Thursday 25 June 2009

Big Surprise (7)

Part VII. HP3 OSCE, 7 minutes, 20%.
What should have been the last.

I totally did not expect it. The patient presented with cough. For the first 30 seconds while reading the case intro, before going into the consulting room, the word cough didn't ring a bell loud enough in my head. I expected sudden onset, central crushing chest pain (angina or full blown AMI), where I can then ask about the risk factors, etc. Heart attack is, in fact, the global #1 killer.

Thankfully, I have on the night before done a read-through of all the presenting symptoms in the ICM book, and sort of made links between their associated features. Cough goes with sputum (phlegm, kahak), haemoptysis, chest pain, breathlessness, wheeze, smoking, and fever. I reckon I did well with the cough, phlegm and coughing up blood. The ICM video on these were very interesting to me (thanks to Syarul), and all I did in the exam was copycat-ing the doctors and the way that they asked questions to find out more about the symptom.

What stressed me out was that I missed asking about chest pain and breathlessness! I realised this during the 3-hour lock-in after finishing my session, when I checked my workbook and found out that they are also associated features with cough. Surprisingly there's no feedback session with the doctor and patient this time around.

The reassuring thing for me is this thing posted online on LMS by our coordinator just 2 days ago:
On the whole I was impressed with the performance in this examination and the communication skills and interviewing skills were of a high standard.
Normally the OSCE (interview) is the last of our exams - which I see as the "pinnacle" where we utilise our medical knowledge to care for a person - but that's just me sometimes being over-dramatic. Our Prac Exam got the last slot this time.
OSCE=Objective Structured Clinical Examination, ICM=Introduction to Clinical Medicine
AMI=acute myocardial infarction, LMS=Learning Management System
Were you looking for something else?

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