Professional Documents
Culture Documents
ABCDE approach. Discussing examination of the leg
Appropriate investigation. Discussing limb X‐ray with confidence ‐ very slow and hesitant.
Interpreting X‐rays ‐ mostly accurate
A&E Facial Some students did not identify this as a pneumothorax until
injury prompted!
A&E MS injury Good and efficient with collected information to reach a working
diagnosis.
A&E ABCD approach. Indications for CT head were a struggle.
Unconscious Appropriate investigations.
Patient
A&E Wound About 50% can not understand texity of local anaesthetic & dose.
Care
Did well on the history, assessment and principle of wound A good number could not remember how to calculate the
management. maximal volume of local anaesthesia + toxicity of local
anaesthesia.
Understand principle of wound care Needs to know about does & effect of lignocaine.
Importance of occupation / dominant hand
A&E Wrist injury Want to give analgesia and x ray. Too keen on this. Must concentrate on cause of the fall: mechanical vs. non mech.
Anatomy ‐ one or two ‐‐‐> correct carpus.
Sling ‐ many were not very good at this
Sling
Collar Bone
Most students did not do very well though they were satisfactory Mentioning all factors affective accuracy.
Page 1 of 9
Year 5 Semester 1 OSCEs ‐ Generic Feedback for Students
Station In general what did students do well on this question In general what did students do poorly or not do on this
question
CBM Diabetes Smoking and alcohol history often mixed even by good
Type 2 Statin candidates. Poor explanations of Q risk & true benefits of statins.
The communication skills were good. I felt quite a few of the students did not understand the task ‐
explain the diagnosis, they explored the symptoms of depression
instead.
All had good basic knowledge of diabetes CV risk. A lot to cover so hard to cover everything.
All had fixed agenda initially, rather than asking patient why came
in
Generally all quite doctor centred in management.
Explore the patient's reason for not taking statin and reassured re Did not convey consequences of high CV risk.
adverse effects. Talked about diabetes and cholesterol separately.
Good clear explanations and patient centred approach.
CBM LUTS 1 All understood that prostate was the problem here. Most had Some were too worried about avoiding jargon to the extent that
Prostate good knowledge but some failed to convey this! they didn't mention disease or drug names. One or two didn't
seem to understand that mentioning cancer might be upsetting /
disturbing!
History Taking / Red flag screening. Health promotion / primary prevention of CVD.
Use of comm. Skills. Discuss medical management of BPH.
Discussion of PSA Willingness to investigate outcomes with a view to planning a
management plan.
CBM PV bleed Communication skills good. History taking often did not address other issues such as STIs.
COCP Red flags often omitted.
Ideas, concern & expectations rarely all done.
Poor formulation of management plans.
Weak on STIs.
Some candidates did v. well Poorer candidates did not go into enough detail in the history ‐
All covered alternative contraception. see below. None said would examine if persisted.
Most communicated well. Mainly missed sexual history.
Poorer candidates tend to rush into concerns expectations before
competing the Hx.
Gynae Hx. Diagnosis. Diff. contraception methods. Smear discussion. Red flags in gynae.
CBM PV bleed Communication skills were generally good. Smoking omitted by nearly all students.
POP Displayed patient centred attitudes. Tending to take inadequate history, little attention to SITs,
Tried to involved patients in decision‐making process. struggled to come up with clear choices for management options.
Few students agreed a clear coherent management plan with the
patient.'
Very few clearly explored ideas concerns & expectations.
Mainly, they established why she'd been started on cerazette + Most did not check taking pill regularly.
the bleeding pattern empathised well. Didn't ask sexual history.
Most did not offer internal exam ‐ a lot said they'd do early smear
Some established in migraine causes but many didn't (which they shouldn't) but didn't say they would do speculum
exam to look at Cx to check for due courses.
Mainly assumed the patient wanted to change contraception and
a few wanted to try her on a low dose oestrogen pill or offered
patch.
Most didn't know about using tranexamic acid but some GPs
wouldn't
Different LARCs. STI screening.
Communication skills. Gynae Hx & red flags
CBM Urge Most established diagnosis of urgency / urge Incontinence. Confusion re interventions esp. pelvic floor exercise & retraining
incontinence and little knowledge re medication.
Asked about UTIs ‐ differentiated between stress and urge Didn't do health promotion ‐ hardly any did.
incontinence. Didn’t mention bladder drill as a treatment. Not all offered an
Recognised importance of caffeine intake examination ‐ were they in 'history taking mode' ‐ and didn't
Most suggested urinalysis. mention examination as they wouldn't be asked to do it as part of
the OSCE station.
Screening / health promotion not covered
Page 2 of 9
Year 5 Semester 1 OSCEs ‐ Generic Feedback for Students
Station In general what did students do well on this question In general what did students do poorly or not do on this
question
CBM Vaginal Safety netting. Checking on 'ICE'. Adequate description of BV ‐ few managed this.
Discharge BV Several students thought BV was STI and could affect fertility.
Few students were able to discuses Metronidazole in any detail.
Few students were able to offer detailed advice about how to
reduce the chance of BV recurring.
Safety netting. Checking on 'ICE'. Adequate description of BV ‐ few managed this.
Several students thought SV was STI and could affect fertility.
Few students were able to discuses Methroidoble in any detail.
Few students were able to offer detailed advice about how to
reduce the chance of BV receiving
Asking of concerns Mention treatment that it is if not done they miss side effects of
Metronidazole & alcohol
Many students called her Mrs Walker ‐ she is unmarried
Almost all students offer an imaginary leaflet ‐ principally as a
substitute for knowing anything it seems!
Some female and most male students referred to 'down there',
'down below', etc. ‐ no need to avoid saying vagina and valva in
2012! By this stage you cannot rely on 'I'll ask a senior' ‐ take
responsibility for your consultation.
In general students' communication skills were not as good as
normal ‐ don't be put off if you don't know 'the answer' ‐ it is
enough to pass to ask questions and listen + use your basic
medical knowledge.
Really struggled throughout. Few students explained treatment Lack of knowledge of BV prevailed and this was obvious .
well. Use of barrier methods as STI presentation. Not clear on whether was STI. Often said long fertility problems
possible. Not much in depth information on treatment. Patient
often felt confused by the end.
CBM Vaginal Delivering the "news" i.e. positive chlamydia test. A lot of students struggled to give clear instructions re treatment
Discharge Checking 'ICE'. i.e. drug nerve, damage. Many students simply stated
Chlamydia Safe sex advise. "antibiotics".
Explicit health advice re HIV testing (+STS / HBV)
Read the student notes sheet! All except one stated they were a
"5th year medical student" when introducing themselves
(scenario notes state they are a GP) ‐ this confused a patient.
Sexual history taking. Use of condoms Prompts for blood borme virus testing.
Very good approach to patient. Good inspection & palpation. Not much (with psoriasis care a lot did not examine the nails even
Most had a good sensible management & diff. diag. approach. if prompted)
Examined skin well. Good description of lesion ‐ most used Background knowledge of NE v. poor without expectation.
terminology appropriately.
Page 3 of 9
Year 5 Semester 1 OSCEs ‐ Generic Feedback for Students
Station In general what did students do well on this question In general what did students do poorly or not do on this
question
ENT Patient Introduce themselves. Tuning forks levels were poor on the whole. Most couldn't
examination Anatomy visualise.
Neck examination Some seem very uncomfortable properly holding an otoscope.
Ear examination overall was OK Otoscopy & diagnostic skills.
Good approach Poor on interpreting ear.
2 missed a very obvious thyroid scan.
Well on examination of thyroid gland. Could not detect a large mastoid cavity.
Seeing infection where none.
Seeing intact tympanic membrane where large penetration.
Page 4 of 9
Year 5 Semester 1 OSCEs ‐ Generic Feedback for Students
Station In general what did students do well on this question In general what did students do poorly or not do on this
question
MED Blood Did well in areas. All except one managed to reach the diagnosis.
Some came out with sensible differential diagnoses.
Those that didn't make the diagnosis struggled and did quite
badly.
Some didn't know normal ESR values.
Pattern recognition raised ESR. Did not pay attention to blood results reference range.
Able to identify abnormal blood results as the reference range is Unable to describe the abnormal results in clear medical
given. terminology to another physician. (normocytic, normochromic
Knows the symptoms and treatment of GCA. anaemia.)
Need to know prompt steroid treatment is essential to reduce
risk of permanent blindness.
MED ECG Acute management of MI. Missed Q waves.
Picked up ST elevation.
MED Patient Generally correct examination technique. Many did not time the murmur with a pulse or used the radial
Examination They all heard the murmur. pulse to time them.
CVS Approach to patient. Picking up scars. Recognising AR.
Examination systematic.
Got murmur but all failed to make diagnosis of VSD although in Poor differential diagnosis for systolic murmur.
both patients murmur fairly classical.
All polite. Most realised AVR. There was no systematic pattern to the question / station.
They did the examination well, all identified sternotomy scar and Some students got confused between pul. Fibrosis and LVF, as
dorsal kyphosis. the sternal scan + metal aortic valve sound led them more to
cardiac cause.
Approach to patient. Wrong diagnosis.
Most were systematic.
MS + AF = General examination technique MS ‐ Missed murmur + loud SI
AVR ‐ All picked up the signs
Good examination techniques Not always good at correctly identifying signs
‐ aortic valve replacements
‐ mitral regurgitation
MED Patient Able to pick up prosthetic valve click.
Examination Able to pick up AF (none of the candidates missed it) Subtle sign (mitral valve murmur). Majority of candidates needed
CVS prompting & were asked to listen to mitral valve 2nd time.
Examination technique overall excellent. Difficult case with RUL collapse ‐‐> difficult signs more for PACES
Confident, really lovely approach to patients. than 5th years. Students did 'better' on 2nd case of
kyphoscoliosis.
Only 1 candidate did TVF ‐ generally good technique. Considerable confusion in lung function test.
Examination. Notice tracheal deviation.
Formulate appropriate differentials.
Two good resp cases with clear signs. Some struggled to interpret auscultatory findings which of course
were the key to diagnosis.
NEU Facial Pain Localisations, characters and features pain. Associated features ‐ weight loss
Recognition of nero diseases presenting ‐ trigeminal neuralgia.
Asking pt. worries.
Took an adequate history. Didn't take a very through history ‐ poor on the effects of the pain
Asked important questions re headache / fever / visual symptoms on Work, Home Life, Sleep
i.e. the reg flags. Important that they know this. Didn't follow up on patients' concerns. Comments like "fine",
when patient told them pain was dreadful i.e. lacked EMPATHY.
Poor on why MS might came come to general neurologist.
Page 5 of 9
Year 5 Semester 1 OSCEs ‐ Generic Feedback for Students
Station In general what did students do well on this question In general what did students do poorly or not do on this
question
NEU Sensory Good at history taking. Difficulty relating history to likely localisation. Hand symptoms
Exam Most were able to examine them well;. with normal reflection.
Motor examination ‐ fine ‐Very poor on joint position sense assessment ‐ held finger
Position / exposure of patient ‐ fine incorrectly / much too large movements made
Associated features + tx ‐ fine ‐ quite poor on meaningful sensory examination ‐ spent lots of
time on dermatomes in upper arm + sometimes v scant exam +
clear delineation of the sensory loss in the hand.
Quite mixed. I get the feeling students are compartmentalising by diagnosis.
Patients don't turn up with diagnosis but with symptoms. Should
we instruct them to pick cases by their presenting symptoms so
they don't get stuck in the diagnosis.
History / Exam / Management. Well presented. Ability to summarise. Tendency to start talking in detail.
Most candidates appeared well prepared and were of the Many seemed not to have observed many clinical cases and this
expected standard. was reflected in their understanding.
Many structured their answers well.
Majority of students did have good understanding of the topics. Could do better with summarising the case rather than reading
Good history taking skills. the whole case.
O&G infertility History taking was good in general. General pre‐pregnancy advise & investigations ‐ e.g. Rubella,
investigations weight, smoking.
Good history of female aspect. Good management. About obtaining history about male factor.
Most took female history well & knew most investigations. Most did not take the male history.
Found management more difficult
O&G Pelvic pain History Differential Diagnosis
Most took a history well. They did not pick up in the severity and most had an incorrect
differential ‐ endometriosis etc.
Many wanted to manage the problem conservatively.
Good history taking. All got the differentials / management Mostly forgot to ask about smear hx, forgot to mention
correct. Generally well answered question. temperature / pulse / BP.
History taking. Management ‐ poor response by the candidates need
Good rapport with the role player. considerable prompting.
O&G Premature The history taking No idea what 'different' meant.
rupture of Poor performance in the 'management' question.
membranes The history taking No idea what 'differential' meant.
Poor performance on the 'management' question.
History taking Some called birth at 30 wks. 'miscarriage'
Some equated Pprom with preterm labour.
Many did not know to do speculum to look for liquor.
Many had no idea hoe to manage PPROM. Many induced labour
unnecessarily early.
Obvious that they have not seen this common presentation
managed in triage.
History taking Invest & management of SROM
Screening On History taking ‐ only social & smear & screening.
History taking reasonably well in most cases. Many struggled with management & investigation
On the whole ‐ good history taking skills Re management
‐ admission to hospital
‐ dexamethasone
‐ hysterectomy
(mentioned by 1 or 2 candidates)
Clinical explanation / discussion was good. Few didn't take good histories.
Related to placenta previa. Crossmatch active management.
Mostly good management.
Took appropriate history. Recognised need for C. section and risk Didn't mention need for steroids. Most did not discuss elective
of hysterectomy. admission until delivery.
Page 6 of 9
Year 5 Semester 1 OSCEs ‐ Generic Feedback for Students
Station In general what did students do well on this question In general what did students do poorly or not do on this
question
PED System examination Inordely + haphazard way of approach to development
Development/E Developmental assessment ‐ knows sequence well assessment.
xamination Good approach.
They were good in learning to examine especially ‐ ‐ variable most of them good.*
communicating with children. CVS ‐ to check especially pulses on both sides
One candidate examined the child with the clothes on.
PED History They did not make the connection between all the feeding
concerns.
Exploring the history of presenting complaint, food diary + eating Not exploring social history, missing maternal depression.
habits. Exploring gastro‐intestinal symptoms.
Interpreting growth chart well.
PSY Assessment Good communication skills. Events of the overdose. Not ask quite enough detail about past history especially alcohol /
of Risk 1 drug history
All were a similar standard it seems straight forward & therefore See above
does not discriminate very much between candidates
Initial introductions There was lack of focus. ‐ structure of questioning style
Most had good communication skills. Starting to question about overdoes at the end of overdose after
finishing task.
One candidate didn't know that he was not supposed to talk to
examiner.
History of details of overdose. Assessment of current risk. Other background history ‐ Drug & Associate history.
Screening for depression, anxiety.
PSY Assessment Good students responded well to fact this was an embarrassed, Some missed the past history & other elements of risk
of Risk 3 regretful patient with accidental O.D. [overdose] assessment.
History of circumstances surrounding overdose, including current History of past psychiatric history & ruling out underlying anxiety
risk assessment. or depressive illness.
Elucidation of support network
PSY History Good communication skills. Not go into enough detail about relevant detail about relevant
Taking 2 (A) Ruling out depression. aspect of past history / psychiatric history.
History taking ‐ Presenting Complaints Excluding Alcohol / Substance misuse
Risk assessment
Elicit symptoms of anxiety symptoms Didn't look in detail at precipitating factors. Many wasted
treatment options.
PSY History Discussed diagnosis well & showed good knowledge of Diagnose dementia appropriately & some leapt into giving
Taking 2 (B) management. dementia diagnosis without first asking the right & necessary
questions.
PSY Information Factual information about schizophrenia retained well by Most students seemed to want to display how much they know
about Diagnosis candidates. rather than building upon the relative's existing understanding.
1
All very emphatic, sensitive, polite reassuring to the simulated Did not address negative symptoms.
patient. All professional attitude ‐ no concerns. Generally good Very few mentioned it is a serious mental illness.
communication skills. Prognosis could have been better covered.
Questions on violence, some not sure. Should mention it does
tend to run in some families, slightly increased risk in 1st degree
relatives.
Explained well positive symptoms & prognosis. Didn't mention anything about negative symptoms.
Less elaboration on Aetiology.
Less have mentioned the social support & therapy in addition to
medication.
Good communication skills. Not empathetic towards the relative.
Symptom explanation Poor stastics of Schizophrenia.
Engaging relatives in conversation. No structure to the information provided.
PSY Information Generally good communication skills. Aetiology ‐ no one covered secondary mania (antidepressant‐
about Diagnosis All students had a professional manner, empathic towards included).
2 simulated patients, sensitive and reassuring. Be more clear on the fact it does run in some families, increase
risk to 1st degree relatives.
Not enough discussion about lithium, its risk & monitoring
Explanations of symptoms of BPAD. No empathy towards the relative.
Communication skills. Too many questions, sometimes to the relative.
Incorrect statistics.
Ending the station.
Page 7 of 9
Year 5 Semester 1 OSCEs ‐ Generic Feedback for Students
Station In general what did students do well on this question In general what did students do poorly or not do on this
question
PSY Treatment Communication skills ‐ listening & checking understanding. Most They didn't metric drugs in due doses or ECT.
info 2 (A) knew at least some side effects. Most understanding of discontinuation symptoms was limited.
Explanations of CBT were good. Very few mentioned ECT.
Most didn't knew side effects (apart from headaches & blood
pressure) they got confused with SSRI side effects (some
mentioned gastric bleeding).
Students less clear or misinformed about sexual side effects ‐
they all mentioned decreased libido and a minority mentioned
erectile dysfunction & for women (it was an actress) delayed
orgasm (was not mentioned except once).
The communication skills were quite good. Two candidate got Same students went off trucking and started exploring symptoms
the role player to reiterate the information to be sure she of depression.
understood.
Explaining mechanisms of action. Sexual side effects clarity.
Role player should have more prompts
PSY Treatment Communication skills Students did not explain diagnosis ‐ only treatment
Information 2
(B)
SUR AIP Acute All did ABC well. Some did not knew not to do CT if unstable.
Abdo ABC Survey Secondary Survey
Conservation treatment of splenic injury.
Assessment of the ill patient, initial management and Failed to address all aspects of patient management of ill
investigations. patients. Re‐examination & secondary survey.
SUR Patient Examination. History.
Examination Seemed to know Rh A. Knee examination hit & miss
Musculoskeltal Examination of hands generally good. Went through the motions but 2 students missed an obvious
knee effusion
Describe medical problems affecting your hands. Mentioning boutonnieres
They were all fully competent with MUSCULOSKELETAL.
Almost all of them did well at the musculoskeletal examination of Many had to be prompted to take a drug history.
the hand and did all the spread tests and movement.
Go through the motions of examination. No student checked summaries (through there were no props)
Overall explaining what they were going to do to the patient. The majority of students would not perform McMurray's Test in
case it hurt the patient, despite not having a diagnosis.
Fail to elicit mechanism of injury.
The vast majority failed to describe the patient general
appearance, have signs etc.
Very well. Some candidates ‐‐‐> No pelvic symptoms asked.
No detailed history of pait. What increased, what decreased,
radiation.
Some candidates ‐‐‐> No gait examination.
No neck examination or even mentioning it.
Did not understand that rheumatoid arthritis is an AUTO immune
condition. Need to improve teaching regarding examination of
the hand (arm).
SUR Perforated Diagnosis. Investigate. Management. Understand why investigations were done or why specific
Duodenal Ulcer management points were important.
Investigation of DD
Diagnosis. Fluid resuscitation
Obvious diagnosis, every single student spotted it. Straight Relatively easy case, some points of management are missed by
forward history. some students.
Page 8 of 9
Year 5 Semester 1 OSCEs ‐ Generic Feedback for Students
Station In general what did students do well on this question In general what did students do poorly or not do on this
question
SUR Vascular Intro themselves well & took good histories Really very little idea about efficient examination of varicose
veins.
Generally this Q was answered really well by the candidates Start in the abdomen for feeling for pulses.
Missed out 'obvious' general surgical signs e.g. umbo hernia as
they were so Vascular system
Most of them well versed with vascular system examination and Most of them did not auscultate
knowledge base for relevant DD.
Page 9 of 9