My Objective Structured Clinical Examinations

Ryan B., Second Year Medical StudentPractice.  They say it makes things perfect right?  Learning how to be a doctor is NO exception.  Objective Structured Clinical Examinations are a fancy way of how medical students practice and display their developing skills as physicians.  That title is a huge mouthful, so it’s usually shortened to just “OSCE” (pronounced ahh-ski).  So far they have easily been my favorite part of 2nd year.

IMG_0530White Coat Suited-Up for OSCE’s

While OSCE’s become more seriously graded examinations further down the road in our educational process, for MS2’s they are mostly for practice and learning.  The best way to picture an OSCE is to imagine all us students dressing up in our professional garb and white coats, then role playing as actual doctors.  Our patient is an actor who has been trained to mimic the history and symptoms of a case that has been assigned to us.  You would think that since they are only acting, it would be easy to see through any “fake” disease, but these actors are so convincing you would never be able to tell if they were really sick or just pretending!

IMG_0518Awaiting our “Patient”

Let me describe the basic procedure of an OSCE by telling you about my most recent experience a few Thursdays ago:  The “patient” was waiting for me in a simulated clinic room.  These look like any physician’s office you would see if you were visiting your own doctor, except this one is monitored by several concealed cameras that record the entire encounter.  Before entering the room, I read the patient’s chief complaint and vital signs from a sign on the door: “Jane Doe is a 50-year-old woman presenting to the Emergency Department with a headache.” (Don’t worry, this is all fictional so I’m not breaking any confidentiality rules!) Her vitals included a fever of 101.5, along with increased heart and breathing rates.  My first thoughts were, “Oh no, a headache could be ANYTHING!” I was really hoping for a cardiac case as I am more confident in my knowledge of the heart. I made some quick notes on my clipboard to give myself an idea of how the interview and physical should go.  I had 20 minutes to complete the entire encounter, so I knew I would have to be focused, yet thorough.

After knocking, I entered the room to find a very distressed looking woman lying down on the exam bed.  I introduced myself and shook her hand as she slowly brought herself up to sitting position.  Any idea that this was an actor was far from my mind, as her appearance told me this woman was VERY sick.  Had I met her on the street, I would never have know she was acting!  Her voice, her demeanor, her appearance… just about everything told me she needed help. It’s good that it felt real; it made it easy to take the event seriously. Everything from remembering important questions to showing empathy, to establishing a proper physician-patient relationship came naturally.

I began the interview and, very slowly and painfully, she unfolded the story about a nasty headache that had been plaguing her for the past 5 days.  She had finally been brought into the emergency department by her husband, who was growing worried about her deteriorating health. As the familiar process seemed to flow, I quickly became caught up in the interview.  At this point, taking a history wasn’t such a scary thing.  I was really just having a conversation with someone, hoping I could help them along the way.  The next thing I knew, I was walking back out of the patient room, having completed a history and physical in the allotted twenty minutes.  Time flies when you are diagnosing!

I knew the patient had to have some sort of an infection, but several different ideas came to mind.  Was it meningitis?  Encephalitis? A nasty sinus infection?  This next part of our OSCE was kind of fun.  A group of 7 students, including myself, who had had the same patient story, gathered together to bounce ideas around and try to make the proper diagnosis.  Just imagine TV’s Dr. House and his team,  and you have a pretty good idea of what the next half hour looked like.

teamPicture This!

IMG_0523Meningitis? Encephalitis? “Diseased-brain-itis?”

house_boardYou Sure about That??

IMG_0525Pharez’s Confident Smile Solidifies our Diagnosis

After agreeing on encephalitis, we put together a presentation for our preceptors and other classmates who were assigned a different case.  The presentation went smoothly, with each of us presenting a different aspect of the case.  Our preceptors would give us pointers on how to make a good presentation, giving us priceless hints on how to impress our future attending physicians.  And it turned out we were right… our patient was having a battle with encephalitis, due to a Flaviviridae viral infection (otherwise known as West Nile virus). Boom! Another life saved! 🙂

IMG_0528Ready to Present Our Ideas

I feel like I learned an incredible amount in those few hours.  Now of course I am always learning new information during the onslaught that is the first two years of medical education, but the active process of applying and practicing the knowledge I’ve been working so hard to gain is really what solidified it for me.  This excites me for the 3rd and 4th years of medical school, when our education will be 90% of doing exactly this: interacting with real people to apply and use practical medical knowledge in a clinical situation.  I get such a rush from the entire process… I know this is EXACTLY what I want to be doing with my life, and when I am able to make a positive impact on the lives of others, it will be all the more gratifying.  I am so excited to be a doctor someday!

IMG_0519Diagnosis is Fun!

But in the mean time… Exam week approaches in six short days.  Fortunately, this entire blog was finished several weeks ago when I participated in the encounter; I was required to let my other classmates finish their experience before I could share it with you!  So here’s to the final push before Christmas break begins a week from Friday.  I see skiing in Montana, my home in Ohio, enjoying the holidays with friends and family, lots of good food, SLEEP, and a Bengals football game, among other things, in the near future.  So here goes that final sprint to the halfway mark of MS2!  Happy holidays everyone! 🙂

IMG_0623

Just Imagine, At This Point Every One of These Binders Is In My Head!

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About Ryan B.

Ever watched the TV show Scrubs? Well then just imagine a 6'8" JD and you have me in a nutshell... Random, quirky, hyperactive, feeling, open, always daydreaming, and generally holding on to every last ounce of childhood I can. I'm an Ohioan and proud of it. I love cheering for my Cincinnati sports teams, even though it seems we only make the playoffs once every 30 years. I am a dog person and can't wait for the day when I can have one of my own! I enjoy water sports, brunch, anything with a good story, trying to swing dance, managing a fantasy football team, playing racquetball, baseball, or beach volleyball, laser tag, almost every nerdy tv show with 'star' somewhere in the title, jazz music, and lots of other things. Most of all I love people and I hope someday I'll meet you too!