One of the worst parts of working for any exam in medicine is knowing where to begin. With every topic being huge, it can be a bit of a nightmare - especially when everyone tells you that all you have to do is to 'understand the basic concepts' and you'll be fine. Unfortunately, whilst this is true, it doesn't change the fact that you do still have to memorise & learn a whole lot of stuff. This section of the website will hopefully offer some useful tips and advice towards making that process a little easier...
Clinical Exams & OSCEs
Preparation:
- Whilst it might seem obvious, try see as many patients as possible before the exam. Examiners are far more interested in how you go about examining a patient than if you actually get the correct diagnosis (which is usually only a few points out of the whole mark-sheet). Your university's main hospital is guaranteed to get packed with students all trying to hunt down the few patients with good clinical signs in the month or two before exams, so make an early start. The smaller District General Hostpitals can often be good places to head to, with very few other students, and generally friendlier doctors who are usually more than happy to suggest good patients and to even watch and quiz you as you examine. If you are at a medical school that does electives before finals, this can be another good time to practice your examination skills in places that are probably relatively student-free.
- Use the many 'OSCE' designed books to get an idea of what kind of patients will come up. The more advanced Royal College Membership books are often good sources of knowledge as to what conditions are 'exam favourites'. Even though the level of detail found in these books may be way beyond what you need for finals, some do contain useful guides as to what comes up, how often it comes up, and how to approach the relevant examination and questions. There are certain 'old exam favourites' that it would be careless not to prepare for (such as pulmonary fibrosis, dextrocardia, prosthetic heart valves, etc.) In addition, there will be the 'common hospital inpatient regulars' that will be in plentiful supply on the day of the exam (such as Chronic Airways Diseases, patients with surgical paraphanalia - eg. stomas and drains), etc.) Make a list of these conditions, and plan how you would approach the examination for each of them. You may not get the exact same case in the exam, but at least you will be more prepared to see that condition.
- Practice on friends. That's what they are there for. It can be just as useful (and reassuring) to sit and watch other people examine you (and get things wrong) as it is to practice the examination routines over and over again yourself.
- Form a small 'tutorial' group and see patients together. Not only is this nicer for the patients (gets a whole batch of students over with in a shorter time than if they turned up individually), but it is always good practice to be watched by a whole group of people when you are examining. It will inevitably be more nerve-wracking at first, but you will eventually learn to 'blank' the herd of people standing around the bed scrutinising your every move. Once you get used to it, however, you will be well on the way to being prepared to face the examiners (who will be doing just the same!) If you can, it can be useful to find someone (an SpR or SHO preparing for their own postgraduate examinations is best) to help. They can not only be a great source of patients with good clinical signs, but can also 'play examiner' and ask you relevant questions at the end of your examination. Make sure you practice presenting your findings at the end of each examination - this can often be the hardest part in the real examination. Keep your presentation brief and relevant (ie. geared up towards supporting what you believe is the correct diagnosis). If you are stumped, don't worry - you can still present what you found, proving that you are capable of performing a sound clinical examination.
In the exam:
- It will all go very quickly. You will move from station-to-station, and the examination will be over before you know it.
- Take your time, and listen carefully to the instructions of the examiners. If you are uncertain, then ask them to clarify. If, for example, they say 'auscultate this gentleman's praecordium', it would be sensible to do make some brief 'general observations', briefly palpate the radial pulse (you can do this whilst inspecting and palpating the praecordium), and to then move straight onto auscultation of the heart sounds (whilst simultaneously palpating the caroid pulse). Don't waste time looking for any other peripheral signs (eg. hand signs) unless you are specifically asked to 'examine the cardiovascular system'.
- There will be easy marks for washing your hands before and after the examination (often, alcohol gel bottles to clip onto your belt/bag are provided - if not, then get free bottles from the hospital's infection control people in advance).
- There will also be easy marks for basic communication skills - introducing yourself, explaining what you are about to do in clear 'lay' language, obtaining the patient's consent for the examination, explaining any actions/movements you wish the patient to make during the examination, maintaining the patient's dignity by the appropriate use of drapes or blankets to cover them up whilst you are not examining a particular area, and also for thanking them at the end. Don't forget these basics - as they make up a big chunk of your final mark!
- Any of the examiners (you will usually have 2 per station) can ask you any type of question. If you know an examiner to be a surgeon, don't be caught off-guard if they ask you a very medical question. Surgeons have been known to occasionally have some vague medical knowledge. They also have a mark-sheet. Don't let this surprise you.
- Think before you speak. Taking a second to prepare your thoughts can make all the difference between some mumbled noises and a coherent answer. Use the 'quiet' times in the examination (such as auscultation or palpation) to think about what you have found so far and what you are expecting to find. Also use this time, to plan roughly how you might summarise your findings depending on any differential diagnosis that you are coming up with.
- If it all starts to go wrong and you have absolutely no idea what the signs are all eluding to, then stay calm. You can still save things by performing a well-executed and thorough examination. The only thing that will guarantee that you do this on the day, is lots of prior rehearsal of the examination routines before the exam.
- To end on a more light hearted note - the majority of people will always pass - this is not a postgraduate exam! The whole aim of medical final examinations is to see if you are capable of performing a thorough examination. If you know how and why you do the various steps, and know what you might expect to find, then you have achieved most of the goals of a safe junior doctor. If you do all this and pick up the signs too, then that is a bonus. Practice lots in advance, and the exam will just sail by.
