Wednesday, March 14, 2007

Biochem Seminar, PBL, and OSCE

The seminar this morning was about nucleotide and amino acid metabolism, and it was pretty dry--lots of pathways. I think about half of the class didn't come. (The new attendance policy doesn't go into effect until after we get back from spring break at the end of the month.) There were some really interesting parts though. I think the best story the speaker told us was about a researcher named Victor Herbert, who wanted his clinical fellow, Louis Sullivan, to undergo folate deficiency in the name of science. Sullivan was not having any part of it, so Herbert did the experiment on himself instead. He wound up almost dying from potassium deficiency, but he managed to collect excellent data on the course of folate deficiency.

PBL went well. We are still doing the case about the doctor with the twin brother, and it has some very interesting twists to it. Happily, I don't have a learning objective to do for Friday this time.

I spent a couple of hours this afternoon going over all of the questions we are supposed to ask patients for each review of system. (There is a set of questions that you have to learn for each organ system.) A bunch of us also viewed the physical diagnosis video that comes with our textbook. We were divided into four different groups for the OSCE. I was in the last group that went at 4:15, which is why I had so much time to review beforehand. The sessions are held over at Case at the Mount Sinai Simulation Center. There are three simulations: two that last fifteen minutes each, and one that lasts 30 minutes. In each case, there is an observer in the room with you who has a checklist and is there to verify whether you complete all of the tasks. I did the two short simulations first, then the long one. But half of the people did them the other way around.

Here's how it goes. You are not permitted to bring a cheat sheet into the room with you, but they give you scratch paper on a clipboard. You stand outside the door of the "exam room" where the actor (standardized patient) and the observer (one of the clinical preceptors) are waiting for you. On the door is a sheet of paper that gives you some info about the "patient" (name, vitals, complaint) and what tasks you need to do (take a history, perform an exam). You are able to make notes on the scratch paper. Then you go in there and begin the exam. At the end, the observer gives you five minutes of oral feedback, which is later followed by a written evaluation that goes into your portfolio as evidence toward your clinical skills competency. Each simulation is videotaped, although in previous years the tapes have not been usable. I will post some OSCE tips for you rising M1s later, but that is the general gist.

My first "patient" was there for a physical. I had to get his medical and surgical history, find out what medications he took, and ask about his allergies. Then I did a cardiac exam on him. Overall, this session went very well except that I was apparently standing on the wrong side of the patient while I examined him. The second one had a cough. I had to get the history of his illness, go through the pulmonary review of systems, and perform the pulmonary exam on him. This was my best exam. The observer really didn't have much to critique. The third "patient" was a woman who had abdominal pain. This was the thirty minute simulation. I had to get her history of illness, medical history, surgical history, medications, allergies, social history, go through the review of systems, and then perform an abdominal exam. I forgot to percuss her abdomen and ask her the CAGE questions for her alcohol use, but otherwise the exam went well. I was so focused on what I was doing that I didn't even realize until the end that the observer for this simulation was one of my communications preceptors!

Overall, the OSCE was a lot less stressful than I had expected it to be. In fact, it was even kind of fun. I am happy to say that I passed all three of the simulations, and as far as I know, so did everyone else. We are apparently going to be doing a few more of these OSCEs next year too. I'm exhausted now and pretty much just ready to crash. Unfortunately, I'm going to have to get up early though to finish my homework for my clinical research class.

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