Interesting Observations on a mock OSCE Teaching Day

Hi all – so a few days back I had the unique opportunity to organize (OK who am I kidding? I helped to organise) a 1-day course for the FRCA OSCE exam in our deanery. We as the juniors of the department of anaesthetics/ITU/Theaters were called upon to help with various tasks: timekeeper for the different stations, be a patient for history taking, or be one of the relatives for counselling, be a mannequin for examinations, etc. I had a multitude of nominal tasks on the day, but what I found to be invaluable to me that day were a few observations that I made observing the various candidates as they filed through the different stations, and I list those observations here in no particular order to be taken as advice for all my colleagues who have OSCEs to take, bear these in mind:

– Be cognisant of time. As you walk up to the OSCE station, whether it gives you 30 seconds to read through an initial scenario or there is a piece of paper with questions written on it that you are expect to answer, get into the mental zone where you can mould yourself to give what is required of that particular station in the time provided. If there is one question that needs to be answered, you can be a bit relaxed, if there are 3 questions on the paper, make sure you are aware of the time you have to divide amongst them all to do justice to all. If the station requires an interaction with someone like a viva or a direct encounter, make sure you have a framework in mind, a mental checklist to check things off during the actual station so that you are not rambling on about your second point when there are 7 other things you need to be talking about.

–  When asked a question, don’t feel pressured to answer as soon as you sit down – take a breath, pause, ponder over the question for a few seconds, frame your answer for the next few, and then open your mouth to speak. Do not repeat the question back to the examiner in wonderment, as if puzzling it over, you may think you are buying time while you collect your thoughts, but it looks unprofessional. If you need time to answer, take it, but do not insult the examiners’ intelligence by repeating the question back word for word. It is a waste of time.

– When asked a question, avoid using pronouns like ‘you’ as a general term. “If you are on the floor for a long time, your creatinine kinase levels may rise.” While correct, it looks like you are addressing the examiner, whereas a more professional way to answer would be “Patients lying on the floor for extended periods of time may have elevated levels of creatinine kinase.”

– Following on from the previous point – when describing the anatomical location of anything, or a function, it is OK to use your hands to express yourself, but do not gesture towards your own body as a descriptor for your answer. In answer to the question Where can an IO needle be inserted? you may think it is the right answer to point to your sternum, your humerus or your tibial tuberosity, but it won’t score you any points. Also please practise certain expressions or gestures, gesturing towards your crotch for instance when talking about urinary catheterisation is inappropriate. And for goodness sake, it is even worse to point these things out on the examiners body.

– Use proper terminology, use buzzwords if you know them (we all know them) and specific things carry specific marks so make sure you attend some sort of course at least once in your life for OSCE practise so that you know what the examiner is looking for in a particular station when they ask you a particular question. Also, examiners know when you are beating about the bush and not getting to the point – so don’t waste their time (and yours), admit you do not know, and move on.

– Having done poorly in a previous station has no bearing on how you can or should perform in the next one – so do not let anything bother you. Yes, you may well have failed the previous station, but if you continue to mull over it or let it get to you, you may ruin your chances of passing the next one as well. Once you step out of one station, close that chapter, and open the next one with a clean slate.

–  Do not try to impress with big words and fancy terms – be simple, logical and just answer to the best of your knowledge. They are there to test your knowledge and see how good you are with using that knowledge. They are not there to ask for your hand in marriage.

–  If there is a written station, please write clearly. In our current professional examination climate, where usually there is a tick box or a fill-in-the-correct-circle type answer sheets, we forget how to answer the short answer type questions. Make sure it is legible. Your right answer is useless if no one can decipher it.

–  Read up on the simple things (in case of our anaesthetics colleagues, anatomy and physiology, undoubtedly – aside from the usual physics etc) – understand the concept behind why something is done or not done, and it will make it easier for you in these exams.

–  Study. I don’t know why it is so under-rated, that OSCE exams are interaction based and so I just don’t need to read up on how to take a history or do a pre-op assessment or perform a physical examination or test the cranial nerves – we do it everyday, and we get into a comfortable zone – but the exam might need for us to brush up on those skills and make sure we are not missing out on anything. MOST candidates missed an important part of the history taking station, as well as the counselling station – points were docked, valuable points, and for some that can mean the difference between passing and failing.

The Day of the Beating Heart Donor

24/08/17

I observed an eye-opening and mind-boggling event today – something I had heard of a thousand times before, and I knew was commonplace and such a great, great gift to give to someone – yet you never think things through and the details and the minutiae and the step-wise journey that gets you to a certain result sometimes just doesn’t register till you are actually on the other side of the coin. Today I observed an anaesthetist keep a clinically braindead patient comfortable on his journey to giving the greatest gift to a multitude of individuals – through his organs that he donated, the gift of life. I am still reeling, and literally have no words to express how chaotic and inexplicably sad I felt on the inside, and what the whole process entailed and how I came to realise and came to terms with what I bore witness to today – I will surely like to revisit this topic at a later point for a much-needed debrief. But not today. I just felt like I had to share something about this day, and I will. But not today.

RIP.

26/08/17

OK – so here I am, it is the following weekend – and I finally have enough time to do justice to this post
the day began with a pain clinic round – for those of you just joining us, I am now in a anaesthetics placement currently, and aside from all the wonderful cases we are meant to preside over anaesthetics-wise in theatres during various surgeries, we are also required to oversee patients in acute painful crises of any sort, and make a pertinent plan for adequate analgesia, whether it be a PCA pump or varying doses of different drug regimens. It was a cheerful day – not because we saw patients in pain, but because we saw the aftermath of what adequate analgesia does – happy, comfortable, asleep patients – patients with broken vertebrae from falling off horses and post surgery patients and patients with chronic pain issues who had become acutely unwell – all were magically comfortable with the various cocktails measured out to them in various dispensers (epidurals, blocks, PCAs, oral/iv/subcut/intramusc meds) – and to top it off, my consultant was a particularly cheerful, fun person; the ward round was informative and collaborative, and we struck up a dynamic where we bounced ideas off of one another, and she made sure I felt included and did not feel as alienated with the whole deal of being new to the idea of a pain clinic as I thought I would be.
Fast forward to 3 hours later and my consultant gets bleeped about being roped in to performing the anaesthetic for a donor extraction surgery – a team from the nearby major transplant centre were coming in to perform the surgery, and to harvest the organ(s) from a patient currently admitted in our hospital. My consultant asked me if I wanted to continue with the day’s pain rounds or would I like to join her in the theater to see this procedure? I excitedly said yes, thinking I would get to see the miracle of someone donating their kidney to their loved one and both donor and recipient ending up side by side on adjacent beds in the ITU. The reality was far from this very romantic notion.
As I changed into theater-appropriate attire – I realised what was going on as the team from the other hospital introduced themselves and told us the story – this was a 50-something male patient, who had suddenly had a massive stroke, and had been declared clinically brain dead the evening before. He was being kept artificially alive on a ventilator, and the family had said their goodbyes and understood the terminal nature of his condition. All of this however did not prepare me for what this procedure actually entailed: We would be providing anaesthetic to a brain dead patient, in order for him to be as comfortable as possible during the procedure which would entail the team of surgeons harvesting whatever organs had been consented for donation (in this case both kidneys, liver and pancreas) and for us to keep his organs as adequately perfused and optimum physiology as possible till the last possible minute, and at the point of removal of the organs, the blood exsanguinated from his body, at which point we were told ‘your services would no longer be required’ meaning to say the patient would then have been declared officially dead. So we wheeled this patient into the operating theater for what were to be his last few hours of life (albeit artificial due to the ventilator). It doesn’t get any sadder than this does it? It does, in fact. Not with anything else that happened during the procedure – but with the multitude of realisations I had over the next few hours.

I have seen asystole many hundreds of times (I am not proud of it, just the nature of my job) but I have never seen a beating heart become…just a heart. It literally was beating enthusiastically one second right in front of me and then it…wasn’t.

I have attended many surgical procedures which involve trying to get the patient to improve – never to mark the end of their life.

I have seen a heart being jump-started by electric paddles to kickstart it to life – never have I experienced the opposite, cardiac activity ceasing as a result of the drainage of blood from the major vessels entering the heart, and therefore from the rest of the body.

I have heard of so many organs that are transplanted into deserving human beings whose very life depends on the organ(s) being amazingly gifted by someone else who no longer requires their use – but I have never quite registered what it means to actually remove tissue of any sort from a ‘alive-till-the-organs-are-removed’ body so that once these viable tissue are removed, the body will essentially very quickly shutdown.

But I also had one other, very major overwhelming realisation: there is no precedence and no other example I feel of such an amazing, voluntary gift, either on the part of the donor, or on the part of the family who consent to the donation – a gift that may well mean (quite literally) the difference between life and assuredly painful death for so many individuals. While I may have initially felt that the procedure meant the end of a life, I was wrong. The procedure that I witnessed did not just mean the start of a new lease of life for the individual(s) who got those organs, but also their families and friends and loved ones and all the lives in turn they will interact with and influence and touch just by being alive – they may go on to teach, to lend, to help, to protect, to heal, to donate; they may go on to hold someone’s hand, walk someone down the aisle, attend a graduation, a christening or a birthday. They all owe every moment from here onwards to this, the procedure that started it all – thanks to the beating heart donor.

ECT – the conflict within

DISCLAIMER 1 – EXTRA-LONG POST. You have been warned.
DISCLAIMER 2 – More importantly – this is in no way supposed to be a ‘for’ or ‘against’ type of post regarding any particular therapy/treatment – it is just my opinion and my own feelings about this experience which was very new to me. Bear with me, before rushing to judgement or conclusion – and if you already have formed an opinion without prior knowledge/experience then please stop reading further!)

For those of you who do not know, I have recently started my 6 month rotation in Anesthesia as part of my emergency medicine training, and it has introduced me to a whole new weird and wonderful world that is equal parts unexpected and fun and slightly scary but mostly awesome. But more about that later. Today (and for the past few days) I have been wrestling with some inner demons (wow, that’s not melodramatic at all!) about a recent experience and the ensuing internal conflict broiling inside me. I will try to explain things in my usual way, which is to take you on that journey with me.

So the day usually starts at 7:30 AM, and the rota tells you it’s a different theater every morning – I checked the night before and all it said was that I was assigned to a particular consultant to shadow (read badger/annoy for the rest of the day!) and that we were supposed to be in the “ECT” area (theater?) in a completely different building from the one I had been going to for operations/procedures requiring anaesthetics in the past week. My first thought was ECT? It can’t be electroconvulsive therapy? That’s not still being done in this day and age? But I texted one of my friends in the same rotation as I am, and he said this area was in the building that houses the maternity block, and I thought it was probably some sort of gynaecological/obstetric procedure requiring anaesthesia which is why I am being assigned to this and I am sure I thought of ECV – external cephalic version! I reassured myself and went to bed, woke up the next day bright and early and headed to whatever this amazing day heralded. It was not amazing. Atleast, not initially.

ECT, as it turned out, did mean electroconvulsive therapy – a treatment for drug-resistant psychiatric conditions (please excuse the rough/non-medical language) – and I found out that what I was assigned to today was in fact the ECT suite, a separate entity from the rest of the hospital- where I was shown around while I was waiting for the consultant. There was a procedure room, with anaesthetic stuff and an OT table, and a separate recovery area. There were 4 nurses, a head nurse, 2 health care assistants and 1 psychiatrist/consultant – aside from my anaesthetics consultant and absolute-novice-baby me! The whole area was very peaceful and calm, and the staff were very friendly and spoke in calm, reassuring voices even when they asked me if I would like a cup of tea. I felt myself calm down a bit (I was nervous because A- I had no idea what to expect and B- I HAD NO IDEA WHAT TO EXPECT!)

There were 4 patients on the list for today. 3 of them (the first 2 and the last one) were regulars, here for their 7th, 3rd and 11th treatments, so they did not need pre-assessments doing from an anaesthetics point of view – just a confirmation of their consent for the current procedure (consent did not mean a blanket consent for all treatments, you could consent to the first treatment and revoke consent at any later treatment session, if you were deemed to have capacity. All 4 patients today had capacity) The 4th one had completed 12 sessions of the ECT previously and that usually meant their treatment was over. But their doctor had assessed them and had thought that despite the improvement the patient could benefit from further sessions, and so they had to give another detailed informed consent – because initially they had consented to the 12 sessions, and this was adding on to what they had initially consented for. But I digress – there was just so much to take in and learn that I do not want to miss out on any of the details/finer points that I came across.

So anyway – while we waited for the first patient to turn up, my consultant took pity on the incredulous expression that I had on my face (this was without me realising it) and explained a few things to me, and looked up a very good paper for me to read about ECT. He broke down what we needed to do here, which basically entailed: introducing ourselves; confirming patient details; confirming no changes to medical/pre-assessment history had taken place in the last week since last treatment; putting a cannula in; hooking them up to some monitoring (continuous ECG trace, pulse oximeter, blood pressure, an initial temperature reading) and also hooking them to an EEG machine which is basically just like an ECG of the brain – mapping the electrical activity of the brain; administering the induction agent (usually propofol) and/or a sedative, and supporting the patients breathing before, during and after the procedure till the anaesthetic wears off.  ECT is basically electric current that is run via two ports/electrodes placed at both temples while the patient is unconscious. The current causes your neutrons to fire in a way to cause a generalised toniclonic seizure, and your brain activity is mapped continuously to make sure it has worked, and that the seizure lasts a certain length of time (usually greater than 10 seconds but on average about 30seconds in duration). It is essentially equivalent to being ‘under’ for a surgical procedure, just like you don’t feel the surgeons scalpel or drill, you do not feel the actual shock. Your heart rate and oxygen levels and blood pressure and all that jazz is continuously monitored and in the event of any fluctuations, it is handled by the team of extremely qualified individuals in attendance, as it would be in any surgical procedure. But the actual procedure was what caused me to be so incredulous. Why, you may ask? I will explain, but first let me take you through the first patient’s treatment.

This was a 50-something female, with a history of depression, and she had become so depressed that she had stopped eating and drinking, and none of the medication or combinations of medications had seemed to work on her. I had all this information from her history sheet, and chatting with the consultant psychiatrist made it clear that this was sort of a last resort. She had become anorexic to the point that she didn’t really have the strength to lift up her head from where she lay in bed, to take a sip of water. She was initially medically rehabilitated, her caloric intake monitored and her strength returned, and while she had become medically fit, her depression was still strong. She began this prescribed treatment, and today was coming in for her 7th session. She had been almost a complete mute prior to the first treatment, and was markedly different today. She walked in to the room unsupported (I thought she would atleast be in a wheelchair). She made eye contact with all of us. She smiled at me when I said good morning, and replied shyly that it was indeed a good morning. As they hooked her up to the various monitors she looked around with that smile her face, and gave adequate responses to the questions and requests from the staff members, such as May I put these ECG stickers on you?, and can I put a cannula into the back of your hand? We walked her through the procedure, put her under and after she had drifted off to sleep and we were monitoring her airway and breathing, we put a rubber/foam type thing between her teeth so she wouldn’t end up biting her tongue or lips, and then they placed those electrodes on her temples and …I don’t know what I expected, probably that the patients arms would flail around and her legs would jerk up off the table and it would all be very violent and gruesome. It was certainly difficult to see, but nothing quite as dramatic as that. She just straightened out a bit, feet became a bit rigid and there was a generalise trembling, followed by some twitching. The continuous EEG trace showed she had had a seizure that lasted 34 seconds, and while she became tachycardiac during it, she settled down almost at once after the seizure ended. She began breathing spontaneously after a few minutes and was taken to recovery as she regained consciousness. And now for the crux of this post – the reason why I was so conflicted.

All my life, or at least the last 10 years when I have been a doctor (15 if you count medical school) I have been working with the idea that we need to minimize seizures and we work very hard to figure why someone may have had their first fit, to try and prevent it from happening again, and I have been involved in extensively counselling and reassuring family and patients and parents of toddlers etc on the subject – so the ‘inducing’ of a seizure as a treatment was a bit of a shock – no pun intended! I knew the patient came to no harm from the immediate procedure, the electric current and the anaesthesia, and they actually did not feel anything, much like any surgical procedure (with the added benefit of amnesia as a known side effect of propofol!) and much more importantly, the patients reportedly feel better and they don’t have memory of it etc etc. But having never actually witnessed it before, I had quite mixed feelings about it because it conflicted with my mindset of ‘how to manage a seizing patient’ – as opposed to this current situation – once again, no pun intended! The conflict I speak about is not of the “ohmygod I do not agree with this practise how dare they?!” type of reflection, and I apologise if it sounded that way. Rather it is more of a “everything I feel inherently about this situation is basically not true!” and I had to actively try and work towards not panicking when I saw this patient seize. And the one after that. And the one after that. It didn’t get any easier, and I didn’t get used to it and it really bothered me. I didn’t know what really was most bothersome for me. Was it the fact that I pride myself in being completely professional and see all sorts of unexpected medical scenarios and presentations as an emergency medicine trainee with the calm and focussed approach that is taught and cultivated in my specialty, but that in my almost 6 or so years of emergency medicine experience, I have never been this affected by any procedure or situation? In other words, was it the procedure that had bothered me, or my own reaction to it?

A few positive notes/observations from the day –
*Any patient who can consent because they are deemed to have capacity will be asked for their explicit consent for the treatment, and they will be given the full information regarding it. Out of the 4 patients scheduled for the day, the 3rd one who was coming in for her 13th treatment (having completed 12 previous ones and deemed to still be in requirement of a few further sessions) came in and then declined to give consent for the next one. And, even though she had consented for 12 sessions and had had them, AND she had the capacity to refuse at any time, we respected her decision and she went home. We didn’t just strap her down like a bunch of frankenstein-y mad doctors while cackling in high pitched laughter to administer jolts of voltage against her will – though I will be the first to admit this is what I thought when I first found out I was in the ECT suite, that this was my unfortunate concept of ECT, based on nothing but my (very vivid, it turns out) imagination.
*Also, it has been around since 1938 – there is tons of research on this topic and while it is all shrouded in controversy mostly due to preconceived notions and ideas, there is no denying the absolute faith people have in this treatment.
*The sons of the first patient who’s treatment I detailed earlier were sat outside in the relatives’ room and while the patient was being wheeled to recovery, I went and asked them how they felt the treatment was affecting their mum. They both agreed there was a distinct difference in Mum, that she had begun enjoying her meals – looking forward to what was on the menu for the day,  offering to go to the park with the grandchildren and making plans for one of the sons’ wedding that was supposed to be an out of country type thing. This was in stark contrast to her being in the throes of progressively worsening depression since their father had passed away a few years ago.
*They don’t just administer this treatment without trying anything else.
*It is not like touching a live wire; you don’t feel anything – you aren’t zapped like a Tom&Jerry cartoon situation. In fact, the voltage is so low that I was surprised that while the current was being administered, one of the nurses had their hands on the patient’s chin as a reinforcing/reassuring measure. They were clearly not feeling the effects of a transmitted significant voltage, unlike in a cardiac arrest situation if you administer an electrical shock, you have to be clear and not touching any part of the patient’s body lest you get a shock as well. It is all very professional and clean and protocol-oriented.
*There are a lot of good people working very hard to make the experience as comfortable and easy for the patient as possible.

At some point I will probably do some research into the subject. It has certainly piqued my interest – but I am ashamed to admit I won’t be looking forward to the next time I get assigned to this area, and I dread looking at the rota announcing when I am going to go there next. And at some point I may actually grow to appreciate the whole process. And look beyond the obvious conflict. But today is not that day. Sigh.

It’s not just about the exams and the competences – COURSES!

Here is a list of courses and additional skills that I would recommend (I am trying to tick off these on my own personal checklist so this is not an official list, rather my own opinion):

ALS – Definitely a requirement to even be considered eligible for a training post – a basic course to attend for any training or non training doctor – certification lends you 4 years, and then needs to be recertified

APLS or EPLS – whether or not you’re paediatrically inclined – the paediatric life support courses, or their european counterparts are a good feather to add to your cap

ATLS – the advanced trauma life support – need I say more?

Ultrasound levels 1&2 – good thing to begin this early on in your training, what with everything being scanned for these days even vascular access – its a good thing to have ticked off earlier in your career so you can begin the arduous process of getting signed off for it which may take a while

Attend conferences – the RCEM provides a lot of guidelines, and then there are always foreign conferences like SMACC (Social Media and Critical Care) – be very open to the exchange of ideas, you never know which interaction might be a teaching moment or lead to one – and change your practise.

Look at out of program opportunities or secondments that either support your career growth in your own field or cater to your own personal growth and add to your skill set in addition to your training pathway. See if your deanery or your local hospital has any sponsored programs, maybe an additional masters program or other academic or teaching opportunity, a mentorship course or a volunteer ALS/BLS instructor or even a nominated teaching go-to person for medical students rotating in your specialty. It adds to your CV, makes you a better candidate for the future and just rounds you off that much better. (My deanery offers a few postgraduate degrees in stuff like entrepreneurship and leadership skills – I am seriously considering the option to apply to be considered for such an opportunity!)

Exam prep courses – no shame in that, in the ever-changing exam scenario for the training program, it can’t hurt to be well-informed and look at guidance options – my deanery regularly arranges examination preparatory guidance courses. Consider joining!

European Board of Emergency Medicine exams – consider applying for these and taking them – the first part is something you get eligible for if you have 3 years of emergency medicine experience that someone can vouch for for non training people – for trainees it is after the successful completion of 3rd year of their training. Something to definitely consider as adding to the many feathers in your cap.

Simulation days – very informative and you learn so much, not just from doing it yourself, but from how others do it and how there may be a range of approaches and you can look at what works for you!

Guest Blog Post by Dr. Hassan Alraee – “My MRCEM OSCE Experience”

This is our second guest blog post from esteemed colleague Dr. Hassan Alraee – Emergency Medicine Registrar (Ireland). I take no credit for the following text.

Dear Colleagues,
I am sharing my MRCEM OSCE experience with you guys as I realized while preparing for the exam there was not much guidance available online. The aim of this post is to familiarize everyone with what the exam entails and a few tips which may be helpful in your preparation for the OSCE.
This may not be a structured or typical guidance post, it may come out as a random collection of thoughts but I will try my best to note down everything that was helpful to me during the preparation for the OSCE.
First of all to be eligible to appear in the exam you need to have passed the FRCEM Primary exam, passing the FRCEM Intermediate SAQ exam is NOT one of the eligibility criteria. However, in my experience passing the FRCEM Intermediate SAQ exam gives you a baseline in theoretical knowledge that is required for the OSCE. So it would be ideal to attempt the exams in the sequence that has been set, i.e. Primary, Intermediate and OSCE.
Before beginning your preparation for the exam have a look at the MRCEM Information Pack available on the RCEM website. A list of study material that may be helpful includes;
1. MCEM Part C: 125 OSCE Stations by Kiran Somani
2. Mastering Emergency Medicine: A Practical Guide by Mathew Hall
3. Bromley Webinars
4. At least 1 (if not more) of the following courses; The London Clinical Course, The Bromley Course or the Manchester Course.
The exam itself feels like a daunting task during the preparation phase as it is completely different to the previous parts and reading books alone is not the best way to get through it. My advice would be to stick to one of the above mentioned books and go through it once. The next step would be to create a practice group which should comprise of at least 3 members. This would mean all 3 of you would be able to rotate through different roles during the practice sessions, i.e. The candidate, The actor and The examiner. In my humble opinion this practice group is the key to being successful in the exam. The final step would be to book one of the above mentioned courses. In order to maximize the courses you need to be fully prepared for the exam by the time you attend the course and treat it as a Mock Examination.
Each of the courses has their own pros and cons but all of them are helpful in preparing you for the OSCE.
Each OSCE comprises of 18 stations, 2 of which are rest stations. The exam does not test your theoretical knowledge to a great extent, the stations in the OSCE are designed to test various skills. Like all OSCE exams there is a fair degree of play acting and exaggeration of your daily practices is required. By this I mean that the examiner will only mark you on the actions you perform during the exam, so make sure you show every step and tick most boxes in the examiner’s checklist.
The basic outline of the stations encountered within the OSCE are;
1) There are 2 to 3 history taking stations, remember to complete the station by giving the patient a management plan based on the history.
2) A Systemic examination station (CVS, Respiratory, Abdominal, Cranial Nerve or Peripheral Vascular examination)
3) A Joint examination station (Hip, Shoulder, Knee, Back, C-spine or a limb examination)
4) A Breaking Bad News scenario
5) There are 2 or 3 teaching stations which may include teaching a procedure or examination to a student or a junior doctor.
6) There is always a Conflict Resolution in the OSCE as well, which may be a missed fracture or pneumothorax or a difficult referral. This station also includes talking to a patient with Alcohol Dependence or Binge Drinking.
7) 2 scenarios within the OSCE are always Resuscitation Scenarios and test your skills in ACLS, APLS or ATLS. These stations seem like they are the most difficult ones while preparing for the exam, but in my opinion you can easily pass these if you make a good approach towards resus stations during your practice sessions. The Key to the resus scenarios is sticking to the ABCDE approach.
8) ENT and Eye station; in the exam they can check your knowledge on these in various ways it can be a simple otoscopic or ophthalmoscopic examination, teaching may be incorporated into it or history taking could be tested but there will always be a station that will involve ENT or Eye.
9) A quick assessment station; this one is a tricky one, it usually has the task of taking a short history, performing a focused examination and formulating a management plan based on your findings and summarizing it to the patient.
10) An Information Providing station; this station usually involves a relative of the patient to whom you have to explain a new diagnosis or management of a medical condition. Juvenile Diabetes Mellitus and Addision’s Disease are 2 examples that I can recall.
11) A Psychiatric Station is always present in the OSCE, you may be asked to performed a Mental state examination on a patient or assess suicide risk, they may add a conflict resolution component to this station as well.

In my opinion if you divide your preparation according to these 11 types of stations you will be able to cover most of the things required to be successful. Some additional topics that are tested in different ways and I haven’t categorized under the stations include; DVT, major incidents, seizures and driving advice. It would be wise to look up the NICE guidelines on these.
I would also suggest that you reach the city where the exam is being held one day earlier and have a look at your examination center that day. Just so you know how long it takes to get there and don’t have the extra stress of finding the center on the morning of the exam. Please spend your last 2 days traveling and relaxing, there is no point in trying to cram in stuff over the last 2-3 days as this is not a theoretical exam where they expect you to know everything.
On the exam day itself it is understandable to be anxious and stressed and believe me the examiners know that the candidates are under pressure and are not there to fail you. You should know that staying cool and calm is the most important feature that will enable you to be successful. It usually takes 1 or 2 stations to get into the groove of the exam as the 1st station comes up it is normal to feel a little nervous or blank out temporarily. Do not act bold and wing it if you are unsure about something, be safe at this stage and say you are unable to recall at this point in time and that you will consult the department policy or your consultant before implementing it.
Do not worry if any of your stations don’t go as well as you expected them to, leave the previous station behind you and move on to the next one. Do not let your performance on the previous station affect your performance on the next one. I know this is easier said than done but it has to be said as it is human nature to dwell on the past. You should also know that there is not a minimum number of stations that need to be passed to pass the exam, that was how it used to be in the past. The marking scheme has changed to a cumulative score now and a different passing mark is set for every OSCE day so even if you fail a station you carry forward marks from it towards your overall score. Therefore it is imperative that you score marks for the basic things on each station. Some of these include greeting the actor, washing hands before and after examination, wearing personal protective equipment (or at least mentioning it to the examiner), being warm and courteous and thanking the actor at the end. These simple things may be the difference between a pass and fail score in your OSCE.
I hope it was helpful for all those that are reading this post, good luck with your exam, with a bit of structure and practice I’m sure you will pass the OSCE.