I sat my finals during the past three weeks and am now am in limbo waiting for results.
This time next week I will be either be a doctor or a medical student waiting to resit Finals.
At my uni, Finals is made up of three parts: Two written papers and a four-hour OSCE clinical exam. We have to pass all three parts to qualify and if we fail at any part we have to do the whole thing again in June.
My first written paper was vile - I usually feel the exams are fair but this one was whacky and woolly and I'm really worried that there's no way I have passed it. The second paper was more what I would expect and was fair and clear in what was expected. And then we come to the living hell, otherwise known as the OSCE!
Our OSCE is divided into two parts. The first part takes place on a mock ward and the second half in outpatients. We have actors for the ward stuff and real patients for the long cases.
I will give you an idea of what went on for those of you that are interested in what happens in medical finals (Apologies to anyone that isn’t interested in this stuff!)
To set the scene.....100 sweaty terrified medical students lined up in a corridor. A bell rings and we are herded to our first "station"
This was a desk with a laptop showing a plain x-ray of a pelvis. There were also some written questions. We had to identify what was wrong and I could see that there was a pelvic ramus fracture (like two cracks in a polo mint) The problem here was that the written questions seemed to hint at a fractured neck of femur (NOF) but for the life of me I couldn't see it. Fractured NOFs can often be clear as day like this one but this xray was not clear. I later learnt that the others thought that there must be fractured NOF and wrote that they could see one because they felt that there must be one there somewhere!
I was then herded into a room with a consultant and a head CT scan - TERRIFYING! He asked me to describe the scan and I got excited (Doesn't take much these days) because it was a massive ischeamic stroke. He asked me which artery was involved and I wasn't sure so guessed at the biggest one. The consultant was wonderful! He asked me if I would thrombolyse this patient and I started waffling that she had arrived within an hour and this might be a good idea....as I said this he was shaking his head saying that it was a massive stroke so I shook my head along with him and said "No - much too big to thrombolyse!"
Then he left the room and an actress came in - she was supposed to be the daughter of the patient who's scan we were looking at. She had clearly been to the Hyacinth Bucket School of Drama and had been practicing her "Woe is me" face in the mirror. I now realise that this was meant to be a test in "Breaking bad news" as in telling the patient her mam was going to die, but what did I do?....told her that the next 24hours would be important and we would take it hour by hour" I even waffled on about my dad having the same stroke and he was now disabled but living independently.....hell I really missed the boat with this one!
We were then herded into a room with five desks. At each one were written questions and every five minutes the bell would go and we would have to move to the next. The questions were fair enough but the harassed exam co-ordinators (Med school secretaries who had obviously been kicked out of their normal jobs for the day to come and help to make a bad experience even worse) got mixed up and sent some of us out and then screamed at us to get back in!…brilliant
We had to plot growth charts for a baby, prescribe an anti-pyretic for a child and describe what tests we would do for an ill baby.
I then went into a room with a consultant, an actress (Here we go again) and a massive plastic vagina. I was told that the lady was 20 weeks pregnant and was bleeding and could I do a speculum exam. This went smoothly enough except that the women (Who was sitting three metres away from the fanny) kept moaning and crying throughout. My only mistake here was that I forgot to close the speculum as I withdrew – I noticed she had stopped moaning by now and presume that my incompetence had stunned her into silence.
(Acute emergency station)
This was a disaster! Behind the curtain was another actor (Bugger) the boss from casualty and a clinical skills nurse. The scenario was that this chap had been admitted with acute breathlessness. My mind was blank so I clicked into nurse mode and held his hand. I then thought that oxygen would be a good idea so the nurse started to arrange this and asked me how much…I couldn’t remember so prescribed “a lot” of oxygen (Are you cringing like I am?) Anyway – the consultant asked me for differentials and I went for pneumonia or a pulmonary embolism. Then he gave me the patient’s x-ray – a barn door cardiomegaly with pulmonary oedema so I revised my diagnosis to heart failure. I then got quizzed about what drugs I would prescribe and said loop diuretics (To get rid of some of the fluid). The consultant wanted more and in my ever increasing blind panic I decided to prescribe beta blockers. I know that there is controversy with beta blockers and heart failure because they make the heart beat slower and so can tip an already failing heart over the edge. Even knowing all this I still went ahead and said it. My Casualty boss was not impressed.
I then had to do an arterial blood gas on a plastic arm – this went fairly well but I was so glad to be out this station as made some horrendous errors
Another room with five desks in. Again written questions on lumbar puncture results, prescribing antibiotics for meningitis, cataract surgery questions, hydration in children. Then got taken into a room with another actor and an ENT consultant. God was he bored – he stood with his back to me looking out the window and looked ready to cry. I had to explain cataract surgery to the actor, all nice and straightforward
Then for Part two – we got herded like worried cattle into the outpatients department. Here we would be doing three long cases – all real patients this time (Thank god – no more actors) We had ten minutes to take a history, ten minutes to examine and ten minutes to be grilled by the consultant
Each patient was with a consultant in a room and the raw fear of knocking on the door and not knowing what was on the other side won’t leave me for many years.
This was a lovely chap with terminal cancer. All went fine and the consultant didn’t give me a hard time – just a few questions on PSA testing and presentation of different cancers
This was a strange one. There was a young man who basically had a blocked nose! Was a bit of a nightmare for me because I …ahem…..might have had a little holiday during this block. The questions were a bit tricky as I am not very up on sinusitis but it went OK. I kept thinking that it was too easy and that I had missed a lethal brain tumour but hopefully not
Chronic care patient
This was a little tricky too. I had an elderly chap with inflammatory bowel disease and never quite worked out whether it was Crohns or ulcerative colitis. I got questioned about macrocytic anaemia and that was it…..Finals over!
So that was it – four years of hell condensed into four hours of torture
Results are out this week and I feel sick. I think I failed the first paper and if this is the case I will have to do the whole thing again June. What a terrible thought