The OSCEs

Now, I know you probably want a blow by blow account of the OSCEs. I know I’d want to read that, if I was awaiting my own exams or starting my pre-reg but the College are very strict about posting details on social media or even chatting about the contents of the stations (as they reuse the stations).  So I’ll talk generally about my experience of the exams.

I’m not giving much away by reminding you there are 17 stations (made up of one rest station, two pilot stations and fourteen “real” stations).  To pass the OSCEs, you need to pass 10/14 “real” stations.

The rest station came towards the end of my OSCEs (it was fifth from the end and, sigh, the water cooler was empty when I got there).  It was the longest 5 minutes of my life.  I just wanted to get the experience over and done with and sitting twiddling my thumbs for 5 mins was just as stressful as being examined.

Each exam sitting has one Volk station and it was during this that I realised how nervous I actually was.  Although I’m comfortable with Volk, I made a really silly mistake but only spotted it in the last 30 seconds (I had mirrored but not inverted the symbols).  Making a stupid error on something as bread and butter as indirect ophthalmoscopy shook me a little.  I made me wonder what I’d missed on the previous stations.

I was relieved disappointed that I didn’t get to use my mad focimetry skills (I went into uni on Friday and sat for an hour practising my focimetry on the giant boxes of glasses Caley’s Ophthalmic Materials lecturer hoards).

There were a couple of stations where it was obvious what was happening from the instructions on the door.  It’s nice to walk into a room already formulating your answer.  I also got to share my love of contact lenses in one station – my enthusiasm had my assessor smiling, which was nice.

The actors in the communication stations were really good.  It felt quite natural speaking to them.  One of them struggled a little with my accent, although, for a Glaswegian, I feel I’m pretty clear.

I knew three of my assessors but managed not to chat to them (something I was told off for during my mocks).

The OSCEs were over in under 2 hours.  I still don’t feel that it’s really over.  I left the building, went for a coffee with one of the other pre-regs to catch up on gossip and then I got on a train and came home.  It was all very anti-climactic.

On the train home, I started doubting myself.  I kept remembering little bits and pieces that I should have said or things that I could’ve explained better.  My management for one station still has me a little worried – it was something I’d never come across before, that didn’t feature on my referral guidelines, so I was unsure about whether to refer or not.  In the end, I referred to the GP.  I really hope that one’s a pilot!

Anyway, good luck to everyone who is sitting theirs in the next week.  Revise your referral guidelines (use the ones on the College website instead of your local ones), there are no trick questions and try to relax.

NES Mock OSCEs

So I had my second set of station exams on Friday.  Like the ones in Birmingham last month, I was amazed at how quickly the time went.  We had seventeen stations, including a rest stop (which I had last, oh well), and then we got one-to-one feedback from the examiners at each station.

I was really impressed with the amount of feedback I received and, if you read my last post, you’ll be pleased to know that this time I did well in the colour vision testing station (after failing it in Aston) but focimetry… well, I’ll get to that one in due course.

So, there were a couple of stations that were similar to those I sat in Aston:

For colour vision, I had the exact same scenario so there really was no excuse for not doing well.  This time I saw the lamp, the ruler, the score sheet.  The only thing I forgot (and I’m kicking myself about it) was to ask the patient if they had glasses right at the start of the test.  In the scenario, the patient was a presbyope so they probably would’ve needed a pair of readers for the test.

Indirect ophthalmoscopy involved finding symbols in the peripheral retina (previously it was words).  Again, I was given a choice of Volk lens and opted for the 90D.  I could only see two sets of symbols so I panicked and asked the examiner if that’s all there were.  He told me to read the instructions.  I then asked if I could move the eye (“No”).  In the end, there were only two sets and I got both in vaguely the right places.  One thing I forgot to do was to cross out symbols I’d drawn but then modified the location of, to make more accurate.  Given I had plenty of time at this station, I really should’ve checked the sheet before I handed it in but instead I spent the rest of the time double checking for more symbols around the eye.  I also used the dummy’s nose to focus the slit lamp rather than the rod and I really should’ve written down that it was the left eye, although you could argue that, given the structures on the drawing, it was pretty obvious.

I, again, had a communication station relating a child’s prescription to a parent.  I got some pretty clear feedback from the Aston examiner on what they wanted to hear, I went with what the examiner had fed back to me rather than with what I would say in real life.  In this case, I got the opposite feedback.  It’s interesting to see how opinion varies on something that’s so ubiquitous.  Anyway, my main feedback was to make clear that I was giving the full prescription and for full time wear.  Also, my examiner didn’t like some of the language I used.  I talked about a “wee prescription” and how we’d get the child a pair of glasses that they’d love.  I countered that I like to use positive language, especially when dealing with children and their parents.

There was also the “child is allergic to the dog” station, which, unsurprisingly, I managed to do well on.

This time around, I was more aware of my surroundings and, in the stations with a patient, I remembered to finish my diagnosis/management/etc with “Do you have any questions?” I also tried to repeat the main points at the end, if I had time.

The focimetry station I failed abysmally.  I actually walked in, saw the focimeter and just gave up.  I half-heartedly spoke to the patient then looked at her specs but I just couldn’t muster much beyond focusing the focimeter.  I’m planning on going into uni on a day off and just sitting at the focimeter practising until I feel confident.  That was the only station I failed so I don’t feel too bad about the OSCEs.  It is really embarrassing, though, when you get something that is relatively simple so wrong.

There were a couple of data interpretation stations, which I like.  My mind usually just jumps straight to an answer so I find it difficult to work backwards and give a differential diagnosis.  The cases that the College present tend to be classic examples of the pathology you are being asked to diagnose and manage.  My examiner’s feedback was really helpful – she said that “this is a red eye so list all the differential diagnoses for a red eye”, they don’t have to fit the signs completely.

The BV station was one that I had been dreading.  It was just an examiner, a laptop and a piece of paper.  The video I was shown wasn’t particularly good as the lady who was being recorded doing motility had her head tilted to one side.  In the end, I watched the video twice before settling on a diagnosis and management.

All in all, I quite enjoyed the mock OSCEs.  My real OSCEs are on the 1st July.

Oh, and I haven’t forgotten about building slit lamp cameras, I’ve just come across a problem getting a hold of the correct type of foam.  I called Kayfoam and they don’t supply it so I bought some EVA gym floor mats from eBay and I’m waiting on them turning up to see if they are suitable.

Mock OSCEs

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.