In the last week of each third year rotation there are exams and evaluations to complete. There is a content exam, a clinical skills exam, and in the surgery clerkship we have an oral exam. The longest and most taxing exam experience is the clinical skills exam, known as the OSCE. OSCE stands for objective structured clinical examination. The exam consists of several cases involving standardized patients, with 15 minutes in the room for each case, and then 10 minutes to complete a modified note and differential diagnosis.
Although I’ve now worked in several clinics with 10-20 minute visits, somehow the OSCE scenarios always feel more rushed. There is a more intense pressure to ask all the questions and not miss anything, since the encounter is being graded and scrutinized. Also, after so many real patient experiences, it is a bit disconcerting to remember that the standardized patient is acting, and a little annoying to have to feign sympathy and use the same standard phrases and comments for the sole purpose of demonstrating interpersonal skills. I’ve had increasing difficulty suspending my disbelief during these standardized patient encounters. Thankfully, the faculty and staff who work in our simulation center have been making things more interesting by giving the standardized patients an updated look with a real attention to detail. For example, the “patient” with a post-operative fever spritzed himself with a spray bottle to appear diaphoretic. He had a small incision that looked like it may have been a temporary tattoo, with real surgical tape stuck over it. He even had a fake IV line and a fake urinary catheter! Another standardized patient writhed around on the exam table, which was much more informative and helpful in diagnosing her condition than just lying there calmly. Although standardized patient experiences are becoming old hat, it was pleasing to see how much work was put into the exam session to make it run smoothly and feel as real as possible.
The OSCE for surgery was exhausting. We saw six standardized patients and wrote six notes and all of this after we took a 2.5 hour content exam in the morning. It was a long day. Hopefully my stamina will continue to increase as I move through more rotations. By the end of third year, I’ll need to be ready to tackle eight cases in a row so I can be ready for our school’s end-of-year OSCE and eventually for Step 2 CS. I’ll have to keep practicing and keep you posted!