Saturday, 5 May 2012


Is it an Objective Structured Clinical Examination or a  Subjective Structured Clinical Examination?

On paper is should be objective but in real life its down to whether or not the examiner takes an instant like or dislike to you.

The FM passed a resit OSCE yesterday. On her first sitting she got 31/32 for the head and neck station. Second time round she failed this station, despite her examination being exactly the same, a neck lump in exactly the same place and her suggested differentials being the same.

This time round she got full marks in the lower Peripheral NS and Breast station, despite failing them first time round. Her examinations were exactly the same, down to the same way she introduced herself and held the tendon hammer. This time round the OSCE gods were smiling.

There is also the fact that OSCEs are a game. First time round she passed the critical care station but dropped a couple of marks. After getting feedback she realised there was a mark for commenting on the values of observations given to her in the station. Second time round she scored much highly for saying things like this...

"This blood pressure of 80/40 is low, I am concerned by it."

Repeat above statement but for pulse rate, respiratory rate, oxygen saturation etc.

A similar example is in the radiology station. Two bloody marks for simply stating that this is a "PA chest radiograph."

Is this really the best way we have to decide who is suitable to be a doctor or not?

On another note she got 29/30 for her abdomen examination (on both times), saying to the examiner that she would admit this patient who had an ileostomy two months and was in an incredible amount of pain, was probably the right thing to say.

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