Just finished examining 26 Sem 9 students for the Short OSCE. I feel dead tired.
The scenario is easy (hmm, somehow everything is easy after one has passed the exam! I didn’t think it was easy at all when I was a medical student!!!). I had a 50+ malay man who has a mitral valve replacement done on him 2 years ago. He also has atrial fibrillation. The positive clinical findings the students were expected to get were: an irregularly irregular pulse with varying volume; sternotomy scar on the chest wall (precordium), a displaced apex beat with visible pulsation and a distinct mechanical click one can hear all the way from PLUTO (just kidding). I can hear it from 6 feet away (my ex-supervisor, Prof CCL who is a cardiologist could hear it 12 feet away).
Compared to the Sem 7 students, the clinical skills of this batch of students were superior. It’s a wonder what 1 more year of clinical training can do.
And here are the bloopers (not many I am happy to say):
1. The patient’s darn handphone went off 4 TIMES during the exam, blaring the irritating ‘Mission Impossible’ theme song (it wasn’t irritating when I was watching the movie though). The patient said he did not know how to off the darn thing and so a few times during the exam, some students had to perform their examination accompanied by the theme song. Talk about the irony and drama! And since I am not a ‘Samsung-nite’. I had no idea how to put his phone into silent mode.
2. This guy takes the cake. He went and examined the respiratory system even though the instructions clearly stated to examine the cardiovascular system! He even looked for chest expansion. After politely reminding him that we were interested in the heart, he went on to declare “This man has no breath sounds!” after listening to the patient’s chest! And when he took out his stethoscope, a very loud distinctive ‘QUACK’ sound was heard! He was carrying a toy duckie. Must be a strong DIGI supporter.
3. During one of the intolerable 5 minutes breaks, I happen to chance upon the student in the next station explaining to the examiner that the X ray she was observing showed a “broken tibia” even though it was an X ray of a wrist fracture. (Actually I am not surprised you know, I once watched a local medical drama where this ‘surgeon’ diagnosed a “bleeding in the head and need immediate surgery” when he was holding an X ray of the forearms!)
4. Two students replied that they want to replace the patient’s heart valve when asked how would they manage the patient’s condition. (The answer is long term anticoagulation with warfarin). When pointed that the patient had INDEED gone through a valve replacement, the response was that of immense shock, disbelief (?at such a awful blunder just commited) and deafening silence.
5. One student, when pointed out that there is an audible mechanical click (audible from PLUTO), which he did not hear, promptly blamed the air conditioner for masking the sound! When I mentioned that one of his fellow examinee was able to hear the click above the blaring sound of the Mission Impossible (I, II and III) theme song, he said “Oh no!!! Die-la!”
There you have it. The exam ends today. I am praying hard that no one fails (otherwise, tomorrow I will be running around preparing for the borderline re-sit exam).
Watch this space. I shall update on the results tomorrow.
Meanwhile, it’s another 1 hour away to the Fellowship Dinner. After 4 days of toil, a nice dinner would be truly welcomed indeed.
Thurs, 150207 @ 1826