Need help on how to study for 2nd year OSCE!!!

[pigglewiggle]

Hi-i was wondering if anyone else had to do an OSCE at the end of 2nd year. We have one in a month and I have no idea how to study for it. Is there a list of things that we have to complete? Also, do you know of any online videos that show you how to do everything? Thanks!

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[indo]

Isn't it a full H&P osce?

The biggest obstacle with doing an H&P is the order and timing. After you figure out what order to do the various components in the exam takes very little time.


Haven't you had any class instruction on how to do a physical yet?

 

[SamusLives]

For us, the 2nd year OSCE was just like the USMLE Step 2 CS exam (with the exception that they told us what physical exams at each station). You should find out the structure for your own examination from your school.

Basically, you'll probably need to take a focused history, perform a focused physical, and close the encounter. Then you write a note--history, physical findings, DDx, Plan. 15 minutes for the H&P, and 10 minutes for the note.

I would recommend the First Aid for the USMLE Step 2 CS. You can probably read through that pretty quickly. The cases at the end are probably what most of your encounters will be like. Our OSCE was graded like the CS--Spoken English Proficiency, Communication and Interpersonal Skills, and Integrated Clinical Encounter. CIS is basically calling pt by name, introduce yourself by name, shake hands, watch for pt comfort (offer tissue if crying), show sympathy, summarize history, ask permission for doing physical, wash hands before physical, pull leg rest out when pt laying down, drape patient (expose only small areas of pt), giving the patient your clinical impression, counseling, discussing plan/workup, asking about questions/concerns. ICE is taking a good history, performing appropriate physical, and writing your note. SEP is speaking clearly, so you don't need to repeat things. Its a checkbox exam, you either do something or you don't.

If your worried about your physical exam skills, find out what resources you school has online. My school has the Bates physical exams online, I watched them the day before the exam.

You may want to get a partner to practice with. It will give you an idea of how to manage your time (15 minutes is enough, if you practice). As for the notes, do not write "normal"--that's bad. Write "Lungs: CTAB (clear to auscultation bilaterally), Heart: normal S1/S2, no murmurs, rubs, gallops. Find out about acceptable abbreviations.

One month should be more than enough to prepare.

 

[soeagerun2or]

Make sure you insist on giving everyone a rectal exam. I did this on 2CS and passed with flying colors. Plus, I figure if it's close to $1200 they should earn it.

 

[XoQo]

Hi-i was wondering if anyone else had to do an OSCE at the end of 2nd year. We have one in a month and I have no idea how to study for it. Is there a list of things that we have to complete? Also, do you know of any online videos that show you how to do everything? Thanks!

It depends on how your school runs it. I can only speak based on what my school did and what the Step 2 CS experience was like...


Tidbits:

-we never did a full h&p for our OSCEs, only focused exams (i.e. they told us which systems to examine). This is similar to how Step 2 CS is done (focused exam), except that for CS you have to figure out what you should examine. On CS you don't have time to do a full physical.

-certain exams should ALWAYS be done (always take a quick listen to the heart, lungs for instance).

-practice each of the organ system exams in such a way that you always do a certain order. This helps you not forget things. This also makes sure that you have your toolbox for certain complaints (i.e. tactile fremitus on a coughing patient u suspect might have pneumnia, etc).

-our OSCEs were "checklist" graded and i think CS is the same too. Basically the standardized patients have stuff they are supposed to see if you do. It's a *subset* of a full pulmonary exam -- they might see if you listed to both the anterior and posterior fields, if you checked egophony, but might not have a checkbox for whispered sililoquy).

-First Aid for CS is a good review book for you to use -- both for the hx questions and the physical exam checklists. They have practice scenarios for you to use as well. Best way to take advantage of this is to find a friend and read the scenario outloud to the other and verbally go thru (and walk thru the exam) and then compare to the book

-learn to be brief with your notes. phrases and bulletpoints are ok

-know the standard h&p order of sections. it just makes it easier for people grading your exam. it also helps you make sure you never forget something crucial (i.e. always ask PMH, PSH, meds, allergies)

- i am briefer than most on social hx. i ask about smoking, alcohol and what they did for a living. depending on how your school grades, this might or might not be enough.

-review of systems HAVE A QUICK SPIEL memorized for this) hit the critical points from each organ system (i.e. always ask about fevers/chills for gen. always ask about belly pain/diahrrea/constip/melena/hematochezia for GI, etc. first aid has a blurb about this i vaguly remember)


feel free to PM if you have specific questions.

 

[MacGyver]

certain exams should ALWAYS be done (always take a quick listen to the heart, lungs for instance).

For the Step 2 CS, this is not true. It depends on the complaint. For example if you get a dizziness case, lungs should be the last thing you think about. Do the following first:

1) Gait testing
2) EOMI
3) Orthostatics
4) Carotid palpation, auscultation
5) Romberg
6) Hearing test (finger rub, Rinne, Weber)
7) Heart auscultation
8) Rest of hte cranial nerves

only after you do all that should you do lungs. in a 15 minute time slot, you dont have time to get a thorough history AND do all that stuff AND do a lung exam

 

[XoQo]

For the Step 2 CS, this is not true. It depends on the complaint. For example if you get a dizziness case, lungs should be the last thing you think about. Do the following first:

1) Gait testing
2) EOMI
3) Orthostatics
4) Carotid palpation, auscultation
5) Romberg
6) Hearing test (finger rub, Rinne, Weber)
7) Heart auscultation
8) Rest of hte cranial nerves

only after you do all that should you do lungs. in a 15 minute time slot, you dont have time to get a thorough history AND do all that stuff AND do a lung exam

Absolutely agree with your take on the OSCE -- you absolutely must prioritize based on the chief complaint. Thing is, the sense i got from how it was scored was that much more of your points go to Hx. I spent ~10 mins on hx and ~5 mins on physical exam. I actually had a patient like you described...Rinne/weber/orthostatics i found to be too time consuming and just "ordered' them on my note. I still passed


When i said heart/lungs -- I literally meant take the 30 seconds to listen to the heart, lungs. No palp. No percuss, no fremitus, just listen. I do this even if the patient comes in with a busted toe or a sprained ankle. Just habit i guess.


On our OSCEs they occasionally threw a point at CV/lung ausc it seemed.