OSCE: Objective Structured Clinical Examination {Old Post}

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

Helpful sites:

http://www.osceskills.com/ 

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!

Calling All M1’s: Organ System Studying {Old Post}

As the new M1’s at OUWB are almost near the end of the first semester of medical school, I’ve already started to hear the chatter about winter break. Some students are planning vacations and simply awaiting the relaxation time, while others are trying to get advice on how to prepare for organ system studying. Although I full-heartedly recommend RELAXING during your M1 winter break, I wanted to get this post written ahead of time because there is a lot of budgeting and buying in advance that goes into being prepared come day one of the second semester.

 I’m going to break down all of the key resources that I use to study, along with links and pricing and also talk about my favorite things about each one. Organ system studying is done differently by almost every medical student, so it’s important to find what works for you. The resources I’ve included in this post are used by nearly my entire class, so it’s worth checking into! I’ll also give a brief overview of how I study for organ systems.

Resources (click for link):

1. First Aid 2015: This has slowly become my holy grail. Great resource to check that you know all the high yield things pertaining to the unit. I annotate information from other sources (ie lecture, other texts, etc) in both this book and resource #2. It is a little bit sparser in the information, so I wouldn’t recommend starting studying from this book, rather reviewing with this text. ($45)

2. First Aid Organ Systems: I purchased the two pack, which has a great book for review of basic science (will come in handy for step studying) and the organ system book. ($45)

3. Rapid Review Pathology: Okay, this book will look a little bit intimidating when you first get it. It is basically a bullet point review of all the high yield pathology for each organ system. I usually read through it towards the end of each unit, because it does require some understanding of the material beforehand. ($50) 

4. Pathoma: High yield review of pathology in which you listen to Dr. Sattar and annotate in the text alongside. There are 35+ hours of video and the text includes some awesome images. I’d highly recommend purchasing this! (several packages exist with different lengths of access, but I purchased the 21 month pro which costs $119.95 now)

 5. Sketchy Micro: Anyone that uses this microbiology resource will give it 5 stars, I guarantee. This is an online video source that covers many of the different bugs you will learn during the organ system courses. They use sketches to teach you high yield facts about each bug. Highly recommend! ($159 for 12 months access, $99 for 6 months access)

6. High Yield Embryology: One of the topics I struggle with is embryology so I got this extra text to help me. I find it really useful because its short and to the point. I’d recommend seeking out additional resources for topics you are shaky in. ($32) 

7. Q banks RX and Kaplan: Both of these Qbanks are extremely helpful during the organ system courses. They are a great way to test your knowledge and learn new things. They both have explanations after each question as to why the answer choices are incorrect or correct. I find this really useful because I don’t necessarily need to go back into textbooks to find why something was right or wrong. Additionally, they both give a good break down of how you are doing overall and in each topic area. (Rx- several different packages, but I got the til you pass option which is listed at $299, Kaplan- luckily, our school actually pays for this qbank but if you are buying it you’ll be set back about $199 for the until your test option)

 8. Costanzo’s Physiology and/or BRS physio: Both of these resources are amazing for understanding physiology. I personally use both, but I know people who prefer one over the other. Both are nearly the same resource (written by the same writer), but BRS is significantly shorter and is in more of a bullet point form, while Costanzo is much longer and in paragraph form. (Costanzo – $53, BRS- $43) 

  One additional thing to think about is grouping together with your class to get discounts. I know our M2 class negotiated discounts on both the RX qbank and the pathoma access.

 Okay, so that was a lot of information and these still aren’t all the resources I use. I also use Lange pharmacology cards, occasionally I use the Lippincott’s microbiology cards, and Robbins & Cotran pathology questions (among others). You really have to experiment in the beginning to figure out what resources work for you and then stick to them. Below I’ve outlined the general scheme of my studying. As I’ve gotten more efficient studying for these courses, I’ve been better able to identifying which resources to use more heavily during each system.

Study Plan

1. Tackle physiology by during a first pass (read through once) of Costanzo

2. Start working through histology and embryology using High yield embryo, lecture slides, and first aid organ systems

3. First pass through BRS physio

4. Annotate Costanzo text into BRS physio (this allows me to get a second pass of both)

5. Listen to and annotate Pathoma (first pass)

6. Read pathology sections in first aid organ system (first pass)

7. Annotate Pathoma into first aid (this allows me to get a second pass of Pathoma and pathology in first aid)

8. Go back and review physio and annotate it into first aid (third pass)

9. Start learning pharmacology (pharm cards + first aid) and microbiology (using Sketchy Micro and Lippincott’s cards) (first pass, then I do these periodically until the exam)

10. Read through first aid organ systems in its entirety

11. Read through Rapid review pathology (first pass)

12. Work on Robbins & Cotran questions

13. Read through first aid step 1

14. Make any annotations from rapid review into first aid (second pass of rapid review)

14. Start Q banks, while reviewing all of the above (for q banks I do the RX bank first and do easy questions, then medium and lastly hard….after I do the Kaplan qbank with all of the levels of questions)

15. Revisit lectures I feel will be important or weren’t covered in any of the above resources

16. Revisit first aid organ systems and first aid step 1 (a few more times and one final read through the day before the exam)

 Obviously, this won’t make much sense to M1’s until you actually start organ systems. And in addition, there are some units that are light in physiology (heme/lymph) or heavier (renal and respiratory). So your studying will change depending on the structure and information of the organ system.

What’s new in life? So, we finished up our short endocrine unit this past Monday and some of the girls and I celebrated afterwards at the Rochester Brunch House. It was to die for!

We just started out reproductive unit, which I’m really excited about. My grandpa was an OB/GYN so its something I’ve always tried to keep an open mind towards. I think learning the pathology in this section will be really exciting. I think a lot of the M2’s are feeling a bit “lost” at this point in time. We are kind of in a rut where we keep doing the same thing over and over again (aka studying for each organ system). I’ve been trying to take some of my spare time to do new things and spend quality time with the people I love. I found this quote on Instagram (@typoworld) that I really liked and thought I’d share.

I didn’t take time of in between my senior year of college and first year of medical school, so I’ve been trying to do some “soul searching” lately. It’s important to give yourself a break during medical school and explore a little bit. One of the upcoming events that I’m super excited about is taking a trip over Christmas break. B and I are headed to Arizona (Grand Canyon & family visit), Las Vegas, and Park City, Utah (more family time).

Last, shameless plug to donate to my boyfriend’s Movember fund! Here’s some information on the Movember Foundation: The Movember Foundation is a global charity committed to men living happier, healthier, longer lives. Since 2003, millions have joined the men’s health movement, raising $650 million and funding over 1,000 programs focusing on prostate cancer, testicular cancer, poor mental health and physical inactivity.

Link: https://us.movember.com/mospace/12802221