Wouldn’t it be luxurious in General Practice to have three minutes to consider what the patient is likely to present with, and to consider and document a safe plan for proceeding with the consultation?
That’s what your OSCE reading time is for (and for recharging after the previous station).
There are many techniques for managing your reading time but here are some tips that can be effective:
Stop. Close your eyes and calm your mind. The amount of time you spend on this is inversely proportional to how you felt you went in the previous case. If it went well, pat yourself on the back, clear your mind, and proceed – if not, don’t dwell on the negatives but use a little time to calm your busy mind. In practice, we don’t move from one patient to another without a little break, especially if was a difficult consultation. You can still pass the exam having done not so well in one station, but if you let your performance in one station affect all the others, then the outcome may not be so good.
Read the Question. Jot down what the question might be about and which Domains of General Practice should be covered.
Read the Question again. Jot down the key information you will need to consider.
Read the tasks – how many are there? Jot down how much time you should spend on each one.
List prompts for each task e.g.
History: You can use acronyms such as NILDOOCARF, or develop lists of important things to cover for each age group (e.g. developmental history and immunisations for Paediatrics).
Examination: Vital signs, Specific examinations, Office tests. Do you need to talk the examiner through the examination or just discuss significant negative and positive signs?
Investigations: This might be before or after the differential. What are those investigations that will further define your diagnosis?
Differential Diagnosis: Use a surgical sieve to cover all the bases – VITAMINCDEF, VINDICATE are common ones.
Management: Short, medium and long-term. Pharmacological vs non-pharmacological. Doctor-initiated vs patient-initiated (e.g. medications vs lifestyle). Always, always safety-net and arrange follow-up.
Repeat Step 1:
Calm your mind
- You may like to jot down the questions or examinations you always forgot when you were practicing.
- List out the masquerades in case you get stuck.
- Preventive health – there is always room for this. What would the Red Book say for this age group?
Plan & practice
It is really important that you have a planned approach to reading time. The reason why it is there is that 8 or 19 minutes only provide the opportunity for a ‘window’ into a consultation, so information needs to be given beforehand, and every piece of information is there for a reason.
You need to practice how you will use your reading time every time you practice for the OSCE (and try it when you see patients too!) so that you have your approach ‘automated’ by the time you sit. Some doctors use a grid format, putting each step onto a different part of the page, others list everything out – the right way is the way that works best for you and you will only know what works by practice. If you plan and execute your reading time plan efficiently, your OSCE consultation is much more likely to have a positive outcome, and similarly, if you plan and prepare for consultations your medicine will be better!
Please note: This post was originally published on the Medcast exam preparation blog: https://medcast.com.au/blogs/three-minute-osce-reading-time-in-5-steps/