I’m sorry for the lateness of this post but this week has been a bit of a blur. I’m on holiday at the moment so I thought I’d catch up with a few things, including this blog.

On Monday morning, I sat in a training centre waiting to be taken in for my mock OSCEs. It seemed that I was the only one there that had not had OSCE stations at university so I felt at a bit of a disadvantage. When we were briefed, the tutor asked if we had all done something like this before and I was the only one shaking my head.

We were in a group of 9 and there were 10 stations, each 5 mins in duration. They followed the same pattern as the actual OSCES: a minute to read the blurb on the door then 5 mins to perform a task. Most of the stations there were communication based although some also asked us to perform a task.

The tasks were pretty simple, in theory:

1) write down the three words printed at the back of the plastic eye, using Volk to see them. This tested your use/choice of the correct power of lens (I opted for the 90D, which gave me a view of most of the words simultaneously), the ability to focus the slit lamp, your awareness of the inverted/mirrored nature of the image and lastly, your ability to remain unfazed by the scary, disembodied polystyrene head that was unceremoniously clamped to the headrest.

2) focimetry. This is the part I was dreading. I can do it, I have done it in the past but I always second guess myself. In this case, we had to focimeter one lens of a varifocal. The task involved marking up the lens, focusing the focimeter (I forgot to do this and ended up having to do it half way through the station), getting the correct sphere, cyl and cyl axis, writing down any prism and then the add, centres and heights.

I tensed up for the entire 5 mins and forgot to do the heights, PDs and I was slightly out on the cyl and cyl axis.

3) check van Herricks on a real patient and decide if it was safe to dilate. There were marks for hygiene and setting up the slit lamp correctly, for checking nasal and temporal angles and for getting them right. There was then a decision: to dilate or not?

I found this one a bit too easy. I did the task in under a minute then sat staring into space for the other four, wondering if it was some weird trick and if I’d gotten it completely wrong. I hadn’t.

Since I do van Herricks and Volk on 99% of my patients, I was pretty fast at these tasks and confident in my results.

4) colour vision testing was one of my first stations and, although I got some things right, I was too blinkered to notice the scoring sheets, the daylight lamp and the measuring tape. I chose the correct test and tested monocularly (which was indicated for this test) but everything else was wrong.

Looking back, I think I would’ve been fine with this station if it hadn’t happened at the start of the mocks, when I was just settling into the process. Excuses, excuses, I know!

The rest of the stations were communication or data analysis. I had to explain to a concerned parent why her anisometropic child needed glasses*, why someone with dry AMD wouldn’t benefit from Lucentis (also, we had to provide advice on diet, smoking, supplements, vision correction, etc). I also had to diagnose a painless, red eye (viral conjunctivitis) and give advice. The other stations included a painless loss of vision (optic neuritis, in this case)**, I had to phone HES and ask for an emergency appointment for a gentleman with a suspected retinal detachment (again, you had to diagnose this from information given before calling) and I had to answer three questions about a case of pigmentary glaucoma (diagnosis, why, treatment, I think).

I passed, btw, but I could have done a lot better if I had been less panicked. This is why mocks are so important and I truly feel that I would be at a tremendous disadvantage if I just turned up to the real thing in July without having experienced the process before.

Things I learned from these mock OSCEs:

0) Introduce yourself to the patient, if there is one. You can also introduce yourself to the polystyrene head, if you want, I’m sure they won’t take marks off for that.
1) Take time at the beginning to survey your equipment.
2) Carefully read the paperwork before you start. Remember to look at the backs of papers as well (oops). Don’t start talking until you have read everything.
3) Focus your equipment, clean it if you need to (the hint will be the wipes sitting nearby)
4) Look at pictures carefully. If there’s a photo of something unexpected (like the anterior segment) in a glaucoma case, there might be pigment in the anterior chamber.
5) Don’t look for a weird and wonderful explanation for symptoms and signs. If you think it’s allergic conjunctivitis then stick with that: just remember to ask about duration of symptoms, history of allergies (inc. hayfever) and if there’s been any recent changes in the patient’s home.
6) Check for understanding, summarise what the patient is saying to clarify and then summarise what you are advising.

When I walked into the stations that involved explaining something or doing Hx & Sxs on a patient, I introduced myself and then did a quick summary of what I had read in the station instructions. “Hi, my name’s Michelle. I see that you’ve come in with a red, watery eye today that’s been bothering you for a while…” Although, in practice, as I’m ushering someone into my room, I tend to ask them the open ended question: “So, what’s happened?” I realise that the OSCE patients are not going to volunteer information as freely as the patient who comes to me with a corneal abrasion or ulcer or retinal detachment. Real patients usually tell a story that will answer all the LOFTSEA questions that need answered.

I’ve managed to get a place at the J&J OSCE course on the 6th June (it’s a Friday) so I’ll, hopefully, manage to improve on the three stations I struggled with a little.

* This is something I have had a lot of experience doing in practice so I was pretty cocky about the outcome of this one. In fact, my examiner for this station seemed to take a bit of a dislike to me and, in my feedback, decided to critique everything I said and the fact that I “talk too much”. I did pass that station but the feedback was harsh.

** My feedback for this one was wonderful, I think I’ll frame it to look at on bad days. It ends with “you would have scored excellent on everything if you had turned over the page and seen the other results”. At the time, I thought they were being a bit stingy with information at this station but it was all down to me being inattentive to detail.

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