OSCE II… In Review

Monday, April 23, a date that has been haunting me for the past few months, marked the day that I embarked on my second Objective Structured Clinical Examination: The OSCE.

Having swallowed 400mg of GABA (an inhibitory neurotransmitter, which shuts off the fight or flight sympathetic nervous system) and a litre of water and having an empty stomach due to running to the washroom with various episodes of diarrhea, I felt “great”.  There is something about the sensation of waiting outside a door for 1.5 minutes to plan your case that makes your heart palpitate beyond all control.  One of our professors joked that it was like waiting in line for a roller-coaster ride at an amusement park.  Excuse me?  It was more like waiting in line for your turn at the execution block… but maybe he’s not a roller-coaster kind of guy.  The cases I got were chronic cough and nausea with abdominal discomfort.  So, after jotting down some random, useless notes, I summoned up all the composure I could find and nervously awaited my fate.

The harmonica goes, I open the door and plunge into the room.  Hand student card to evaluator (try not to drop it on the floor this time around), try not to look him/her in the eye, wash hands with foul-smelling hand sanitizer, shake patients’s hand, try to ignore the fact that your own hand is sweaty and shaking, look him in the eyes and say, “I’m Talia, I hear you have a cough…”.  Shit, I didn’t actually say anything out loud, whatever came out of my mouth was a garbled mumble, ok, repeat it.  Try to make your voice come out calmly and smoothly.  This proves to be a challenge.  Ok, now sit in the chair, try not to miss it and land on floor, encourage brain to send messages to postural muscles, to inhibit the muscles that are shaking, annoyingly, of their own accord.  Remember to make eye contact with the patient and try not to look as harassed and terrified as you feel.

I look down at my sheet.  I have “LODRFICARA” written on it.  What does that mean? Right, an acronym… one I’ve gone over a million times.  I hate acronyms.  So… L… location.  Doesn’t apply to cough… O, onset, “when did your cough start?”  The questioning becomes easier, you being to relax into it, however, you find that, only if you remain slightly disconnected from reality, you can stay on task and not freak out.

Before long I find that I’m out of questions to ask.  It must have taken only 3 minutes to go through them all… I’ve sure there were more…  We’ve been told that we should spend at least 10-12 minutes on the patient history.  “Ok,” I say, “I guess… I’ll start performing a physical exam, if I think of more questions, I’ll just… ask them.”  Damn, where’s my professionalism and confidence at?  I guess the marks for those are the same place as my breakfast – down the toilet.

Afterwards, I complete what I set out to do, and sit in wait for the damned thing to be over.

So, at the end of it all, I learned some things from this shove-you-off-the-side-of-a-cliff-and-hope-you-bounce approach to learning and examinations.

– Even though the history taking felt like it took 3 minutes, it must have taken at least 6-7.  Note to self: if you ever want to kill time, say at a bus stop or something, take a patient history.

– Asking about sexual history is just as awkward as you thought it would be and you never thought there would actually be a time when you’d be flooded with relief when the answer to “are you sexually active”, even when asked to a 30-year-old, is a simple “no”.

– My percussion sucks and I have no idea how to chart.

– I can only keep one physical exam in my head at a time.  With lung I could have checked the lips, clubbing of the fingers and capillary refill for good measure… but I decided to just focus on the lungs. Oh, well, room for improvement…

– I need to remember the word “bronchitis” for future clinical encounters.

– Even though I consider myself an avid Bob Dylan fan, I have come to seriously hate the sound of harmonicas (which signal that the exam is starting), except when I finished and spent the rest of the encounter awkwardly staring at my clipboard (or the patient’s chest, until I caught myself), willing the time to finish so I could leave.  In that case, the sound of a harmonica was a blessing.  Thanks, Mr. Dylan!

– Nothing I eat for a while will ever taste as sweet as the slightly stale Nature Valley granola bar that they gave us at the end of the exam.  Ahhh… our OSCE is over!

Congratulations to all second year CCNM students! OSCE II is officially behind us! We did it!

Update: for more hilarious info on the OSCE, check out this video that my classmate, Erica, found and posted on her blog:

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