tips and key facts for OSCEs By Alasdair K.B. Ruthven
واحد من الكتب الاساسية للتحضير لامتحان الجزء التالت من الزمالة البريطانية PACES
Essential Examination began life as a set of notes I produced for my undergraduate exams. At that time I was unable to find a book that succinctly laid out the full sequence for examination of one body system on one page. This format remains the key feature of the book, which has steadily expanded over the past 10 years. Although the content has been extensively reviewed, refined and updated, much of it is still presented in ways that helped me to remember it at medical school.
To use this book requires a good baseline understanding of the physiology and pathophysiology of the systems considered. Some detail has been omitted intentionally – for example, nowhere is the exact method of examining for flapping tremor explained. It is assumed that core skills like this become second nature as they are taught time and time again in clinical teaching. This makes space for other useful information, and detailed descriptions of less familiar elements of examination where the margins between looking slick and looking awkward are narrower. Often there are many ways of examining for the same thing in medicine; in such cases I have described either the method preferred by specialists, or where no consensus exists, the method that I find the easiest.
It goes without saying that when examining patients, in an OSCE or not, you should appear smart (this includes hair, facial hair and clothing) and be ‘bare below the elbows’. Always be polite and courteous, and ensure you do not cause any harm, e.g. before palpating an abdomen or manoeuvring a joint, ask if it has been painful. Respect your patients’ dignity and avoid unnecessary exposure; where necessary for a thorough examination, minimize the duration of exposure and always ensure privacy. A chaperone should be present for all intimate examinations, and you may consider using one in other scenarios (e.g. a male clinician examining a young female’s abdomen). In an OSCE, have a very low threshold to mention that you would consider having a chaperone.
APPEARANCE & CONDUCT
Often in an OSCE you will not be asked to complete the full examination of a particular body system. Instead, you may be asked to complete part of that examination (e.g. rather than ‘examine the cardiovascular system’, simply ‘examine the precordium’). However, in order to do this you must draw from a baseline knowledge of the examination in its entirety. Alternatively you may be asked to examine multiple systems at once (e.g. a cardio-respiratory examination). Always listen to what the examiner asks, and clarify if necessary. Make sure you have practised these types of scenarios.
Usually you should examine from the patient’s right-hand side, although some examinations require you to move around the bed. Remember that many examinations follow a standard sequence, for example:
Core medical: peripheral signs – inspection – palpation – percussion – auscultation Neurological: inspection – tone – power – reflexes – sensation – co-ordination Musculoskeletal: look – feel – move – special tests – function – check distal neurovascular integrity
If you get lost in an examination (so easy to do under the pressure of assessment), default to these basic frameworks to get yourself back on track. Some examinations, of course, follow their own unique sequence; these are the most difficult to learn and so you must become very familiar with them.
At the end of your examination, present your findings clearly and succinctly. Always have some concluding remarks up your sleeve too – it’s a good way to finish off, and gives the impression that you really know your stuff.
Finally, remember that in order to pass you do not need to recall every single piece of information contained in this book – a slick, comprehensive clinical examination combined with some solid core knowledge is certainly enough. The old saying that difficult questions mean you are doing well is very true – don’t forget it!