Friday, November 20, 2009

The Final Hurdle

As part of  my final year exam at University of Melbourne, I had OSCE and one long case in the last two weeks.

OSCE stands for Objective Structured Clinical Examination. It means that you spend roughly 9 minutes either taking history from an actor or performing a brief but concise physical examination in front of an examiner or interpreting radiological images such as chest x-ray and answering several questions.

Long case means that you are given one hour with a patient in the hospital. In that one hour, you need to know why the patient is in the hospital and to perform relevant physical examination and at the same time, think of appropriate management plan for that patient. You then present your history and examination findings to two examiners. The examiners will be either a general surgeon, physician or a general practitioner. The examiners will asks several questions relevant to the patient and test the depth of your knowledge based on your answer.

I had two OSCE at two different location for two days. The first day OSCE was held at the medical faculty and the second OSCE was held at the hospital.

Medical Faculty
  1. Patient presented to you with dizzy spell. It was benign paroxysmal positional vertigo. I was not sure what else to ask in this station and was asking weird and random questions towards the end of the station.
  2. Interview patient who was referred from Emergency Department to Neurology Outpatient. The ED doctors felt that her epilepsy is not fully controlled. Again, I was not sure how should I approach this station. I have to read the question several times and in the end, running out of time to answer the questions from the examiner.
  3. Pregnant women who is vomiting. Take history and discuss the differential diagnosis and the relevant investigation. Hyperemesis gravidarum is the keyword for this station. I totally forgot about the intravenous fluid therapy.
  4. Interpret peak flow chart and teach good inhaler technique to asthmatic patient. Was running out of time in this station.
  5. Radiology station. CT Brain: Haemorrhagic Stroke. Chest X-ray: Tension Pneumothorax. Interpret lab result: Nephrotic syndrome. I don't have enough time in this station.
Clinical School
  1. Interview a patient who is feeling unwell. He had malaria. I think I did pretty alright in this station.
  2. Interview a patient who had recurrent abdominal pain. It turned out the patient had acute pancreatitis. Need to know the differential diagnosis and the relevant investigation. Despite memorising all the causes of acute pancreatitis before the exam, I forgot all the causes due to anxiety attack.
  3. Procedural skill station. Need to perform airway management and CPR
  4. Perform cardiovascular examination on a patient who had a murmur. I think the murmur was mitral regurgitation. Not really sure about the murmur since I was pretty nervous thinking the differential diagnosis for both diastolic and systolic murmurs.
  5. Perform relevant examination for patient who had right hip pain. Need to do gait, Trendenlenburg test and hip joint examination. After that, need to interpret the hip X-Ray (Osteoarthritis) and discuss the appropriate management of osteoarthritis.

Long Case
I had the opportunity to interview a patient who came in to the hospital with acute asthma attack in the background of nephrotic syndrome (I already had nephrotic syndrome as part of my OSCE).

I don't think I did well in my presentation and the examiners does not ask me any particular question related to asthma management. Instead they opt to ask me questions related to nephrotic syndrome. It was quite difficult since I haven't learned in detail about nephrotic syndrome. When they asked the type of glomerulonephritis causing nephrotic syndrome, I stumbled a bit and just said maybe diabetic nephropathy and rapidly proggressive GN. When they asked me to explain the mechanisms of hypercoagulability state in nephrotic syndrome, I guess this must be my limit. I'm not sure which clotting factors or proteins that will explain the symptoms. I mentioned several clotting factors, protein C and S and antithrombin. I don't know the real mechanism to explain those symptom.

Anyway, up to this point, they haven't asked me anything about asthma. If they were to ask me about asthma, I guess I could do a bit better in my long case.

Hopefully all my friends and I could pass the final year exam and able to graduate together on 5th December 2009.


Dr Mom said...

they never ask you the question that you want to answer in the long case!!!

adoi nephrotic syndrome - i thought having it in the osce was enough!!

i think everyone's passed if they haven't received a call by 5pm today.

nihas said...

ganbatei ne... Doc, u kena lulus... kan nak bawak balik 2cert hujung tahun ne... hehehe... any idea about DVT tak? bukan DVVT enjin kereta tu heh...

Hafiz said...

@ Dr Mom, alhamdulillah, that is good to know :)

@ nihas, do you mean the deep vein thrombosis?

TeacherNunu said...

wow, moga cemerlang this dec nanti and come back to malaysia soon..malaysian need more dr :) especially the young one like u heheh

SoFie NuR said...

fuhhh...that's hard...takut la pulak rasa..huhu..

insyaAllah everyone will pass it n be able to graduate on 5th Dec :)

Hafiz said...

@ teacher Nunu, yup. I will be working at Malaysia next year :)

@ Sofie, it was hard and but it was expected. After all the final year exam is supposed to be the hardest exam for any students.

Alhamdulillah, I think I passed and the result will come out this Friday.

Nur Faizah Subani said...

Salam..Congrat on ur grad n ur wedding..hrp ade cite time houseman nnt..

p/s:when i'm in ur position..xdelh terkejut sgt kot..hee..time kasih..^_^

Anonymous said...

I want to quote your post in my blog. It can?
And you et an account on Twitter?

Anonymous said...

Thanks a lot, Hafiz, this will certainly be helpful for our finals 2011 Melb Uni. Hope to c u back in Msia