Showing posts with label OSCE. Show all posts
Showing posts with label OSCE. Show all posts

Monday, 2 July 2012

I get by with a little help...

...from my friends, and other medical students who I don't even know that well.

The burnout that I mentioned has really been affecting my ability to work. I'd got books out from the library, from which to re-learn everything I knew in January, and hardly opened them. When I did open them (following an extensive internal battle to make myself do some work), I either struggled to concentrate or just fell asleep. I needed to leech off other people's energy to get things done, as I didn't have any left of my own.

A few lovely friends had offered to help; I found this really useful. There was no internal battle to work, as I'd met with them specifically to work, so I had to do it, and they wanted me to. A friend played the patient and either invented a history or tookone from a book (book review coming soon!) while I played the doctor and took a full history, with OSCE-style strict time limits. Friends in my year who had passed everything gave advice on how I needed to improve my performance. I also practised examinations, such as orthopaedic joint examinations, again to time limits.

This was so helpful and avoided me having to motivate myself (unsuccessfully); I realised I needed more of this. But three friends couldn't provide the help between them, and I'd feel bad taking up so much of their time.

I posted a status on facebook asking if anyone could help over the weekend, and had conversation with a friend offering me advice, but nothing more. Eventually I realised that motivating myself was getting nowhere, and although having three friends to help was wonderful, it wouldn't see me through the exam. So I sent a facebook message to 16 other people, students in my year and the year below, good friends and less good friends. I explained my burnout and need for people to help, what I needed (extensive surgical knowledge not required!) and the times that I needed help. Within 24 hours I had seven wonderful replies, all encouraging and movtivating me, and each offering different times that they were free to help.

Just reading those replies made me feel that this huge task might be possible, that maybe there was a chance I could face this big exam with confidence, and succeed. All except one stuck to their word and came to help (the one who didn't, didn't live near and we hadn't made as concrete a plan), all for over an hour.

For a whole week I did no work on my own, and felt very little guilt about it, because I'd worked with nine different people, and the quality of the practice was so much better than anything I could do alone. Quality over quantity, number of hours less important.

I had a little further help the next week, to ensure that I maintained my history taking skills, which had improved greatly, becoming slick and fluent. I there had some confidence going into the exam, I  knew that I could do it because I'd done it many times before. There is nothing like preparation to grow confidence.


Failure lies not in falling down, but in not getting back up again. For me to get back up, I needed help. There is no shame in needing help, the failure is in not seeking help. Asking a whole bunch of people to help me was one of the best things I've ever done. If only I'd recognised the neeed and could have asked for it earlier. Oh, hindsight.

If you need help, ask, and keep asking. Ask for specifics - I told everyone what I needed, and when, in timeslots for people to choose (e.g. "I need Thursday evening, Friday morning and evening" etc). It was easy for people to help because they knew what I needed.

In paediatrics people sometimes talk of "the team around the child" (or the team around the family). I've had so much support the last two weeks it felt like the team around the [TTBAMS].

If I have passed, it will be thanks to all these lovely people, and because I asked for help.


That's "me" in the middle of the team huddle - having that much support feels amazing. (Thanks to the Nigerian football team for the picture)

Wednesday, 27 June 2012

Ideas, Concerns and Expectations, Baby

I've seen this wonderful video/song via Wishful Thinking in Medical Education, about asking ideas, concerns and expectations (ICE) of a patient in an exam. It often seems contrived, and though this video is about exams for general pracctice trainees, it's so true for medical school finals too. It's definitely on my mind given the final OSCE in a few days, though I find myself running out of time before asking it.

Also, I've been told the real skill is not about whether you ask ICE, but how you respond to it.



I would love to know the guys that put this together... they must have more interesting characters than some GPs I know!

Sunday, 24 June 2012

Like a little piece of charcoal

I woke up on Monday with so much dread for the week ahead and the work required that it suddenly came to as I was lying in bed: I am burnt out. On the one hand, that's horrible and means that I have no energy to do any work at all. But on the other hand, it's greatly relieving. It means I'm not lazy and useless, it's not all my fault that I haven't done enough work, it's just that I've done so much work and been so stressed for the exams in January and May that I just don't have enough energy left to keep going.

It felt so good to put a name on how horrendous I've been feeling about this exam and having to work for it. Burnout is a recognised concept, and a friend of mine had it after the January exams. I contacted her on Monday and she gave me some advice, including: get away from everything, go for a run even if you don't like running (which I did, briefly), burnout usually means you've done enough work already (yes, I did enough work in May, but unfortunately not for this re-take), to go easy on yourself (definitely), and to make a list of all your achievements, to push you on through this last one. I like that list of achievements idea - I haven't done it, but I have been thinking a little more about good things I've done, and that this re-take is really just to put the cherry on the cake. Except you can't have the cake without the cherry on, it is essential.

I realised that if I don't have enough energy to keep working through this revision period to the exam (which I don't), then the solution is to use other people's energy. Leech off them to get me through it, and work with others.

Which is what I've been doing. The only self-directed work I've done alone all week is to listen to a few podcasts whilst out walking places. So far, so good. Boo for burnout, but massive hooray for recognising it and getting through it.

Wednesday, 13 June 2012

I keep my visions to myself

Guess the song lyrics title at the bottom....

The night before last I dreamt that I'd found a patient, a rather mad lady who clearly needed some help, just outside a hospital (that looked a bit like Berlin Tegel airport somehow), but I couldn't get any phone signal to call an ambulance. So I had to take the patient into a hospital waiting room while I got some help, and I couldn't find any. I was upset that I couldn't help her. Somehow much later on someone pointed out that I could take her to Accident & Emergency, and I was so relieved, but also very worried at how I'd managed to forget that A&E existed....

Last night I dreamt there was a very special revision lecture happening. I spent a long time trying to find out who was giving it, trying to track them down, and find out where the revision lecture was. This somehow related to a wall hanging. But I couldn't find the lecture, or who the lecturer might be (I was looking amongst friends and acquaintances, rather than anyone who actually is a lecturer), and I got very stressed about it.

If I carry on like this the nights for the next few weeks will be very interesting. And stressful. Why I didn't feel at all able to help the patient in the first dream I don't know, maybe it reflects my lack of confidence. And maybe the fact that I was so desparately searching for the revision lecture reflects my lack of sel-motivation and need to have people teach me rather than me learning anything for myself.


I hope I get some more sleep than this in the next few weeks though, I'm going to need it.






Dreams, by Fleetwood Mac. Who are wonderful (and were not in anyway murdered or destroyed by Glee - in fact that episode reminded me how amazing Fleetwood Mac's music is and made me dig out my old CDs)

Saturday, 9 June 2012

There are no laurels to rest on

Nice as it was to learn that I'd passed all of my recent exams, that silver lining had a cloud. Yesterday I was given my exact marks for the exams, and discovered that my two recent practical exams were very, very narrow passes. By 4 or 5 marks, and since the overall exam has over a thousand marks, that is tiny. I scraped through both exams, and it was very very close. Too close, there's no margin for error.

The day of the big exam was a "good day". I'd done a load of confidence building and affirmations, put my positive mindset on, and got in the best frame of mind. Nothing at all went wrong, and I was the best I could be for almost all the exam (although towards the end of the three hours I did get pretty tired, everyone does). So if my absolute best is to scrape through with the tiniest margin of error, what happens if I'm not at my absolute best next time? I might have a streaming cold, a headache, too much nerves, a grumpy examiner - anything that could lose me those 4 or 5 marks.

This has at least put the frighteners on and given me a considerable kick up the rear to get me back into revising and not sitting around beinig complacent, but for a good 24 hours it pushed me too far. I think there's a scale of:
complacent, unmotivated, not working enough ----to---- motivated, hard-working, slightly scared but in a healthy way -----to---- panicked, totally terrified, unable to work, so convinced of failure what's the point in working
and I went from the left end to the right end, completely bypassing the healthy middle. An email from a friend, an email from a mentor, and some time with the other re-takers later, I'm feeling a bit less chicken-heady (I am no longer running around with my head chopped off, which I was mentally doing this morning). I'm towards the right of the middle and it would be good to get even further towards the middle.

It would be easier if I knew what I was actually doing wrong in the exams and had some idea of what to improve, but no, that would be too easy. Medical school is a cryptic crossword. It's very frustrating to have a station which I thought went amazingly (patient/actor clearly liked me, I asked all the questions for the diagnosis and all the others to rule out a differential diagnosis, I answered the viva questions brilliantly - I am not a show-off, but I thought it was my best station of the day), the examiner gave largely positive feedback comments, with the only negative that I was "a little slow to get through all the points" - this does at least suggest that I got through all the points, to fail the station getting a little over 50% of the marks. How does that work?!

So in the absence of really having an idea of what to improve, I just need to spend the next three weeks becoming the most incredible doctor all-round that there could possibly be. I will dazzle and amaze all the examiners. A tall order but who knows what could happen...

And I will not spend the next three weeks wondering whether these horrendous results suggest that actually I'm not really ready to be a doctor, and it would be much safer for me and the general public if I did re-take the year, learn how to be a good doctor, and make a better attempt next year when I actually know something. That is not productive thinking. But it is tempting.


The above is yet another reason why this blog is anonymous. My patients don't really want to know how much I've failed, or how close I came to failing. At least, they don't want to know that and then continue to be treated by me. And I will want them to continue to be treated by me - it would be embarassing for me and problematic for the hospital if not. Much as medicine is trying to break with the tradition of paternalistic "the patient doesn't want to know X [often that they had cancer]", I feel it's appropriate here if only for my own peace of mind. I want my patients to have confidence in me. If I pass, I've passed and I am good enough to be their doctor. If they knew the numbers this may be less obvious.

Friday, 25 May 2012

Thank goodness for that

I passed my exams, I am deemed safe enough and competent enough to be an almost-doctor. But of course I am not yet a doctor, because I have the first-attempt re-take still to go in five weeks' time.

I've just passed four big exams, which should be a celebration, but all I can feel is relief: thank God for that, thank God that's over, thank God I don't have to do that again. Oh and hooray for me as well? Maybe. Not so sure about that bit.

The full extent of my celebrating has been having a cream tea yesterday, and a fancy readymeal from Waitrose. All of my friends who actually are now doctors (no re-takes for them) must have gone big on the celebrations yesterday, but they'll just have to join me in my celebrations come July. Or they won't because when I get my results, we'll all be on holiday.... but July can be my big party.

The only extra benefit of these results is that it gives more weight to the argument that my failure in January was the medical school's fault, not mine. Their "mishap" did throw me off, and now that I'm over that, nothing can throw me now.

There's very little to stop me now - four weeks of exam preparation, which is all re-learning things that I already know, and then time to ace the re-take, which I fully intend to. Medical school in its simplest form is five years, and when I started I was told it costs £250,000 to train a doctor (it's probably a fair bit more now). So after we passed each year, there were various claims of "I'm now two fifths a doctor!" or my favourite "I am now worth £100,000" (after passing two years).
So now that I've done 4 years and 34 weeks (out of 40) of a 5 year course (let's not include my extra years, for simplicity's sake - they weren't strictly medicine), that makes me 97% a doctor. And 97% of quarter of a million is £242,500 - that's what I'm worth! That's got to be something to celebrate... it's too much money for anyone to want to waste (though it wouldn't be the first time) so I am going to ace the June exam. With bells on.

Watch this space for the mega-big-time-party-celebration in July. In the meantime, thank goodness for that.

Thursday, 17 May 2012

The biggest and finalest final

If it weren't for the pesky re-take I have to do in a few weeks, today could have been my last exam of medical school. It was the biggest, most comprehensive, and most terrifying exam of them all - the Medicine OSCE* (incorporating elderly care and mental health and anything at all that's not surgery, obstetrics, gynaecology and paediatrics). The one that if you fail, you can't work as a doctor for another year.
Today I wore the shirt that I wore to my interview to get into medical school 7 1/2 years ago, in 2004. It felt appropriately full circle. And if it was lucky then, it could be lucky now (though it was slightly on the tighter side now than then!). 
 
* OSCE = observed structured clinical examination. Big scary practical exam where you pretend to be a doctor, to prove you can. In a too short space of time, repeated many times over for half a day. The stuff of nightmares.

Saturday, 5 May 2012

Dignity

Today I was writing notes on practical procedures, for practical exam revision. Specifically, I was writing about male catheterisation, which is a complicated process, so I made a nice step-by-step flow-chart.

One of my flow-chart boxes said simply "expose patient, maintain dignity". That's all it needed to say for th purposes of my notes, but it struck me how unrealistic that is; if it were as easy as just writing it in a flow-chart box and it were magically done, all hospital patients would be wonderfully dignified. Even whilst being catheterised (I've been catheterised; it is an unpleasant and rather undignified procedure, and I know that even without full recollection if it - I was still woozy from the general anaesthetic).

I love the idea that one could just mentally note "maintain dignity" and that would be all it took. It's so far from the truth. In all honesty, I don't even know how to maintain someone's dignity, particularly when they're being catheterised. I find it especially difficult with old people, more so when dementia is a feature (that's another post for another time). Being professional I'm sure helps, but there's more to it than that.

And I certainly don't know how to maintain it since when going over my notes I discovered I had forgotten that vital step "cover patient with sterile drape" - sheet with small hole for penis to protrude onto sterile field is going to provide somewhat more dignity than general genital exposure. Woops. The sheet is in the catheter pack, so it's unlikely I'd forget when I'm actually trying to do it.

I also forgot to mention the essential step of "reposition foreskin" - if the foreskin is retracted for a long period of time, scarring and serious damage can result. I should be able to do this in practice; the first time I observed a male catheterisation, the doctor had forgotten to do this and I reminded them, so I should be ok (as should the patient's penis).

For now, all my brief notes can really include is the simple "maintain dignity", but at least it will serve as a reminder that in practice, this is always something to consider. It will remind me to think about the patient's dignity, even if achieving it is a task that seems mysterious, difficult, and at times, impossible.

Sunday, 22 April 2012

I want to fail

Before I go much further, I should update this, that I failed one of the final exams this year. Taking the title of this blog literally – trying, but not succeeding, to be a medical student…

It was a big deal at the time (I wrote a blogpost about it in my head, entitled [insert list of expletives here] because that was how it felt) and a big stress involving an appeals process relating to a “procedural error” during the exam, which was not in any way caused by me but impacted considerably on me (and only me). The appeal took two months, but was eventually as successful as it was ever going to be (not necessarily as successful as I’d have liked) and I’m allowed to take the re-take as though it’s my first attempt. This has no effect on the actual resit itself, but means that if I fail it, the medical school won’t be able to kick me out as they otherwise might have been able to. It guarantees me a third go, were I to need one. Let’s hope it doesn’t get to that, it’s already dragged on long enough.

So the advantage of this appeal result for now is simply in stress management – I should be less stressed going into it knowing that it’s not my last attempt, not a sudden death situation. And should therefore be more likely to do ok, at least that’s the theory.
(The other advantage is that it could, just possibly, be perceived as the medical school admitting responsibility for the “error” – which has not happened so far, and has not explicitly been said (quite the opposite, I was told it was one examiner’s fault and therefore not the medical school’s responsibility) but perhaps this appeal indicates that it was their responsibility. An apology would have been nice too, but I won’t ask for miracles.)

The re-take will be a three and a half hour long practical exam (as was the first one) at some point in June; I don’t anticipate finding out when any time soon – that would be far too useful.

So I have four final exams in the next four weeks, culminating in the massive scary practical one that expects me to know everything and prove I’m good enough to be a doctor. Which I’m not (obviously). Not yet anyway.
And then around four to six weeks after that, I’ve got the re-take of the one I’ve failed. Which is equally as big, but probably requires a bit less knowledge, and is re-learning what I learnt last time, rather than just learning, which is what I’m currently doing. And since I failed it by 3% last time, my chances can’t be too bad. And then about three weeks after the last exam (or medical placement or other medical school commitment, whichever comes later) I start work. I do six days of shadowing the junior doctor I’m going to take over from, and then on the 1st of August, same day as all the other junior doctors in the country, I start working properly.


Back to now: I very much wanted to pass all the exams in January. But this time around, I’m not sure if I care. Or even, I can see the benefits of not passing.
It would at least mean I get a break. If I fail something in May, if it’s a minor thing I might be able to re-take it in June with the other one. If it’s the major one I have to re-take in November, or re-take the year. If I fail more than one, I definitely re-take the year. Re-taking the year would not be fun – I haven’t particularly enjoyed it first time around, but I do have some friends in the year below (including a very good friend who is lovely), and I’d get through it, and maybe it would be good to understand what I’m seeing in practice, rather the see it and then understand later when it comes to revision/learning. Though that didn't apply to everything.

But the most important bit: if I failed in May and had to re-take the year, I would have no commitments between May and re-starting the year at the end of August. Three months with nothing. No commitments, nothing, just time to re-learn how to be a human being rather than a vile, miserable stressbag that is set to implode at any second. I like the idea of being a human being.

I know I said that I get three weeks off between end of exams and commitments, and starting work. Plenty of people could say that I’m lucky to get three weeks, that’s as much holiday as they get all year (and it’s not the only holiday I’ll get – I imagine I’ll have at least two weeks holiday from the job before the end of this calendar year). But those three weeks won’t fully be holiday. I’ll still be stressed for at least one week of it, or however long it takes for the medical school to give me my results. And I’ll be moving house, moving cities and finding somewhere to move to if I haven’t already found it by then. I’ll be moving away from the other half, which will be sad as it’s been quite nice living together again these last 6 months. Nice for me, not for him – I wouldn’t want to live with me at the moment.

So let’s say I get two weeks between getting my results saying I’ve passed and am allowed to be a proper doctor, and starting work. And though I intend to holiday then, though not quite sure of the details since other half’s job does not allow holiday in July or August (bit of a bummer when the only time properly off I’ve had this year has been one week in January and the three weeks in July. But a job is a job, so cannot complain), those two weeks will have some elements of stress to them.

For those that think that students doss around and being a student is a perpetual holiday, 2012 has mapped out thus: January – massive revision, final exams, one week off. February and March – full-time placements (full-time being around 8.30 til anytime between 3 and 8, minimum 4.5 days a week), three pieces of horrible written coursework case reports, compiling the horrendous and enormous student formulary, which is just a giant list of 180 drugs and everything you might want to know about them, and completing all the clinical skills for the year. Which I made difficult for myself by losing my skills book in December, and having to start all over again in February. April – one week of placement, one week full-time revision (“vacation” is a lie), two weeks organised revision with lectures etc, then final exams. May – final exams, one week off, which isn’t really when you have a re-take in June looming, then placements and/or intensive revision for the re-take. June – more intensive revision, re-take final exam, then more placements as required. I hope that makes clear that my requirement for some actual time off is not me being pathetic. The only time off I’ll have had all year, the only time off since August last year, was one week in January. Not enough to maintain sanity.

Anyway, my main point is that two weeks is unlikely to be enough to re-learn how to be a human being. Or to fully catch up on sleep and learn how to sleep properly again (I can't remember when I last had a good night's sleep). Especially not two weeks involving moving house and beginning to become slightly petrified about actually having people’s lives as my responsibility.

So failing and having three months off becomes more and more appealing. Which might explain my total and complete lack of motivation for revision and working and any kind of real exam preparation.

The other possibility is failing the big one and re-taking it in November, which would give me five months between the last June exam and the re-take in November, a little time to re-gain my sense of human. And the best bit – no commitments between November and the following July. Seven+ months in which to go nuts and have a great time, go travelling, well and truly re-learn how to be a human being and maybe even how to be a good one. Put it into practice.

The only reason not to go ahead with this genius plan is that I’d lose my academic foundation programme. Which is potentially my passport to whatever post-graduate training I want, and an overall good career. Seems a shame to forgo that. There’s also the issue that I’d have to do all of the exams all over again, but I think doing them a year later (or even five months later with the November option) and with some pre-existing knowledge, I’d stand a much better chance.

Maybe the academic place is a good thing, as it’s the only thing really keeping me going. Though it’s not doing a very good job of that at all, since I’ve been averaging less than two hours work a day this week. Admittedly there have been some revision lectures, and I spent yesterday at a revision course (watch this space for a review) but even so, an hour or two a day is pathetic. And nowhere near enough to pass the big ones.

But despite the incentive of the academic place, I can’t really bring myself to care. I imagine if I do fail, I’ll look back at this post with great regret and think about what an idiot I was. Whilst enjoying my three month long holiday, becoming a better person, and having a great time…

Maybe this is all just because I can’t in any way envisage myself passing (the last time I passed all my exams including practical ones was four years ago, and I’ve got a lot less good since then), so rather than dwelling on that negative, I’m looking for the silver linings in the, what currently feels inevitable, failure. It’s a shame the silver linings seem so tempting.
And that the academic programme isn’t as much of a carrot as I had hoped. Anyone have any tips on where to find motivation when all you need is some time off? I’ve already tried down the back of the sofa, and it wasn’t there.

(Feels a bit silly asking for tips, when no one's ever commented on anything in the year and a half history of this blog... maybe I need to find some readers, an audience. If you've read this, share it?)

Saturday, 21 January 2012

Thank god for OSCE chocolate

If the Daily Mail knew how much confectionery I consumed today, paid for with taxpayers' and NHS money**, they'd have a field day. Though if it gets me through the exam, which gets me to being a doctor, that's for the good of the country, right?!?


**Before anyone who might read this says it's paid for from university fees, final year medical students don't pay them. The NHS do. (However, the NHS student bursary I receive pays for any other chocolate I eat, so maybe it's all much of a muchness.)


OSCE = Observed (or objective?!) structured clinical examination. ie practical exam in which I pretend to be a real doctor, usually with actors but sometimes real patients, and get marked on how good I am at pretending, and therefore whether I should be allowed to do it for real. Each bit lasts about 10 minutes, each exam has that 10-16 times over. Mega stressful.