, you have to go wash your hands again.
6. If you forget a step and remember later, just do it as soon as you remember. It shouldn’t count against you (except in special physical exams when one procedure must come first).
7. Watch your patient’s facial expression, especially during physical exams. Especially during the GI exam and gynecological exams, we want to make sure our patient isn’t just trying to please the doctor when they are actually in a lot of discomfort. Facial expression usually doesn’t lie!
More for the M1’s:
1. You are still getting the hang of things, but take the OSCE seriously. Even though the first one isn’t graded (and you may be tempted to blow this off), think about your future patients and your instructors who will be assessing your level of professionalism throughout medical school.
2. Practice taking blood pressure, pulse and breathing rate. These seem simple, but it’s really easy to panic if you can’t find the pulse or aren’t able to use the equipment properly.
3. Flu shot–know where the lot number is!! I couldn’t seem to find it because it was in a different spot than where we were shown in the practice. Take a deep breath and keep looking.
4. Try to connect with your patient at a deeper level. Don’t force this, but wait for the right timing. Last year, my patient mentioned that breast cancer ran in her family. I took the opportunity then to show her charms I wear on my stethoscope to support breast cancer survivors and research, because I too have breast cancer in my family. I think she really appreciated this gesture.
5. It’s okay to be nervous. During my eye exam my hand was clearly shaking and I knew the standardized patient saw it. I took a deep breath and just apologized, telling her I was a little bit nervous. She cracked a joke and it made me a lot more comfortable. The standardized patients know you haven’t had a ton of practice, and they also know its better for you to be nervous and make mistakes now, rather than in clinic.
6. Practice “awkward” situations. Sexual histories can be a bit scary at first, but if you practice you will be ready for anything. Some standardized patients will not give you the “typical” story of I’ve been with my wife, and have had only a few partners. Some will challenge you, telling you they have had numerous partners, don’t practice safe sex, etc. This is how things will go in real life, they are just preparing you! What seems “normal” to you, may not be where the patient is as. Practice reacting to statements that are unexpected.
7. Make sure to get a FULL history. Patients are not going to list off all their meds for you with each dosage. You need to probe them! If they tell you they take something for their high blood pressure, the least you need to do is ask, “Do you know the medication name or dosage?” If they don’t know, that’s okay, at least you asked. Don’t forget to ask about those over the counters and herbal medicines!
8. Since the M1’s will have to do a flu shot consultation during their first OSCE (and with the rising anti-vax sentiment), I’d be prepared to counsel a patient who doesn’t believe in vaccines or strongly thinks they cause autism. Practice counseling a patient by being open and understanding, but at the same time getting them the facts about the vaccination and teaching them about the importance of being vaccinated.
9. Ask your M2’s to go through a mock OSCE with you! The best way to practice is to act it out with a partner!
More for the M2’s:
*although, all the above still applies
1. Time is of the essence. Compared to M1 year, you will be expected to do more than one physical exam plus a write-up in a short amount of time. That being said, if you are running out of time, don’t panic, just get as much done as you can.
What’s the USMLE step 2 physical exam like? Okay, so this is super far ahead, but I figured I’d dabble and see what this entails. There are 12 patient encounters, each lasting 15 minutes. You have 10 minutes after each to write a patient note. During these encounters you will have to decide which physical exams are relevant for the presenting patient. For the full run down check out: http://www.usmle.org/step-2-cs/#format
In my life…..
Things have been crazy busy and fun!! Last week I got to participate in my first casting clinic & went to Dr. Huang’s home for dinner with the AMWA group. The night was super relaxing and we got a lot of good life tips from her.
I met with some of B’s family for an early Thanksgiving dinner, since we will be out of town for the real thing. It was awesome! We had honey baked ham, scallop potatoes, two different salads, and a brussel sprout dish from Canada. One of B’s cousins also made some awesome drinks, I taste tested most of them! I’m lucky that his family is always so welcoming! We also got to meet a few new people, which is always exciting!