My First (Standardized) Patient

Jeff 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.