Saturday, June 11, 2011

The Longest Day

"I just feel tired all the time." "I want a sick note." "I'm not happy with my medication."

Yes, it's OSCE (Objective Structured Clinical Examination) season and Simulated Patients like me have been working on the medical students' exams for them to be assessed on their consultation skills.

You often have several Simulated Patients (known as SPs) playing the same role so it's important that it's played in exactly the same way - hence we have a training session to standardise the roles, and also there's often a starting statement such as the ones above.

How it goes from then on depends on the student but there are usually a series of challenges that we give them so they can demonstrate their skills - - or lack of them. The level of difficulty depends upon the level of the students. In the early years they might be "taking a history" - finding out all about the patient's lifestyle, circumstances and past medical history as well as the "presenting complaint" - ie what the patient has come to the doctor about!

The fifth years who are about to qualify have much more complex scenarios - a patient asking for something that the doctor simply can't give, for example, or a very emotional patient.

In the early years of medical school each "station" is quite short - a minute to read the instructions and then, say, five minutes to do the task. It's amazing how much can be done in five minutes though. In the later years of medical school, sometimes it can be ten or even twelve minutes.

This week I've done two OSCEs and they were, I have to say, the hardest I've ever done. Very large year groups in the Hull York Medical School first and second years resulted in extremely long days.

On Tuesday I had to be in Hull - sixty-five miles away - by seven-thirty in the morning, and then we finished at about half past six at night, and drove back again.

In between we did eighty - yes, eighty - five-minute "stations" in two-hour blocks.

Then I did a similar thing, playing a different patient with a different problem, in York - a mere twenty-five miles away - on Thursday.

In the room is the examiner and me. A bell goes to start and then each student moves from station to station, with a bell going to signify the end of each station and the start of the next task.

So, from my perceptive, the bell goes, a student comes in and introduces himself or herself, I start with something like one of the statements above, and off we go, with the examiner marking the various skills demonstrated and questions asked - for example, in a scenario about a cough, it would be really important for the student to ask if the patient smoked. Then another bell goes, the student leaves, and the next student starts reading the instructions outside the door for one minute until the bell goes to start again.

It's a difficult two hours for the students of course. I have been doing OSCEs for years and years and worked with thousands of students and I must say that the students I met this week were almost all polite, friendly, knowledgeable, thorough and empathic. The standard of communication skills has really shot up over the years as more emphasis has been placed on it. Hurrah!

The examiners I worked with - both doctors of course - were a real pleasure to work with too and that makes such a difference during such a very long day.

Doing twenty roleplays in a row, then a short break, then another twenty, and so on, is just relentless and takes every ounce of concentration - otherwise you find yourself thinking "Oh no, I just said that!" and yet it was to the previous student. It's vital to give them all the same opportunity of course.

The way I get through it is with a kind of pig-headed determination. When the eightieth student comes in, I do my damndest to behave as though the whole thing is fresh and new. It definitely befuddles your brain afterwards though and SPs do talk about "OSCE brain" as a new and interesting medical condition.

During the very last twenty I did allow myself the luxury of counting down, writing on a piece of paper 20 - - 19 - - 18 - - and so on, in the one-minute gaps between roleplays.

Another of the SPs set himself the interesting personal challenge of drinking the whole two-litre bottle of water that he was provided with.

"And then, at the end, I went to the toilet and I peed for seventy-eight seconds! SEVENTY-EIGHT SECONDS! I timed it!" he said with considerable pride.

Ahhh, OSCE season. Glorious.


Blogger Jennyta said...

Days of that length, plus all the travelling - you deserve a medal, Daphne!

10:11 pm  
Blogger rhymeswithplague said...

I think your work would drive me crazy, but you make it sound exhilarating!

12:07 pm  
Blogger Yorkshire Pudding said...

It will be "glorious" when the hard-earned dosh starts rolling in to fill Lady Daphne and Lord Stephen's coffers to the brim.

12:00 pm  

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