GARGANTUAN steps
Friday, May 29, 2009
the mighty OSCEs
Half of my exams are over, following the mentally gruelling OSCEs yesterday. OSCE stands for Objective Structured Clinical Examination, and this basically assesses a medical student's practical abilities - history taking, examinational skills, suturing and using various medical equipments, as well as knowing various medical procedures well enough to explain to patients. All in all, the main principle of it I believe is to assess a student's ability to communicate appropriately with a patient, dispensing with all the medical jargons that we have picked up in the past three years as well as trying to regain the lost social skills after spending hours stuck behind a book.
Now this is where I believe us Singaporeans are at much of a disadvantage. We definitely aren't as expressive and communicative as the local counterparts here in London, and it definitely shows. Worse still, we aren't able to bluff our way out of tight situations, which I have seen many of my Caucasian friends do so with ease. I would say that we know our work much better than them, but they are able to deliver the knock-out punches in these sort of exams. But I think it definitely puts us in good stead as compared to our Singaporean counterparts when we return back home to work, if we do anyway.
Yesterday OSCEs was held at St. Mary's Hospital for me, at the wretched time of 220pm, which is when I am most sleepy during the day. According to a certain consultant at St. Mary's, with a huge reputation, the OSCEs for the third years of Imperial are as tough, if not tougher, than the final year examinations of Guys, Kings and St. Thomas' Medical School, which happens to be the main rival medical school in London. This probably makes me feel much better, and more prepared to become a doctor in the future. The OSCEs for Imperial consists of twelve stations, ten minutes each, with a minute in between the stations to read the various instructions.
I didn't start well with the first station, having to go in late because the patient and the examiner were not ready. The first station was putting a suture on a 'fake skin' with a laceration on it. This had to be done standing up by me (because the patient was already sitting comfortably in a rather inaccessible position). I still wonder whether I should have shifted the patient, but I think I managed to put in the two stitches fine, though not without some slips. I only ran the second stitch through one side of the wound before tying the knots, and I realised my mistake too late. Thus, I had to cut the knot away and do another suture, by which time I started to perspire profusely, thinking that my time was running out. Thankfully, I was able to put in the next suture in time and run off to the next station.
The next station was trying to explain the use of an inhaler, spacer and a peak flow meter to a patient, and this was dealt with much less discomfort, though the patient did ask some funny question about how many doses of his steroid inhaler should he be taking. I wonder whether I should have known that, but I told him it was up to the consultant's prescription for him. The third station consisted of putting the leads on a patient's chest for him to take an ECG as well as interpreting an ECG. I had an ECG showing someone with an antero-lateral myocardial infarction, which I believe shouldn't have been too far off. And I was slightly thrown off about the medical treatment of atrial fibrillation, finally squeezing out heparin and warfarin, and I hope I did say digoxin, if not, I probably got that section wrong.
The fourth station was performing a respiratory examination on a patient, of which I missed out checking the jugular venous pressure. They also had some fake stethoscopes to hear fake breath sounds when the patient was breathing, and this patient had a monophonic expiratory wheeze. The fifth station consisted of taking blood out of a fake arm of a patient with iron deficiency anaemia. This was probably the easiest station. The sixth station was taking the history of someone with an abominal pain, which I believed to be due to biliary colic. The seventh station was performing a cardiovascular examination on a patient, and he had a mitral regurgitation. The eighth station was taking a history of a patient with a headache, and I think she had a migraine, and I couldn't really come up with much medical advice for her, which might have pulled me down in that station.
The ninth station was examining a patient's breast, which, in my opinion, must be really painful for the patient. Following that, you had to write down your findings in the notes, which is actually quite a clueless thing to do, considering that medical students don't do consultations. The tenth station was performing a neurological examination of a patient's lower limbs. This was done without much of a problem, besides the patient having bilateral loss of sensation below the knee, which was obviously quite fake. And added to that, he had a shuffling gait (the best way I could describe it) which was suppose to have pointed to him having alcoholic-neuropathy (I hope).
The penultimate station was explaining a colonscopy to a patient, and that wasn't too much of a hassle, and the final station involved taking a urological history of a patient who had urinating blood, followed by performing a urine dipstick analysis. I was getting weird signals from the examiner, and I was thinking that I had run out of time with history (without completing it fully), and when I mentioned about proceeding with the dipstick, he asked if I had anymore questions to ask. So I took the hint and went down the wrong road, and the examiner said there was another path I hadn't taken - I had conveniently forgotten about this patient's past medical history which I promptly corrected. By which time, it was time to perform the urine dipstick.
These two hours just went by in a flash and I have never felt so exhausted after an exam before. I think this really is the ultimate endurance test. I was complaining about the OSCEs not being the right way to assess the skills of a student. Many students were skipping going into hospitals the last few weeks before OSCEs, just to practice, and I felt it was rather unfair for people whose firms did not allow that. And there were some of us who were working hard in the hospital, and I felt that that was probably the best way to assess a student. I think that would have been great, and an OSCE examination on top of that is probably the best way, because no matter how much practice a student has done, this does not prepare them in any way for the OSCEs. Doing 12 stations in 2 hours just leaves your mind in a whirl - it really tests your innate ability, and not how much you have practiced at home.
I hope that I have fared well in the OSCEs. I know I could have done better, but that's what I always feel on hindsight. I think I managed to balance my hospital work with my OSCE practice well enough and I should be proud of myself, unlike some of the other medical students, whom I feel don't deserve to become doctors, due to their lack of commitment.
Now this is where I believe us Singaporeans are at much of a disadvantage. We definitely aren't as expressive and communicative as the local counterparts here in London, and it definitely shows. Worse still, we aren't able to bluff our way out of tight situations, which I have seen many of my Caucasian friends do so with ease. I would say that we know our work much better than them, but they are able to deliver the knock-out punches in these sort of exams. But I think it definitely puts us in good stead as compared to our Singaporean counterparts when we return back home to work, if we do anyway.
Yesterday OSCEs was held at St. Mary's Hospital for me, at the wretched time of 220pm, which is when I am most sleepy during the day. According to a certain consultant at St. Mary's, with a huge reputation, the OSCEs for the third years of Imperial are as tough, if not tougher, than the final year examinations of Guys, Kings and St. Thomas' Medical School, which happens to be the main rival medical school in London. This probably makes me feel much better, and more prepared to become a doctor in the future. The OSCEs for Imperial consists of twelve stations, ten minutes each, with a minute in between the stations to read the various instructions.
I didn't start well with the first station, having to go in late because the patient and the examiner were not ready. The first station was putting a suture on a 'fake skin' with a laceration on it. This had to be done standing up by me (because the patient was already sitting comfortably in a rather inaccessible position). I still wonder whether I should have shifted the patient, but I think I managed to put in the two stitches fine, though not without some slips. I only ran the second stitch through one side of the wound before tying the knots, and I realised my mistake too late. Thus, I had to cut the knot away and do another suture, by which time I started to perspire profusely, thinking that my time was running out. Thankfully, I was able to put in the next suture in time and run off to the next station.
The next station was trying to explain the use of an inhaler, spacer and a peak flow meter to a patient, and this was dealt with much less discomfort, though the patient did ask some funny question about how many doses of his steroid inhaler should he be taking. I wonder whether I should have known that, but I told him it was up to the consultant's prescription for him. The third station consisted of putting the leads on a patient's chest for him to take an ECG as well as interpreting an ECG. I had an ECG showing someone with an antero-lateral myocardial infarction, which I believe shouldn't have been too far off. And I was slightly thrown off about the medical treatment of atrial fibrillation, finally squeezing out heparin and warfarin, and I hope I did say digoxin, if not, I probably got that section wrong.
The fourth station was performing a respiratory examination on a patient, of which I missed out checking the jugular venous pressure. They also had some fake stethoscopes to hear fake breath sounds when the patient was breathing, and this patient had a monophonic expiratory wheeze. The fifth station consisted of taking blood out of a fake arm of a patient with iron deficiency anaemia. This was probably the easiest station. The sixth station was taking the history of someone with an abominal pain, which I believed to be due to biliary colic. The seventh station was performing a cardiovascular examination on a patient, and he had a mitral regurgitation. The eighth station was taking a history of a patient with a headache, and I think she had a migraine, and I couldn't really come up with much medical advice for her, which might have pulled me down in that station.
The ninth station was examining a patient's breast, which, in my opinion, must be really painful for the patient. Following that, you had to write down your findings in the notes, which is actually quite a clueless thing to do, considering that medical students don't do consultations. The tenth station was performing a neurological examination of a patient's lower limbs. This was done without much of a problem, besides the patient having bilateral loss of sensation below the knee, which was obviously quite fake. And added to that, he had a shuffling gait (the best way I could describe it) which was suppose to have pointed to him having alcoholic-neuropathy (I hope).
The penultimate station was explaining a colonscopy to a patient, and that wasn't too much of a hassle, and the final station involved taking a urological history of a patient who had urinating blood, followed by performing a urine dipstick analysis. I was getting weird signals from the examiner, and I was thinking that I had run out of time with history (without completing it fully), and when I mentioned about proceeding with the dipstick, he asked if I had anymore questions to ask. So I took the hint and went down the wrong road, and the examiner said there was another path I hadn't taken - I had conveniently forgotten about this patient's past medical history which I promptly corrected. By which time, it was time to perform the urine dipstick.
These two hours just went by in a flash and I have never felt so exhausted after an exam before. I think this really is the ultimate endurance test. I was complaining about the OSCEs not being the right way to assess the skills of a student. Many students were skipping going into hospitals the last few weeks before OSCEs, just to practice, and I felt it was rather unfair for people whose firms did not allow that. And there were some of us who were working hard in the hospital, and I felt that that was probably the best way to assess a student. I think that would have been great, and an OSCE examination on top of that is probably the best way, because no matter how much practice a student has done, this does not prepare them in any way for the OSCEs. Doing 12 stations in 2 hours just leaves your mind in a whirl - it really tests your innate ability, and not how much you have practiced at home.
I hope that I have fared well in the OSCEs. I know I could have done better, but that's what I always feel on hindsight. I think I managed to balance my hospital work with my OSCE practice well enough and I should be proud of myself, unlike some of the other medical students, whom I feel don't deserve to become doctors, due to their lack of commitment.
Labels: Examinations, Imperial College
Monday, May 04, 2009
never a tale of more woe
I spent my Saturday afternoon at the Shakespeare's Globe Theatre watching a play that I had almost learnt by hard for my 'O' Levels. The Shakespeare's Globe Theatre is supposed to be modelled after the original theatre in which Shakespeare was associated with way back in the 16th century. The original was burnt down in the 17th century, and the current Globe Theatre was only opened in 1997. It was quite amazing, walking into this set-up, and having to stand in the yard for the entire duration of the play, which was three hours long! I had a massive lower backache at the end of the play, but it was really worth it. The acting was phenomenal (judged by my rather lowly acting criteria) and the minstrels were excellent.
Thanks to the intense interpretation of the text way back when I was 16, I had a much greater appreciation of the play. I probably would not have enjoyed it half as much as I did if I hadn't taken Literature. Romeo and Juliet is probably one of the most well-known love stories and I think everyone yearns to experience such a deep, selfless romance. This also brought back happy memories of my secondary school mates - you guys know who you are! I'm sure Lim, Pork and Kenn Yeoh would have enjoyed this.
Thanks to the intense interpretation of the text way back when I was 16, I had a much greater appreciation of the play. I probably would not have enjoyed it half as much as I did if I hadn't taken Literature. Romeo and Juliet is probably one of the most well-known love stories and I think everyone yearns to experience such a deep, selfless romance. This also brought back happy memories of my secondary school mates - you guys know who you are! I'm sure Lim, Pork and Kenn Yeoh would have enjoyed this.
The interior of the Shakespeare's Globe Theatre
Meanwhile, it's back to the real world, the grit and grime of medical school life, late nights and long days, a lethal combination that crushes every one of us, till there's nothing left.
Friday, May 01, 2009
swine flu
And you wonder what friendship is all about.
Labels: Humour
