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.


I’m a bonafide genius!

A couple weeks ago I had to do an OSCE where I interview a “patient” (actor) and conduct a short physical and then discuss what I think the problem is and what I want to do with the patient.

These “patient interactions,” as they call them, are recorded and we are required to come back and watch them and evaluate ourselves.

I hate watching myself on video. And today I just saw the video of me interviewing a patient who had a complaint of frequent falling. Got that? She came in complaining of falling.

Well I do the interview, asking about when the problem started and blah blah blah. Her three episodes of falling were sporadic, occurring at different times of the day and in different places. And it wasn’t because of any injuries.

Ten minutes later before I move on to the physical exam, I ask the patient, “Have you noticed any changes in balance?”

What the heck, Jeff?!? She has been complaining about falling and you ask if she has had a change in balance?!?

The patient sat silently and just stared — totally confused, I’m sure. And I, realizing what I had just asked her, quickly recovered and pretended like I was clarifying myself and asked if she had felt any dizziness, headaches, or nausea.


If I were an actor…

Every once in a while I read about how some actor or actress refuses to watch any film that he or she acts in. I used to think that was odd. I mean, why wouldn’t you want to see yourself?

That’s how I felt — at least until I had to watch myself on video. After I saw a standardized patient in an OSCE I had to sit with two other students who had a interviewed two different actresses playing the same role.

The clinical case was simple. A 21 year old Caucasian female who previously suffered from Bronchitis (1.5 weeks ago) has a complaint of vaginal itching. She just completed her course of antibiotics 1 day before coming into the office. Based on that patient ID, and the subsequent history I (and I believe my two colleagues) concluded that this woman had a yeast infection.

That was the easy part. Well, more or less…

The difficult part came after. We sat in a group of three with one of the physicians and watched clips of each other’s interview. We had to comment on what we liked about it and what could be done to improve the interview as a whole.

After this group session we split up and had to watch our own videos in it’s entirety before writing a self-evaluation as well as what we think we could do to get better and what we planned to do in order to actually get better at it.

Well I cringed. I didn’t like watching myself on video. It was awkward. My voice sounded… well it just didn’t sound quite right. I watched myself and thought, “hmmm… I guess I could lose a couple more pounds.” (Is that girly of me to think that? LOL)

At least, however, I did get some positive comments. I’m not horrible at interviewing as long as I don’t go blank midway through. The physician told me I did not look nervous and I actually looked like a doctor in there — or at least on camera.

And the standardized patient wrote the following: “Good job!” and that I made her feel very comfortable during as a patient.

But on the bright side I know I can look a stranger in the eye and with a straight face talk about her vaginal itching, sexual activity, and sexual orientation all while making her feel comfortable.