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Any other symptoms?

OSCEs are a great way to test students. Every student sees the same “patient.” The actor might be different, but the case they are given to memorize and act out is the same. It allows for standardization and makes evaluating students all the more easier because everyone is on the same playing field.

The problem is that OSCE patients are there to test us — not figure out what is wrong and get treated. And since the goal of the “patient” is different, they act differently than real ones.

For example, when I have seen real patients who come in sick, I often need to slow them down because they are just spouting off everything under the sun that is wrong with them or their child. So a mother bringing a child in with a chief complaint of diarrhea will tell you that the diarrhea started at such and such a time and the kid also had a fever and threw up a couple times, etc.

An OSCE mother will tell you that the kid is suffering from diarrhea. And when you ask if the kid has any other symptoms, it is likely that she will reply, “No.”

I get why a fake patient does this. They are there for our practice and for us to be evaluated on our clinical skills. We should be pressing for specific symptoms once we have an idea of the diagnosis. So after taking the history we have to go over the “Review of Systems” and ask specifically for different symptoms (i.e., vomiting, diarrhea, fever, headache, etc.).

But it just feels like I’m playing a game, or that my “patient” really isn’t all that interested. Because as a parent, wouldn’t you be listing off all of the symptoms you have noticed if it is as obvious as a fever you personally measured?

And now this rant ends.

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  • CherylRRC

    I never liked the OSCEs. It was like acting out a scene that could be filmed only once. The standardized patients at my school were great, but I always got nervous because I was afraid of missing something. When I eventually got the chance to work as a standardized patient, I tried to be as “real” as possible. I still prefer my real patients over any standardized patient!