The Podium of OSCE

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Here you are, about to jump…….

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With the fervent exhilaration that is OSCE preparation, it struck me today that the OSCE is a “performance of practicality”.  I was admiring my teenage daughter’s precise performance of  very pre-rehearsed public speech when I reflected that her presentation was analogous to an OSCE oration – she knows the stuff (and backwards) but the audience perception and the time allowed prompted her to amend and adapt the content to achieve an optimal outcome.    ?Little bit like OSCE?  

Then as I reflected I found this awesome pictorial:    

public speaking checklists

So thinking about these key areas, some last minute OSCE tips:

  1.  Audience:  There are Observing Examiners, and Role Players (usually examiners) – read your task and ensure you are directing the right information to the right person in the right language.
  2. Nervous:   Yes you will be (Said Yoda) – Use the day before the exam to just ‘chill’.  You are not going to learn anything the day before that will make the difference between passing and failing.   Run, paddle (SUP or kayak my preference), cycle, long bath, massage, spend time with family, play with your kids – nice breakfast morning of, plan your route to the venue and what you need the night before, wear something appropriate, comfortable and that makes you feel like an AWESOME GP!
  3. Gestures:     You and your foes…… The examiners are human – we will endeavor to portray the patient  as best as our actor-less talent allows.  Watch our mannerisms, tapping feet, inadvertent glances, raised eyebrows – they are all important clues just as in reality.    And think about yours – sit comfortably, readjust your chair -sit forward/sit back  – do what you’d normally do.
  4. Podium:   This is your stage – you have prepared for ages, worked the script, learnt the lines – you have ONE opportunity to show us your best but we cannot mark you on what we think you are thinking.    Announciate your thoughts.   List your differentials.  list your management then explain (in case you run out of time).  Remember to think about short/medium/long term; pharmacological/non-pharmacological; patient/doctor management.    Always be professional and NEVER defer to a supervisor.  If you are referring say who, and what specifically it is to achieve.
  5. Practice:   Key tips here are don’t ever ask for a test or do what you wouldn’t normally do in practice, e.g. if someone needs a troponin they should be in ED.   Consider rural and remote context and ethnicity – how might this affect your management?    It is OK to stop and think about what comes next, e.g. “You’ve given me lots of useful information, I’m just going to take some time to consider how we progress”.   This is what we do in real life.
  6. Skill:   Examination – remember always to ask for General Appearance, all vital signs separately and surgery tests.   Consider the difference between ‘focused examination’ and a traditional one.  Know how to turn on an ophthalmoscope.  Never report a finding you haven’t actually seen.  If you are in doubt re iterating your findings as you go or significant positives or negative – check with the Examiner.  There is also a difference between Treatment and Management.
  7. Professional:  You are about to be a Specialist GP.   We are credentialed to know enough about everything to hold the health budget and defer it to those that have specific areas of knowledge.  Be proud of your GATEKEEPER status and use this to your advantage as the director of holistic care.

Now time to REST (in these stations do the following):

  • Look around and name five things than you can see (e.g. where your next station is, where your next rest is, where the toilets are etc).
  • Listen and name four things than your hear (e.g.   your breath, quiet, etc.)
  • Feel and name three things that you feel (e.g. your heartbeat, the texture of your chair, your bladder)
  • Consider two things that you can taste (i.e. have a drink of water and a lollie)
  • Take a deep breath and appreciate what you may smell (i.e. success).

Remember that we are not out to get you.  This exam is a means to seeing what you ‘do’ in the course of your normal practice and determining whether you are safe and competent to practice independently.   Show us what you’ve got!  Best wishes to all.

Please feel free to comment.

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