Objective? Structured? Clinical Examination?

“My First OSCE”: A Tragedy In One Act

Me:  Okay, sir, I’m just going to take your blood pressure and then we’ll move onto a physical exam.  *pumps cuff up expertly*

Gauge:  *briefly flutters around the 2 mmHg mark, then back to 0*

Me:  … *tightens valve*  Hmm.  Sorry, sir, I’m going to readjust this and try to get this working.

Valve:  No, you aren’t.

Me:  Or it may be a problem with the cuff – *spends an eternity checking for leaks and pumping*  

Patient:  Okay.

Me:  *I am now holding a puffed up balloon of a cuff in my hand*

Patient:  Aha, you fixed it!

Me: *releases valve*  *nothing happens*’

Me:  *awkwardly bats BP cuff balloon around*  No, I guess it’s a problem with.. many things.  Hmmm.

Me: Let’s see.. give me a sec?

Patient:  Oh, uh, no problem.

Me:  *runs to retrieve bag from waiting room*  

Preceptor:  What the -?

Me:  *pulls out brand new sphygmomonometer from bag!*  

Brand New BP Cuff:  *is still awkwardly wrapped in plastic*

Me:  *hastily fumbles with plastic*  Sorry for the wait, sir – since you’re having chest pain, it’s just very important to me that I get your blood pressure right.

Patient:  That is so impressive.  I am so impressed right now.

Me:  Yeesssss.

Preceptor:  … yeah, you have 5 minutes left.

Me:  Noooooo!

“My Feedback”:  A Short Disaster

My Standardized Patient:  You know what I like about you?  You’re tenacious.  You just won’t give up!

Me:  Thank you!

My Standardized Patient:  No matter how bad things seem!

Me:  Oh. Uh, thanks!

My Standardized Patient: – and no matter how utterly hopeless it seems, you refuse to give up.  You have no ego. As an actor, I very much appreciate that quality.  I wish you were one of my co-workers!

Me:  That – hmm.  That means a lot, thank you!

My Standardized Patient:  What a fantastic experience.

My Preceptor:  

Yes sir, my preceptor’s request to “bring that cuff to clerkship tomorrow so we can practice” is certainly a good sign.  THINGS ARE LOOKING UP FOR LITTLE OL’ ME.

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12 thoughts on “Objective? Structured? Clinical Examination?

  1. I had a similar experience on one of my first OSCEs, in which I got the cuff to inflate but couldn’t hear the patient’s pulse. In my feedback at the end, I was told that it would’ve been better if I’d told the patient his blood pressure so that he could be more engaged in his healthcare, and I had to admit that I had no idea what it was.

  2. I laughed uncontrollably until I cried on this one. I can only imagine what you were going through, you handled it well though, it’s good to know you can look back on it and find it funny. I love your blog by the way!!

  3. well played, ma’am.

    In all seriousness, how *do* you get feedback on your OSCEs? (particularly the graded/for-credit/summative ones) This is a recent issue at University Medical School with the proliferation of OSCEs that we have, now, in almost every course.

    • That OSCE was a “practice” one. Good question. We’re P/F for the pre-clinical years, so I don’t think our OSCE in December will count either – it’s just all about us “gauging our strengths/weaknesses.”

      After that.. we go to some crazy 3-5 tier grading system that I’ve never bothered to understand, and who knows. Hopefully it’s not too complicated.

    • To add my $0.02 on this matter, at my school, for every station you have four minutes for feedback. Depending on the evaluator, they may just read off the things on their checklist that you did or didn’t do, or talk about specific things in your technique/interview you did well or could have done better. The really good ones will show you new/improved things.

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