Dazed and confused: a real OSCE experience

After all the preparation, the worry, and the bitten finger nails, Samena Chaudhry realised that the dreaded OSCE was in her control

It is just five minutes before the finals OSCE (objective structured clinical examination) in medicine—the exam everyone seems to dread the most. For this, we practice looking slick for weeks in advance, from analysing angles of nail curvature on forgotten about, bemused patients on the ward, to getting that breadth of experience elastic swing with the patella hammer. Students slouch unnoticed on the back seats of buses or cinemas practicing spot diagnosis.

For me the OSCE was just as I thought it would be. My performance at its worst. The adrenaline rush and its after effects showed me up as a candidate who was close to being more cerebrally compromised than a shrimp. As the first bell rang, I was led into a room and introduced to a man with vague abdominal pain and no signs. Making the unfortunate error of pulling his eyelids up for jaundice, and down to check for anaemia, not only irritated my examiner, but also the patient who yelped in pain with a sore eye. I was unsure what the examiner meant me to find, but he obviously didn't care as he led me down a pathway for renal failure, which the man might have had, if he were ill.

I walked out dazed—with all sorts of mistakes I had made dawning on me too late—but was immediately led to the next station where I tried to spot diagnose a rather large candidate as an acromegalic. Two minutes were spent embarrassing him by describing his overgrown ears and chin before the examiner stopped me, kindly agreeing that he was indeed a large man but that this was not abnormal. Being a little more sensible, I moved on to examine his obviously enlarged goitre.

In the questioning phase, the word weight loss got stuck somewhere along the pathway from head to my tongue muscles. I managed to answer the thyroid function questions by fluke. The next case was fundoscopy. After seeing nothing but black, I mouthed the words “diabetic retinopathy,” since I was fortunately aware that the examiner was not an ophthalmologist. On being instructed to look at the left eye, I inadvertently began with the wrong one and claimed to see laser burns and some blot haemorrhages. The examiner seemed pleased and began to test my basic knowledge of diabetes, which I answered confidently. It was at this point that I realised, the exam was in my power more than the examiners. I passed well on the remaining stations.