Now that the KFP is done and dusted, it’s time to get stuck into OSCE prep. You can see the end in sight and you’ve traversed a long distance in your journey already – now it’s time to conquer the final frontier!
Find a study partner (or a posse of them is better) and practice, practice, practice! It’s better if you can to form a study group with colleagues who have different skill sets, that way you can benefit from each other’s knowledge. Make sure that you set the rules about feedback before you start. Here are some steps that might help on your journey.
THE TEN RULES OF ENGAGEMENT:
- READ the task, write down the key points in reading time, stop during the case and check where you’re up to. When you are consulting and have a difficult case, you stop, summarise and gather your thoughts – do this in the exam too. It’s better than getting lost down the wrong track.
- Have a plan or a proforma. In reading time think about every case as a new patient – PMhx, PSuhx, Meds, Allergies, Social, Fhx, Cigs, Alc (and other drugs), Immunization, Screening/preventive health etc. Write it down on your paper so you can check it off! If you don’t have a proforma you can download one here.
- There is no point making empathetic statements for the sake of it. They should not be tokenistic. Saying “I’m so sorry to hear that” does not work for every case.
- Think about your differentials and use an acronym as a reminder: VITAMINCDEF is my favourite.
- What is the most likely diagnosis, an alternative and the thing you shouldn’t miss? Have you spent as much time exploring the obvious diagnosis as exploring the alternatives?
- Think about your words. Patients don’t like being told they are obese or overweight. Relate it to their current problem and use as a management technique. E.g. Mrs X, I think it’s useful for us to talk about keeping in the healthy weight range – this might assist with improving your back pain. Much more patient-centred than ‘you are obese’.
- There is prevention usually in every case. Read the Red book. Choose one activity a week until the exam to focus on in your practice. E.g. ask everyone >70 about falls prevention, then the next week chose another activity. A post-it note on the top of your monitor will be a big help to remind you.
- Don’t talk just about the ‘disease’ but also the ‘dis-ease’. Consider the impact of the diagnosis on the patient’s ADLs, family and lifestyle.
- Learn relaxation techniques – leave the ‘failed case’ behind. Each case has multiple domains that are marked, so even if you feel you have performed badly, you will still have scored some marks. Importantly move on and give the next case your full attention – just as we do in real life (except we don’t have the luxury of a toilet break and a cup of tea to regather).
- Going to work is the best practice! But, read around your work and ask for feedback from colleagues, patients and practice staff.
Remember that you are marked on your ‘observed behaviour’ – this is throughout the case. We can only mark what we can see and hear, not on our ‘hunch’ about what we think you know.
Demonstrate through your consulting style that you are a safe and knowledgeable practitioner – and you will breach the final frontier to embark on a new journey that is Fellowship.