Spring OSCE

On Monday, I participated in the feedback session for our Heme/Onc block. The students are supposedly asked randomly to participate in these feedback sessions, but somehow I sure seem to end up participating in an awful lot of them!

This week is the beginning of our GI block, and the seminars have been on the oh-so-appealing topic of diarrhea. I can't really complain, though. We've had a relatively light schedule so far because we're taking the spring OSCE this week. Yesterday, I had all day to study for the OSCE after the seminar was over at 10 AM, because we don't have clinic this week. Then I took the OSCE today.

It was worth spending the time to review all the exams, but in the end, it wasn't enough. This OSCE was much harder than the one we did last year, and I felt like I was really floundering around for a large portion of it. Like last year, we had to examine standardized patients, and there was a preceptor in the room with a checklist of skills we were supposed to demonstrate. But there were a bunch of new features as well. First, there were more stations (four in all), and they were much more ambiguous. We weren't told anything more than something along the lines that Mrs. Smith was here for a check-up. At the first station, I did a focused history and physical for a patient who had a sore shoulder. Afterward, I was getting feedback from the preceptor, who told me that I was supposed to do a complete history. He said that I did a good job on the parts of the history that I completed. But I still wound up flunking the station because I missed so many of the objectives.

Ok, well, now that I knew I was supposed to do a complete history, I could handle that. I went in to the second station, which involved counseling a patient on smoking cessation. That one went well and I got very good feedback from the preceptor. The next station was for an abdominal exam, and that one went well too. I had to write a SOAP note at the end, and I just barely got it done in time. But I totally missed the point of the last station. That patient had right sided abdominal pain and a cold, so I did the ENT (ear, nose, and throat) and abdominal exams on him. Then I gave an oral presentation to the preceptor. But it turns out that this patient's flank pain was supposed to be chest pain, and the preceptor said that I should have done a complete cardiac exam. I still don't really get how right flank pain was supposed to scream "cardiac problem!" at me. But I guess the lesson to take away from this is that anyone with pain below the neck and above the pubis is going to get a full cardiac exam AND a full abdominal exam from now on.

I am pretty disappointed about how I performed on this OSCE. Considering how much time I spent preparing, it's frustrating that I failed two out of the four stations. I have already emailed Dr. I, who runs our clinical course, to set up a meeting to discuss my performance. Don't get me wrong--I'm glad that I screwed up now and not on the clinical portion of Step 2 that I will be taking at the end of next year. But at the same time, this OSCE is supposed to be a demonstration of our current level of clinical and communication skills, and I know that my performance was not nearly up to the level of which I'm capable.