cmecde 2

 

Contributors ix

Sara Ahmadi

4th Year Medical Student

University of Oxford

John Lee Allen

3rd Year GEM student

Imperial College London

Daniel Ashmore

5th Year Medical Student

University of Leeds

Vartan Balian

House Officer (FY1)

Warrington & Halton NHS Foundation Trust

Daniel Campbell

5th Year Medical Student

Barts and the London School of Medicine and

Dentistry (QMUL)

Anthony Carver

House Officer (FY1)

East Kent Hospitals University NHS Foundation

Trust

Mohsin Chaudhary

5th Year Medical Student

St George’s Hospital Medical School

Christopher Chopdar

Independent Psychiatrist

Oxford

Akbar de’ Medici

Associate Director

Institute of Sport, Exercise and Health (UCL)

Patrick Elder

2nd Year Medical Student

University of Warwick

Naomi Foster

4th Year Medical Student

University of Dundee

Jay Goel

2nd Year Medical Student

Barts and the London School of Medicine and

Dentistry (QMUL)

Ali Rezaei Haddad

2nd Year Medical Student

University of Warwick

Jane Hamilton

4th Year Medical Student

University of Glasgow

Randeep Singh Heer

3rd Year Medical Student

King’s College London

Patrick Holden

3rd Year Medical Student

University of Cambridge

Benjamin Huggon

1st Year Medical Student

University of Oxford

Sadhia Khan

5th Year Medical Student

University of Manchester

Guglielmo La Torre

2nd Year Medical Student

Brighton and Sussex Medical School

Lilian Lau

3rd Year Medical Student

University of Leicester

Lucy Li

5th Year Medical Student

University of Edinburgh

David Liddiard

Osteopath

Function Health, New Zealand

Katherine Mackay

5th Year Medical Student

University of Oxford

Genevieve Marsh-Feiley

2nd Year Medical Student

University of Aberdeen

Jacob Matthews

5th Year Medical Student

University of Birmingham

Jonathan Mayes

4th Year Medical Student

Newcastle University

Philip McElnay

NIHR Academic Clinical Fellow in Cardiothoracic

Surgery

Newcastle University

x Contributors

Charlotte McIntyre

Core Surgical Trainee

Imperial College Healthcare NHS Trust

Shu Ng

1st Year Medical Student

University of Leeds

Gedalyah Shalom

5th Year Medical Student

University of Liverpool

Abigail Shaw

4th Year Medical Student

University of Bristol

Katherine Stagg

5th Year Medical Student

University of Oxford

Anthony Starr

5th Year Medical Student

University of Lancaster

Tom Stockmann

Fellow in Medical Education

North East London NHS Foundation Trust &

Honorary Research Fellow

Barts and the London School of Medicine and

Dentistry (QMUL)

Amy Szuman

3rd Year Medical Student

Hull York Medical School

Abigail Taylor

5th Year Medical Student

University of Oxford

Daniah Thomas

3rd Year Medical Student

Cardiff University

Rachel E. Wamboldt

4th Year Medical Student

Norwich Medical School, UEA

Preface xi

The first edition of Clinical Skills for OSCEs came out in 2003, a slim volume formed from my revision

notes together with a few contributions from my then housemates. At the time, OSCEs had suddenly

become very big, but medical publishing lagged behind, leaving our generation of medical students

to scramble for preparation materials.

All the big houses rejected my publishing proposal, mostly, I think, because it came from a 23-year-old

medical student. I persisted, and in the end, a small publishing house called Bios took a chance on the

book. Today Bios, having been bought out, is no more. But, remarkably, the book is still here, having

been through no less than three publishers and five editions.

Back in 2003, I could not have dreamt that in 12 years’ time I would be working alongside a team of

40 medical students, junior doctors, publishers, designers, etc. to produce the fifth edition of my little

‘recipe book’. Of course, the book is not so little any more, and, in truth, contains much more than I

ever knew as a medical student or even a house officer – a testament (I hope) to the rising standards

of medical education.

To me, this fifth edition very much represents a return to the roots. The first edition boasted having

been ‘written by students for students’, and with the fifth edition this is once again the case. I am

hugely indebted to each and every student contributor and to the student editor, John Allen, for

having reinvigorated these pages, advising on everything from the broad topics covered to the specific

language used.

Students are the lifeblood of this book, which, to remain useful and relevant, has to be alive to their needs

and concerns. I do not just mean the student contributors, but all students, including – of course – you.

Please do get in touch with me if you have any ideas, however small or large, for improving this book, or

if you would like to form part of the team for the next edition.

Good luck with your exams!

Neel Burton

www.neelburton.com

OSCE tips

• Don’t panic. Be philosophical about your exams. Put them into perspective. And remember

that as long as you do your bit, you are statistically very unlikely to fail. Book a holiday to a sunny

Greek island starting on the day after your exams to help focus your attention.

• Read the instructions carefully and stick to them. Sometimes it’s just possible to have

revised so much that you no longer ‘see’ the instructions and just fire out the bullet points like

an automatic gun. If you forget the instructions or the actor looks at you like Caliban in the mirror, ask to read the instructions again. A related point is this: pay careful attention to the facial

expression of the actor or examiner. Just as an ECG monitor provides live indirect feedback

on the heart’s performance, so the actor or examiner’s facial expression provides live indirect

feedback on your performance, the only difference being – I’m sure you’ll agree – that facial

expressions are far easier to read than ECG monitors.

• Quickly survey the cubicle for the equipment and materials provided. You can be sure that

items such as hand disinfectant, a tendon hammer, a sharps bin, or a box of tissues are not just

random objects that the examiner later plans to take home.

• First impressions count. You never get a second chance to make a good first impression. As

much of your future career depends on it, make sure that you get off to an early start. And who

knows? You might even fool yourself.

• Prefer breadth to depth. Marks are normally distributed across a number of relevant domains,

such that you score more marks for touching upon a large number of domains than for

exploring any one domain in great depth. Do this only if you have time, if it seems particularly

relevant, or if you are specifically asked. Perhaps ironically, touching upon a large number of

domains makes you look more focused, and thereby safer and more competent.

• Don’t let the examiners put you off or hold you back. If they are being difficult, that’s their

problem, not yours. Or at least, it’s everyone’s problem, not yours. And remember that all that

is gold does not glitter; a difficult examiner may be a hidden gem.

• Be genuine. This is easier said than done, but then even actors are people. By convincing yourself that the OSCE stations are real situations, you are much more likely to score highly with

the actors, if only by ‘remembering’ to treat them like real patients. This may hand you a merit

over a pass and, in borderline situations, a pass over a fail. Although they never seem to think

so, students usually fail OSCEs through poor communications skills and lack of empathy, not

through lack of studying and poor memory.

• Enjoy yourself. After all, you did choose to be there, and you probably chose wisely. If you

do badly in one station, try to put it behind you. It’s not for nothing that psychiatrists refer to

‘repression’ as a ‘defence mechanism’, and a selectively bad memory will do you no end of

good.

• Keep to time but do not appear rushed. If you don’t finish by the first bell, simply tell the

examiner what else needs to be said or done, or tell him indirectly by telling the patient,

for example, “Can we make another appointment to give us more time to go through your

treatment options?” Then summarise and conclude. Students often think that tight protocols

impress examiners, but looking slick and natural and handing over some control to the patient

is often far more impressive. And probably easier.

xiii