Mock OSCE

We had a mock OSCE on Wednesday night.  (An OSCE is a oral exam where you interact with either actors playing patients or real patients and you have to be the doctor.)  There were only five active stations and two rest stations, but the organisers had structured it so that it was excellent preparation for the real OSCE at the end of the year.  Here's an overview of what each station was testing.

Station 1: Panic
The first OSCE skill to master is panic.  If you go into your first station and you don't panic, the patient and the examiner will know that you are a clueless noob.  For this reason, getting a good panic on for the first station is essential.  Some things that may help are to drink too much coffee, imagine how your life will be wrecked unless you perform perfectly, and to glance at advanced textbooks immediately before the start of the OSCE to ensure that you are fully aware of how much you don't know.  If, despite your preparation, you find yourself unnaturally calm and relaxed, you could try hyperventilating to induce lightheadedness.  Alternatively, try bluffing your way through by moistening your palms and brow with water to give others the impression of fear.

Station 2: Disorganisation
This skill is most usefully displayed during a station which combines history taking and examination.  You should immediately commence examination, and if possible arrive at a firm diagnosis immediately.  This allows you to suggest management, preferably something which would be contraindicated by common conditions with similar presentations.  Thus, you then are compelled to ask a few history questions which then trigger something in your mind to test by examination, and thus the cycle begins again.  It would be good if, from time to time, you then leap back to history taking by asking some general systems questions.  The effect you're looking for is something like this: "The patient is tachycardic, it's almost certainly a pulmonary embolus, I'd recommend thrombolytics, oh wait, maybe it's blood loss, have you noticed any change in your bowel habits?  The abdomen is tender in the right iliac fossa, how are you sleeping?  And your parents, do they have any history of epilepsy?"

Station 3: Time mismanagement
After station 2 you will realize that you need to be more thorough.  Thus, station 3 is the one where you can delve step by step into the minutiae of the patient's condition.  With any luck, you'll still be only halfway through taking a history when the bell rings for the end of the station.  A good place to get bogged down is when asking about medications - few patients can remember the correct names and doses of their tablets, so this gives you the opportunity to spend a long time trying to pin them down.  "Are you sure it was atenolol?  Not metoprolol?  Or nebivolol?  Or carvedilol?  What colour is the tablet?"  Alternatively, a good chunk of time can be burned up by an inquisitorial style when asking about smoking and alcohol.  Believe nothing that the patient tells you and scold them for not telling you the truth.  With luck you'll not only waste time but antagonise them so much that the rest of the station is complete disaster.

Station 4: Compensatory euphoria
By this stage of the OSCE you're past the halfway mark.  Soon it will all be over, so it's traditional at this point to relax a little and lapse into compensatory euphoria.  Thus, the fourth station is there to test your ability to urge the patient to make sweeping lifestyle changes while assuring them how great the results will be with just a little willpower, and babble at great length in order to show the examiner how wonderful your interpersonal skills are. A useful technique is enthusiastically agree with everything the patient says and then continue talking as if they hadn't said anything.  Another good trick is to dump on the patient all of the detailed pathophysiology that you learned in first and second year.  This will baffle them into stunned silence and ensure you have maximum talking time.  Again, hyperventilating while reading the instructions on the door before you enter the station can be invaluable in getting you into the right frame of mind!

Station 5: Exhausted confusion
This is one of the easiest OSCE skills to master once you know the right approach.  The key step is to begin preparing early on.  Don't eat anything since the night before.  Sleep badly.  If you have any notepaper to write on, keep notes for all stations on the same piece of paper.  Make sure you don't write any names or other identifying material.  This will allow you to keep asking, "What's your name again?", and, "I know I've asked you this before, but where is the pain?"  Hopefully you will have performed terribly on each of the previous stations so you'll be tired, demoralized and sick to death of the whole thing.  Sigh deeply.  Stare down at your notes and shake your head.  From time to time, glance despairingly at the examiner as if begging for help.  If you are unfortunate enough to have to recommend management, try being unable to recall the names of drugs, or unable to pronounce them properly.

So that's how you do a mock OSCE!  If you practise these skills at every opportunity, you'll be ready to savour the full richness of the real OSCE at the end of the year.  Of course it's hard to extrapolate from just 5 stations to the full 20, but keep in mind that these techniques can be used not only in isolation but in combination.  When you're first starting out it's advisable to master them one by one.  By November, however, I expect you'll be able to use these notes to play a beautiful symphony of underperformance in the key of F.

I just wanted to say good luck, and we're all counting on you.