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My First (Standardized) Patient

JeffJeff Wonoprabowo -- The document I downloaded told me that my first integrative OSCE (Objective Structured Clinical Exam) would have a patient with either a neurologic or cardiac complaint. These clinical exams, with a standardized patient (trained actor), are stressful enough for third and fourth year medical students -- at least I imagine they would be. Last school-year, one of my housemates (who was a 3rd year at the time) was preparing for a Psychiatry OSCE and he seemed pretty stressed out about it. He even asked me to pretend I was a patient so he could practice interviewing. Playing crazy is kind of weird.

Well, I'm in the fall quarter of my second year. "Nervous" would be an understatement for how I was feeling about the OSCE. "FINE" would probably be a little more accurate -- but only if you use the definition from the movie, The Italian Job (definition: "Freaked Out, Insecure, Neurotic, and Emotional").

The quick version of the story, the same one I told to a couple of my classmates after the OSCE, is: I started off great. I smiled, greeted, and then, I shook the patient's hand. And then it all went downhill from there.

I laugh about it now -- although I still cringe a little. I still have to make an appointment to go view my video with one of the staff members. That is one movie I am not looking forward to seeing.

Before the OSCE, I spent a lot of my time focusing on the exam part. I practiced and mentally walked through the steps of a cardiac and neurologic exam. Now, I wish I had spent more time going over the parts of the interview.

Before interviewing the patient, I could list off the Review of Systems and the various questions I needed to ask if the chief complaint was a neuro or cardiac problem. After the interview, a flood of questions I should've asked came into my head. For example, the patient's vitals were posted outside the exam room on the door. I jotted them down on my sheet of paper. I should have realized that her age was not listed and during the interview I never thought to ask. In fact, the interview was littered with mental lapses where I would forget to ask certain things or totally gloss over a detail that I should have investigated more deeply.

At this point, I'm chalking it up as a very useful learning experience. I'm glad we had the opportunity to try this during our second year, as it's one of those things that you just have to practice. It'll also make interviewing a real patient next year a little less intimidating, too. Interview skills will come with time, and each of us will develop our own style.

I've heard that we'll get credit for doing it -- and I'm hoping that is the case.

November 24, 2008 in Jeff Wonoprabowo | Permalink


I defy any medical student to say they've never walked out of an OSCE kicking themselves for something they missed/ forgot, which usually occurs to you 30s after walking out... Good luck!

Posted by: Lucia | Nov 26, 2008 1:52:07 PM

OSCE is really a tough thing but fancy doing this on real patients..!!I am an egyptian med student and that how they examine us.... OSCE on a real patient and you are supposed to finish in 10 minutes so count yourself lucky for having standardized patients my friend...

Posted by: ahmad | Nov 26, 2008 2:19:31 PM

In the beginning, OSCEs suck! (You need to mess up a few to learn a few lessons that you'll NEVER forget.) Fortunately, it does become just-another-thing-to-do-to-pass, and you'll struggle to remember why the first few ones seemed to be so hard!

Posted by: ELP | Dec 3, 2008 9:22:24 AM

Yeah, OSCEs are pretty hard. We have a six year course in Australia and we get examined on real patients from 3rd year onwards. We have 15 min to take a history/do an examination. The examination must be done so smoothly as if we've been doing it since birth.

Posted by: Tess | Dec 3, 2008 5:03:56 PM

In Chile, we have different stations where they test different skills and you have only five minutes to complete an specific task. Hopefully you remember 3/4 of the complete examination and thinking is a waste of valuable time.

Posted by: Psykel | Dec 3, 2008 7:27:34 PM

Yup, OSCE = tachycardia & anxiety. Hehehe..

Posted by: Luna | Dec 4, 2008 8:42:08 AM

I am very happy that we are already doing this in our first year as medical students. And yes, we forget a lot of things to ask from the patient. Practice makes perfect!

Posted by: Clarise | Dec 7, 2008 6:53:18 PM

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