1. Preparing for Exams - OSCE Dr. Mala Joneja mj6@queensu.ca

2.  http://www.youtube.com/watch?v=VfExPppvcew http://www.youtube.com/watch?v=VfExPppvcew

3.  You may think that standardized exams are a pain, but everybody has to do them

4. Preparing for the OSCE  References:  Bracken Library – Exam section: 3 day loan

5.  OSCE and Clinical Skills Handbook by Katrina F. Hurley  OSCE &LMCC II Review Notes by Zu-Hua Gao

6. What is an OSCE?  What is an OSCE?  Tool for measuring clinical competence  Developed to evaluate clinical performance in medical students  Test dimensions of clinical competence: Physical examination History taking Interpersonal skills Technical skills Problem solving Decision making Treatment and management

7. How is an OSCE graded?  How is an OSCE graded?  Binary checklist  Complex skills – Global Rating Scale (communication or professionalism)  Sequence/Organization

8. Checklist (the examiner has)  Introduces self to the patient  Refers to the patient by name  Establishes the purpose of the encounter  Uses open-ended questions to obtain story  Establishes presenting complaint in the patient’s own words  Draping the patient  Appropriate closing remarks

9. How should I prepare for an OSCE?  Interestingly, learning for meaning, a desire for this, appears to be associated with better outcome  Literature: OSCE performance = skills + knowledge / anxiety, self-confidence and preparedness  Hurley: It may not be possible to prepare yourself for each question that could be asked

10. Professionalism  Professionalism is a big part  Website –examples of scoring  Demonstrated in Communication  Pointers Set up the interview Watch your body language Don’t interrupt the patient repeatedly  Active listening, repeat back to the patient

11. FIFE  Feelings, ideas, fears and expectations – WHY?  Useful, pays attention to the patient, find out information in a short amount of time

12. As a clinician, you are expected to:  Complete a history and physical examination  Elicit presenting problems and details  Elicit past history, family history, social history, medications and allergies  Review of systems  Show sensitivity, respect  Explain procedures to patient  Use understandable language  Proper use of medical instruments  Exam in logical sequence, focus on system when appropriate  Establish rapport  Show empathy, tact, compassion, maintaining professional and ethical code of conduct  Concisely communicate results and findings  Formulate a problem list

13. ChLORIDE FPP  Character  Location  Onset  Radiation  Intensity  Duration  Events associated  Frequency  Palliative factors  Provocative factors

14. VITAMINS C  Vascular  Infectious  Traumatic  Autoimmune/Allergic  Metabolic  Idiopathic/Iatrogenic  Neoplastic  Substance abuse and Psychiatric  Congenital

15. IPPA  Inspection  Palpation  Percussion  Auscultation

16. LMCC II Exam Tips  Gao  Practice scenarios with others, time the scenarios  Verbalize steps, even when practicing, practice as though it is the exam, as much as possible

17. At the exam…  Read the questions carefully. Be clear about the objectives of the station.  Shake hands with your patient while introducing yourself  Be empathic, address discomfort  Mind your body language

18.  Set the scene, tell the patient what you are going to do  Speak slowly, clearly, at a volume that is not too loud  Thank the patient before leaving the room

19. A surprise question…  Develop a strategy or system to face each question.  ‘if you come upon a question that you have not studied – or begin to draw a blank, try to relax, take a deep breath”  Read the instructions to candidate carefully  “Suspend disbelief” – treat the exam patient as you would a real patient  Don’t be distracted by the examiner

20.  Introduce yourself to the patient, find out or confirm patient’s name  Wash your hands  Develop a rapport with the patient  Be conscientious about patient comfort  Drape the patient properly  Explain what you are doing  State what you are looking for

21. Exam Stress

22.  http://www.youtube.com/watch?v=j5kgXwPq Zjg http://www.youtube.com/watch?v=j5kgXwPq Zjg

23.  This exam is stressful because It is mandatory It is general It is an OSCE  Exams are stressful because It is an evaluation of your performance It is one day

24. Reducing Exam Stress  Accept it.  Prepare for it. Look at the website.  Prepare in groups.  Build confidence.  Practice for the exam.  Rehearse the exam in your mind.  Think positive.  Know what to expect (location, time, format)

25.  If you think you need help, ask for it: Dr. Melissa Andrew Director of Resident Affairs Email: andrewm@queensu.ca