| Home | | This page has information on the type of OSCE stations that you can
expect to face at Year 4 level. Many thanks to Amanda Zarrop, Joel Adams,
Dan Hewitt, Shea Wilson, Paris Bovel, Jemma Golding and Emma Richardson for contributing to this page with their stations from the 2004
exam. Special thanks to Jemma Golding who also provided content that she
had collected from 2003.
Year 4 OSCE Examination: General Advice
I sat the examination in 2002.
I strongly suggest you approach students who sat the Year 4 OSCE in 2003
(5th Years), and ask about their OSCE and what it involved.
This is some general advice about the content on the examination and how
to prepare for it.
Stations:
8 stations at 10 minutes each
1.
Psychiatry
 | This
station didn’t exist in 2002, so you will have to ask someone in Year 5 |
| It
is impossible to have real patients in a 10 minute station |
| It
is too hard to take a psychiatry history properly |
| It
is too stressful for the patients to be asked the same questions over
again |
| If
it is a station with a patient, it will either be an actor or the examiner
pretending to be the patient |
| The
station will most likely cover major topics, so be directed by your PBLs |
| 2004 stations:
 | Case study. somatoform/MDE/Mixed episode/anxiety/organic brain
disorder. The examiner from SCGH was a difficult examiner, provided no
guidance. Ambiguous station. |
| Psych was a filthy slut with some old fuck asking obtuse ambiguous
questions with multiple possible answers, his prompting consisted of Uh
huh, or anything else... It was a woman with symptoms that fitted
perfectly into the GAD DSM IV. but the old shit didn't seem interested
in me answering his questions logically. In later hindsight I
hypothesise that the woman could have had menopause because the was 50 old. |
| Had to read a vignette - pretty obvious anxiety disorder, then just
got asked a bunch of questions about anxiety disorders. Easy as
piss. Answered everything he asked, then he asked extra stuff,
answered that, he told me "excellent, well you can go" and so
I went to get a drink and stuff because I had an extra 3 minutes or so |
| Pretty easy- 56yo unmarried man with depression, assess risk and
describe risk factors. What questions do you ask- ie what info do you
want to get from this patient and what are his risk factors for
developing depression. They basically wanted a risk assessment and
alcohol/drug history with risk factors like his age, gender, marital
status, family history, socioeconomic status and education. |
| Assessing suicide risk. Not too hard. Psych was saying
that its important to speak loudly and confidently. |
| Discussion of panic attacks and panic disorder |
| Written case scenario to discuss: a 50 year old woman whose mother
died 3 years ago, complaining of headache, backache, low mood etc. DDx
was depression, menopause, somatoform disorder. |
|
| 2003 Stations
| I
had a lady with panic attacks and had to know the mechanism behind this
as well as treatment options... from what I've heard you could get a lot
of things but - there is no real patient just a story. The examiner
usually guides you well and if you can 'sound' like you know what you're
talking about I'm sure you'll pull through OK.. ie use the appropriate
buzz words - affect, insight etc... |
| We
got handed a piece of paper with a vignette on it, then discuss the case
with the psych- my case it was a lady in her early 50s - had to discuss
depression, also menopause as a differential. I know there was also one
vignette about personality disorders - the cases varied between sessions |
| affective
disorders, somatoform disorders, schizophrenia. You don't examine or
take a history from a patient, you just sit there with the examiner and
discuss a case. |
| discuss
a written scenario with a doctor. Mine was about depression, where the
prime concern is assessing suicide risk... this is SO
important to do. Other features of depression were discussed. The doctor
assessing me took a mobile phone call during my station, and he told me
to leave, saying that "You've done fine...you can go now..." |
| prescribe
an antidepressant (I believe it was an SSRI aka SRI)- and the important
side effects probably mainly sexual dysfunction. Suicide risk is
generally important for most situations but can't remember for that
station whether I did it- but he said I did fine. |
| elderly
lady on a drug cocktail including benzos - issues around benzo addiction
and withdrawal in the elderly. (not an actual patient - just a scenario
on paper)
|
|
2.
Geriatrics
In
2002 all students had to take assess a patient with regards to function
capacity (assess Barthel’s index via history), and then assess mobility
(timed up and go test)
Other
things might be:
| Performing
an MMSE (from memory) |
| Falls
risk (ED: note to 2004 4th Years- I warned you! See below!) |
| Dementia
vs depression |
Once
again, look at the topics you cover
2003 Station: know the MMSE off by
heart. I had to assess a lady for Dementia by using the MMSE, comment on her low
result, and what the possible causes (inorganic and organic) for such a score.
Know what scores are too low.
2004 station (Views on the same station):
| FALLS. Risk assessment. History of fall. Up and Go (gait). Functional
reach. Too much to do in 8 minutes. I just talked as fast as a could. |
| Geriatrics: had to take a falls history, pretty easy, nice old lady, then
had to assess her gait. |
| GAIT assessment, absolute dragon examiner. She really didn't have anything
astoundingly wrong with her gait, she may have been a bit shuffly with a
slight limp but that was it. She had a Zimmer frame. Take a history of the
fall and its risk factors. Risk Factors: Vision, mechanical- ie loose rugs,
medications, not using walking aids etc. HISTORY: Describe fall, medical
conditions, ADLs, supporting organizations (OT, Meals on wheels etc), you
know the drill. All about the Holistic approach. |
| Old lady sitting in a wheelchair. must take a history focussing on the
fall she had. Then do a general falls risk assessment. then assess gait. |
3.
Infectious diseases
Everyone
got something slightly different in 2002
Stations
included:
| Infection
control in the hospital |
| Pneumonia |
| Sexual
history and STIs |
Stations in 2003/4 included:
| View on the same station:
| Varicella in a 21 year old man: Basically the scenario was- 21 yo man in
hospital for elective surgery develops small vesicles on chest and abdomen
the day before surgery. (Took a while to get to chicken pox) Then questions;
Who would you contact about his condition, what would you do with the other people
in the room and what would you treat with. Blood cultures: Taken from a
patient grows G positive diplococci, but the patient does not develop
symptoms What could it be, (CP S aureus) So a commensal. Describe the steps
of taking a BC and where the operator might have contaminated the sample. |
| Seemed to really vary in difficulty. Mine was pretty easy
though. Talked through two cases. The first ended up being
about contamination of a blood sample with skin flora, the second was
about a varicella infection, risks, vaccination etc. |
|
| Views on the same station (note from Tim: this was exactly the same as the station I had in
2002)
| Just lady asking me questions about easy stuff, first question was
"what is the single most important infection control measure?"
"washing your hands!", then asked about Tb and needle-stick
injuries and stuff, pretty easy questions and she helped me get most of the
answers |
| Discussion of infection control procedures for MRSA, TB, etc (this was
a bit random) |
|
| Views on the same station
| bisexual male + travel: history + questions from examiner:
DDX/investigations/treatments |
| took a sexual history from examiner pretending to be a 20 year
old male with discharge. get travel history as well (he was on holiday
in Thailand and had sex with a Thai man up there. |
|
| Bacterial
vaginosis. |
| Really
easy. Discussed with the doctor VZV rash in a child. Also, the features of a
meningococcal rash and associated symptoms. Know a little about treatment
for some truly common infections (just basics...don't get hung up on doses
etc). |
| Questions
regarding treatment and causes of pneumonia.
Someone also got the same for meningitis |
| Know
the common causes and antibiotic treatments for Pneumonias, UTIs, STIs, IE
and a couple of others I can't remember. |
| All
about meningitis - presentation, tests, bugs, treatment.
|
Generally
a well tolerated station
4.
Ophthalmology
| Two
examiners at the station |
| There
will be a patient |
| Eyes
will be dilated for you |
| Examine
and describe what you see |
| If
you can, give a reasonable diagnosis and differential |
| May
want to mention other things you would look for (eg if diabetic
retinopathy, say you’d check symptoms in other systems, BSL etc) |
| After
that the examiners will ask you questions, and show you pictures of
conditions and ask for a diagnosis etc etc |
| 2004 stations
| Diabetic retinopathy. |
| Nice examiners. Joked around with the doctors for a bit as I
knew them from my rotation. Just briefly looked into lady's eye,
they asked me to say what I was doing. So I was like "ok, can see
vessels, following them to optic disc, there it is.. " "What's
the cup disc ratio?" "about 0.2, normal" "ok, stop
looking, come over here". So essentially had a normal
eye. How odd! then just looked at the pictures til the rest of the
time. |
| Glaucoma- Cup disc ratio. Have a good definition of glaucoma and a
basic treatment plan. Lots of photos- mostly taken from problems on the
web. Know when to say REFER as a GP. Know basic management- lubricating
drops and pain management and that HSV ulcers should NEVER get steroids.
Photos: HSV dendritic ulcer, Orbital Cellulitis, hyphemia, cataract, detached
retina, rupture of Retinal artery into the vitreous. |
| Use ophthalmoscope to check out old man's eye. Glaucoma. Can't
remember all the pictures they showed. |
| Guy with macular degeneration, also lots of photos of various
conditions |
| Man with 0.9 cup disk ratio and the lots of pictures. really easy! |
| Diabetic eye. Very obvious, then lots of obvious pictures, just be
able to recognise the major things that they stress will be in the exam.
(ie the stuff in the web quizzes) |
| Elderly
gentleman post-phaco and lens replacement. Examine eyes with direct
ophthalmoscope. Then got shown some pictures and had to say what they
were - very straightforward. |
| optic
neuritis?- don't know for sure. It's probably good to get on to the pics
if you can- with Russell Townsend as the coordinator last year they were
all from his lectures and if you knew em you could go through them in a
hurry. They also coached me through the ophthalmoscopy quite a bit my
guys. |
| retinal
exam of a patient, then name the conditions shown to you in a number of
photos |
| diabetic
retinopathy. Examining a sweet old lady with an ophthalmoscope.
Describing the proliferative stage of her disease, discussing the optic
disc, and a few questions about the features of diabetic retinopathy. We
then moved on to some photos (not everyone got that far), the only one
of which I remember was an HSV corneal dendritic ulcer that had been
stained with fluorescein. |
| a
look at the retinopathy pictures but I really can't remember these;
there was a picture of the cotton wool spots/hard exudates/flame
haemorrhages and you had to grade the retinopathy; a divergent
strabismus in a kiddie |
| first
there was a patient whose eyes you had to examine - he had cataracts
(easy as, yet I still somehow had to be coaxed into making this
diagnosis). Then they had a whole stack of ophthalmoscopy pictures and
you had to say what it was (so diabetic retinopathy, corneal abrasions,
etc ) - and they just flip through them and you get through as many as
you can in the time allowed. |
| Lady
with peripheral retinal scars from photocoagulation therapy - quite
easily seen, must check that peripheral retina though.
This type of surgery is usually done to repair retinal
detachment.. know a few
differentials for black masses on the retina and know those photos from
the ophthal atlas or website.
|
|
Medicine and Surgery
The
examiners want to see:
| That
you can develop rapport with a patient |
| That
you can conduct a relevant examination |
| Show
that you can do this rapidly and accurately (ie you have been seeing
patients during the year, and not solely buried in your books) |
| Be able to elicit the signs the patients have |
| Present
your findings back to the examiners in a logical and succinct manner |
| Ordered
presentation (ie not all over the place)
| Include
relevant positive and negative findings |
| Not
be a textbook (ie not rattle off a long list of irrelevant findings) |
|
| Be
able to offer a reasonable diagnosis and differential |
The majority of the marks are for history and
examination, not diagnosis!
| There
are two examiners at every station: usually a surgeon and physician |
| This
is regardless of whether the exam is medical or surgical |
| By
having a specialist from a different field, you should even out to what is
reasonable for a doctor to know who is not practicing in that particular
field |
| Note
that surgeons see medical patients and physicians see surgical patients |
| One
will be a ‘dove’ and one will be a ‘hawk’
| Dove:
helps you, gives you encouragement |
| Hawk:
tries to find fault with you |
|
| Don’t
guess the way the examiners will mark you… what seems like a harsh
response from the examiners may in fact be an above average effort on your
part |
| If
the examiners are asking you hard questions that feel above your level,
chances are you’ve picked up most of the easy marks already! |
Station Examples
Medical
| Neurology
| Legs: cerebellar signs and peripheral neuropathy à
chronic alcoholic with diabetes |
| BASTARDS gave us the Charcot-Marie-Tooth guy on the first day. (
I didn't do so well here I think but I didn't get any borderlines so I
must have arsed something. Basically LEARN YOUR GAITS and how to
describe them. This is where I fell down. (Metaphorically speaking)). I
was able to get out that he displayed upper motor neurone signs and that
seemed to be enough. They asked about grading for tone and where the
lesion was likely to be. (I think they were looking for internal capsule
but I only got out brainstem) |
| Neurological: lower limb. Pretty easy, purely sensory loss up to
knee, total stocking distribution peripheral sensory loss. Yeah,
fairly obvious when mapping sensation, motor skills fine, reflexes
absent. |
| Diabetic neuropathy lower limb (the man had a insulin pump). |
| Diabetic neuropathy (lovely stocking distribution sensory loss) |
| Obese diabetic man with peripheral neuropathy and necrobiosis
lipoidica |
| Same old necrobiosis lipoidica man that everyone knows, don't miss the
insulin pump hanging down his leg. He could feel nothing up till his mid
shin, and then all of a sudden the same stimulus caused him pain one
centimetre higher. He had a funny gait, but normal proprioception and
power. The sensory loss wasn't exactly symmetrical. |
| This
one sucked. My dude had a totally bizarre neuropathy that I still don't
know what it was. Take heart in the fact of knowing your neuro exams
well, be able to present the relevant findings concisely, and if you
don't know what diagnosis links them all together, don't fret. The
important bit is the examining, and being able to distinguish upper and
lower motor neuron lesions. |
|
| Cardiovascular
| Heart murmur, mixed AS/MR… I thought it was predominantly AS based on
other findings |
| Artificial heart valve: Examination. Which valve, what other symptoms
would you associate with the failure of this valve. I think it was
mitral regurg. They also asked some basic stuff like what are the left
heart sounds and what valves are they. Tricksy patient: HE HAD A BLOODY
MED ALERT BRACELET for warfarin. I didn't look but when asked I said it
would probably be for warfarin which was enough. He also had a stroke on
his right side. I think it was pretty important to comment on that and
on artificial valves being a risk factor for strokes. Also a few
measures against it. (ie warfarin, aspirin etc.) |
| a guy with two prosthetic valves. READ the medic alert bracelet if
they have one. |
| There
was AF and a murmur, probably MR or AS - they asked for a big
complication of AF to which one MIGHT reply, "thromboembolic
disease, SIR!" |
| A
tricuspid regurgitation
|
|
| Respiratory:
| I still have no idea what he had, weird stuff. I think I've blocked it
due to trauma. I'm suspecting cancer because he was rather cachectic
in hindsight. I said he was skinny, bah! |
| CAL |
| A guy with loud crackles. Didn't get a diagnosis but needed to know
DDx |
| Gentleman with COPD and (I think) bronchiectasis - coarse crackles
over a lower lobe, don't remember which one |
| Old man with bronchiectasis, one hand was wasted and clawed. He had
drain like things all over his chest. |
| COPD/pneumonectomy |
|
| Random conditions that appear from time to time
| Scleroderma/CREST syndrome |
| Charcot-Marie-Tooth |
| Cystic
Fibrosis |
| Lobectomy
or Pneumonectomy |
| Polio
there's one guy that does it every year; a jolly large man who has
buggered legs (LMN exam) |
| Motor
Neuron Disease |
|
|
|
Surgical
| Vascular
| PVD |
| PVD |
| peripheral vascular exam (Buerger's test positive) |
| PVS: Patient with a removed pinky toe. If you can do pulses and look
confident they are happy. Know Berger's test and what it actually means.
Wether it describes large vessel disease or microvascular disease. LEARN
Robbins for distinguishing arterial and venous ulcers. Asked for a DDx. |
| Peripheral vascular disease examination. Not tooooo bad |
| Dude with foot ulcer and various absent/weak pulses |
| Lady with PVD: one leg I couldn't find any pulses at all and there
were 2 scars, one possibly from CABG vein harvest and one from maybe a
femoral bypass. Other leg had all pulses palpable. She had a medic alert
we had to notice. |
| PVD: I could feel hardly any pulses, not even femorals, but heard a
bruit over one of the femorals, burgers was only v slightly positive I
just presented the findings. I felt like they knew that I knew what I
was doing. I got asked where atherosclerosis usually occurs. |
| Infected ulcers/ulcers in general |
| Know
the drainage of the two main leg veins, and how to distinguish between
arterial and venous leg ulcers. Do that Buerger's test (I got grilled on
exactly how long one should allow for the test, and how to assess the
results of the test, but my examiner was an "old friend"). My
dude had a whopping big scar on his medial calf, which I commented was
probably a vein stripped for a CABG... this went down well (ed: this
saved my arse too), and its probably the only reason my "old
friend" passed me on that station. |
|
| Abdomen
| Hepatosplenomegaly with surgical scars over abdomen |
| Mass in the lower abdomen- clearly delineated from surrounding tissue,
immobile with smooth edges. Know how to describe the mass- location,
solid/hollow, tender etc. Asked what tissues the mass could have arisen
from and ddx some cancers. I was lucky in that an upper year got a
carcinoid tumour one year and that's what I guessed it was, (and it
was). Asked about carcinoid tumours. |
| Biiiiiiig liver, as in the edge was way into the right iliac
fossa. About a 20cm span! I missed a giant spider naevi on
her back, oops. But was ok |
| Hepatosplenomegaly |
| Dude with obvious hepatomegaly and hernias (including inguinal - keep
looking for stuff even if you know their major disease) |
| Lady with hepatomegaly (don't know why) and a big incisional hernia |
| Lady with hepatosplenomegaly and giant incisional hernia |
| Palpable liver edge (note barrel chest, liver ptosed not enlarged),
divergence of the rectus and surgical scars from inguinal hernia repair
and appendicectomy. |
| Fat lady with lots of scars, she was in pain, so don't forget to ask
where the pain is and be gentle (I got her to roll over look under her
flanks and found more!!, good for me) hepatosplenomegaly. There was a
huge incisional hernia, (get her to look at her navel and lean forward),
I felt I did a wicked examination, but after that they asked me lots of
obtuse questions that made me feel stupid. |
| Carcinoid
syndrome |
| Polycystic
Kidney Disease |
|
| Thyroid
| Goitre |
| Although
the neck examination is simple, there are common pitfalls they will try
to hit you with. This lady had a necklace and was sitting in a chair
with her back to the wall. You MUST ask her to remove the necklace and
examine the neck from behind as I'm sure you're aware. You must also
request a glass of water for the swallow as you hold on to her neck
because it would be uncomfortable for her to repeatedly swallow.
You must remember to check for a very large goitre which may extend
inferiorly leading to SVC compression (Pemberton's sign)- get her to
hold her arms up for a bit and look for flushing. I mean, I think. |
|
General Advice from all contributors
| I think a lot of people underestimated the importance of studying for specialties.
I found that it was good studying in two parts for the OSCE. Practicing like
buggery on other medical students near the exam to get it smooth looking and
studying Robbins to know the theory. Also reading what upper years had done was
a lifesaver. Most importantly (especially for girls) resist the urge to laugh
nervously or look upset. I do it all the time on ward rounds but it will get you
in trouble here. Look the part- wear a coat, carry gadgets. If nothing else it
does make you feel more the part in the exam. Just like all medicine its a bit
about being confident and pretending you know everything.
|
| I didn't get one bloody
diagnosis, but as long as you can do a decent examination you'll pass easy. |
| Hope
it helps you out! Hope there aren't any booby-traps there either but I think
they're fairly common cases anyway. You have to remember not to be fazed by
the examiner's style - some are unnervingly jovial and others are just stone
walls - try to be confident in yourself no matter who you face and they'll
believe you, if you're confident. You just can't let an unresponsive man
make you feel too worried. |
| Please don't freak out (pass that
on to the others). You will actually pass - even though it doesn't feel like
it at times. Just be confident with what you know, and try to keep the
nerves under control. |
| All
I wanted to say was not to stress too much, I missed most of the important
stuff in my OSCEs (ie I missed all the signs in my abdo exam,
including an enlarged spleen; I called the patient the wrong name and gave
the complete wrong diagnosis in my vascular exam; in my lower limb
neuro I said it was an upper motor neuron problem and it was actually a
lower motor neuron problem... the list goes on... ) and I still got a pretty
good mark!! I think the most important thing is to look really confidant
even if you've f**ked up royally, and keep smiling and being really smooth
with your examinations- practice on each other as much as you can to the
point where you can go through the motions quickly and confidently, and
practice summing up a bit too- all they are looking for is that you can do
the examination with confidence and piece things together, even if don't get
everything you are supposed to find. |
| I think you can see that my
biggest piece of advice is FAKE CONFIDENCE!!! (ed: this is a dangerous
trick if you are getting things wrong) That is the most most most
important thing, don't let them psych you out!!!! |
| Also
don't forget to say stuff like I'd like to know the BP, SaO2 and temp if
relevant.
|
Learn and practice:
| Think
carefully about your examination and things you might have to do (eg using
positional manoeuvres to help work out what a murmur is, looking for
asterixis if hepatomegaly) |
| CVS
examination: likely to be a left sided systolic murmur, or hypertension
(then demonstrate looking for complications) |
| Respiratory
| These
patients will not be acutely unwell |
| They
will be chronic and have signs eg
CAL
, interstitial lung diseases, cystic fibrosis etc |
|
| Abdominal
exam: usually will be masses and scars present |
| Peripheral
vascular exam
| Everyone
got one of these in 2002 |
| So
go badger someone to teach you how to do it |
| See
some vascular patients if you have time |
|
| Neurological
| Most
likely to get neuro legs or cranial nerves |
| Station
should have everything you need (however you don’t need tools to
perform the bulk of the exam, so if it is not available say what you
would do) |
|
| Thyroid: a possibility, so think about it |
Notes:
| The
examiner will stop you if they don’t want you to do something, so just
get on with your examination (eg blood pressure) |
| See
patients so you look like you know what you are doing |
| Potter
around the wards and pick up clues about patients from their rooms, some
of the pointers will be there at the exam by the bedside |
| Describe
what you see and find, don’t guess |
Station marks breakdown
12 marks for standardised parts of the
exam between each student: eg inspection, palpation, percussion, auscultation
2 marks for patient rating:
2
I would seek this doctor actively
1
I would see this doctor
0
This doctor is a bastard who deserves to be burnt at the stake
6 marks for global rating
From the global rating, the marks of the
borderline students are averaged, and this becomes the pass mark for the
station. The pass marks from the
station are averaged to get the pass mark for the exam, then that mark is scaled
up or down to 50% as the pass mark (university doesn’t understand pass marks
that are not 50%, not the faculty choice).
General pointers:
| Get
there early |
| Don’t
panic!
| If
you f**k a station up, don’t worry |
| Each
station is a new beginning |
| You
can fail/borderline up to 1/3 of stations without failing the exam (ie you
can borderline 2 stations out of 8) |
| You
do need 50% to pass |
|
| Dress:
dress neatly, blokes wear a tie, white coat optional (though a good idea in
Year 4), no midriff, no tits |
| Don’t
second guess the examiners |
| If
they offer you a chance to reconsider an answer, they might be giving you a
chance to correct yourself, so think about the offer! |
| Don’t
argue with the examiners, even if you are right (they have been
students/doctors for at least 10 years in most cases) |
| People
who fail generally do so because:
| They
panic in a newish situation |
| Or
they haven’t seen enough patients during the year |
|
| It
becomes obviously to the examiners fairly early on whether or not you know
what you’re doing |
| If
an examiner treats you very badly, report it in the SPOT à
if it is a common theme amongst the SPOTs, that examiner won’t be invited
back |
| Ask
a 5th or 6th year or an intern if you want specific
questions about the exam answered |
|
