OSCE stations for the real world

Having recently undergone trial-by-OSCE, it concerns me that the stations were extremely unrealistic.  Oh sure - they may well be very similar to the stations we'll get at the end of the year.  But they bear absolutely no similarity to the tasks that medical students are required to undertake every day and thus they are a poor measure of medical student core competencies.  Here are some model stations I've come up with to make the OSCE fairer.

Obstetrics and Gynaecology
Student Instructions
You are in a pre-natal clinic doing routine checkups.  You haven't seen a birth all year and realize that this is your last chance to get on board.  Please convince the patient that they should boot the student midwife off the list and let you assist with the birth instead.

Standardized Patient Briefing
Do not agree to let the student be present at your birth even if they cry and beg.  It is important that you mention the following counter-arguments provided to you by the midwifery student:

1. The doctor always misses the birth anyway then swans in with a muffin saying, "How are things going in here, ladies?"
2. On the off chance the doctor doesn't miss the birth, he/she will want to do an unnecessary caesarian.
3. Oh, and doctors are always pressuring you to agree to drugs that will give your baby autism.

As the student leaves the station, let him/her know that you would have agreed if he/she was more experienced.

Surgery
Student Instructions
You are in clinic with Dr Bastard, a surgeon.  He instructs you to examine the patient's Ossicles of Zeno and give him your top ten differential diagnoses and the associated aetiologies.

Standardized Patient Briefing
The student will attempt to examine your Ossicles of Zeno whilst being glared at by Dr Bastard. Ensure that you ask the student the following questions as he does so:

1. Is it true that they don't teach anatomy any more?
2. If that's the case then where is my spleen?
3. No, I'm sure the left is where the liver is.  My cousin has his liver removed when he was five, how long can you live without a liver?
4. So you want to be just like Dr Bastard do you?

General Practice
Student Instructions
It is lunchtime.  You have been consulting with your supervisor all morning and feel that you are finally getting the hang of this stuff.  Enter the staff lunch room and converse with your supervisor.

Supervisor Briefing
The student will attempt to interact with you as if you are human.  Behave capriciously and imperiously.  Ensure that the following points are covered in your conversation:

• Ask them where they have been all morning.
• Introduce them to someone that you know they have met before.  Get the student's name wrong.  Be incredulous if they correct you.
• Ask the student a question about themselves then start talking to someone else while they are answering you.
• Reminisce fondly about previous students who were much more engaged, competent and intelligent.
• Criticise the university and its terrible teaching and newfangled course that has resulted in such a poor student being sent to work with you.
• Announce that a drug rep is turning up soon and throw the student out.

Paediatrics
Student Instructions
Please give the child in this room an injection.

Standardized Patient Briefing
Your child is to receive an injection.  Please follow these steps:

• Instill fear in your child by getting very tense and promising them a huge reward afterward if they don't scream.
• Instill distrust in your child by promising them that it won't hurt at all.
• Overdress your child in multiple layers so that getting access to even a single limb is impossible without a struggle.
• Wait until the child has spotted the needle and has started screaming before raising your concerns about the possible side-effects of the injection.
• Restrain your struggling child until the needle is almost touching their skin.  Then release your child suddenly, allowing them to flail around wildly and maximise the chance of the student stabbing themselves with the needle.

Medicine
Student Instructions
You have been sent to buy lunch for a senior consultant.  You were told to go to "Jack's Cafe down the road to the right" and buy a tandoori chicken, avocado and edam sandwich on white bread, and a large soy macchiato.  You have discovered that Jack's Cafe has been closed for six years.  There was only one other cafe within a reasonable distance and it didn't have much to choose from.  You have returned with a bacon, pumpkin and cottage cheese flatbread wrap and a small latte.  Enter the room and give the consultant her lunch.

Consultant Briefing
Ensure that you raise the following issues with the student when he/she returns with your lunch:

• They have been gone a long time and missed seeing lots of interesting signs in patients.
• This is not the sandwich you wanted.
• This is not the coffee you wanted.
• Jack's Cafe was there last week.
• This is not the sandwich you wanted.

Do not offer to reimburse the student for the cost of your lunch.  If they do ask for money you should remind them that this is not the sandwich you wanted.  If they still persist, point out to them that the university doesn't pay them very much for the teaching you provide.

Psychiatry
Student Instructions
Please observe the following conversation between doctor and patient for five minutes.  At the end of this time you will asked to diagnose each of them with a mental illness and/or personality disorder.

Examiner Marking Sheet
Bonus marks if the student also diagnoses themselves with depression.