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Notes on examination

How to learn the exams

Obviously they should be practiced. It is hard to perform any of these examinations without missing out details even up until the week of the exam.  This will lose you marks in OSCEs and if you have missed anything serious might fail you. Four tips:

  1. The routine can be learnt by practicing on colleagues. Examinations are easy to forget so do it often.
  2. Your technique must be checked by having doctors observing you.
  3. You must get good at recognising the signs. This is much easier to do once you can examine without thinking of the next step and you have a good technique.
  4. Practice the night before and the day of the exam if possible to get the routine in to your short term memory.

How to begin and end exams

Examiners say that they can distinguish a good from poor candidate in the first minute, therefore first impressions are important! Here is how to begin any examination:

  1. Use the mnemonic: “I PEA”: Introduce, Permission, Expose, Ask if there's pain
  2. Wash your hands
  3. Position the pillows
  4. Take a dramatic step back and observe the patient at the end of the bed: this seems awkward and uncomfortable but examiners like it and it helps you look for clues around the bed.
  5. Position the patient
Similarly the end of the examination will leave an impression in the mind of the examiner. Here is what to do:
  1. Cover up, dress, and thank the patient
  2. Ask to do further bedside tests

Presentation

Presenting is a suprisingly difficult skill and the only way to get good is to practice. For some examples of the perfect way to present certain conditions see the book Medical Short Cases for Medical Students (Ryder, Mir, Freeman) .

We have included example presentations for some of the more common OSCE stations. The key is to present the positive findings and the relevant negatives. Medical students often suffer from presenting every positive/negative finding (e.g. there was no ascites, the liver was not enlarges). This makes the examiner feel that you do not know which findings are important. It is much more succint and professional to say "there were no abnormalities of the abdominal system."

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