Now is the time to change your tack

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Boat

Six months ago, or hopefully more, you set sail for ‘Destination Fellowship’ – a sometimes difficult journey fraught with unforeseen challenges interspersed with interesting facts about sometimes unfamiliar places.   The end reward of this journey is the freedom to use your newfound knowledge and experience to embark confidently on your GP career.

I’m sure when you set sail to reach the first port of ‘AKT and KFP’ you had a good map and perspective on how to reach those locations, but now that you’re there, you’re probably reflecting on the success of your journey and how you will approach the next part of the trip.    Some of you have had smooth sailing thus far but for some the seas were a little treacherous.  Whether it is the ports of ‘AKT’, ‘KFP’ or ‘OSCE’ the destination is still the same, but the way that we approach each of the segments in the journey is not – you need to change your tack if you want to sail through.

What do we mean by ‘tack’?   In sailing, ‘tacking’ is manoeuvring your bough in accordance to the prevailing winds to attain the desired direction.     The conservative sailors will be continuing along the same course until the success of their previous journeys have been confirmed, however the savvy captains will be already planning their approach to the next leg of the trip.   Preparation is never wasted so let’s consider how you will embark upon the OSCE leg of your voyage.

The first thing to consider is post-study fatigue and self-care.  Many of you have been studying for these exams for six to twelve months, giving up time for yourself, family and friends.   IT IS OK TO HAVE A BREAK!   If you are fatigued you will not synthesize knowledge well, and, the OSCE requires a different approach – it is about synthesis, contextualisation and communication of knowledge as opposed to knowledge regurgitation or decision-making.   Build self-care and time-out into the next step of your preparation and give yourself permission to recharge the batteries.

I know that it’s trotted out frequently at exam workshops, but that’s because it’s important – good old Miller’s pyramid (and it does look a bit like a sail).

Miller's pyramid

To examine the ‘Does’ of Miller’s pyramid would require many of episodes of direct observation of practice each year, which is not feasible or cost effective but would be ideal in assessing competence.   As an alternative we assess how ‘Shows How’ in the OSCE.     That’s the key – we want you to show us how you do it – in real life, in practice, based on guidelines and evidence-based knowledge.

That’s the difference between studying for the OSCE and the written exams – you need to go to work, see patients, think about your approach and how you are going to show off your knowledge by consulting.

In the AKT we are asking you express that you ‘know’ your clinical knowledge, the KFP that you ‘know how’ to use your knowledge by demonstrating clinical decision-making steps but in the OSCE we want to see how you actually combine the skills displayed in the written exams in a clinical situation – so the only way to learn that skill is to practice!

So here are some key tips for OSCE preparation:

  1. Recharge your batteries: Have a break after the written exams and spend time with loved ones and readdress self-care in readiness for the next leg of the journey.
  2. When it’s time to study:
    • Think about those cases you most fear walking through that OSCE door – why do they trouble you? Is it applied knowledge or the other domains?   Study those first.
    • Practice, Practice, Practice – find a study pal or group and practice cases – ideally find a partner who sees a different patient demographic to yourself, so you can learn from each other.
    • Polish up – Shortcuts in physical examination get no marks in the exam – go back and look at how to do all examinations properly so that you can make appropriate decisions combing your clinical knowledge and decision-making to perform a ‘focused examination’.
    • Develop a proforma for reading time (this topic is worth of a separate post):
      1. What could they be asking about? Which domains?
      2. What are the things I always miss?
      3. What are my tasks and how am I going to manage my time?
  3. Practice looking slick and confident – you need to look like you have done the consultation (including examination) millions of times – and indeed you should have done it at least hundreds of times!
  4. In the weeks prior to the exam, review Guidelines to make sure you are up to date.
  5. Remember that your performance is measured over the station not in individual parts – be professional, courteous, WASH your HANDS!

For most doctors, the written exams are the hurdles, the OSCE is the opportunity to ‘show off your skills’.   Remember that there is never a time in your life as a clinician that you will be so professionally polished and know so much, so now it’s time to find a sextant, put on your Captain’s cap and plot a course for OSCE success!

Please Note:  This post was originally published on the Medcast exam preparation blog.

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