UCL NOVEMBER 2016 MOCK EXAM. FEEDBACK SESSION

 The Mock OSCE took place at NMUH on Tuesday 29th November for final year UCL Medics. Charles Spady, the rest of the Academic Centre and helpers should be congratulated for all their hard work and of course the patients and examiners thanked for their time in participating. Today I facilitated a feedback session in which anonymous feedback was given by 25 of the students either through polleverywhere.com or written feedback. In part I have tabulated their responses. As requested by the students further generic feedback is given in Part II from examiners. If any NMUH examiners would like to send any other generic points about their station please send to be direct at johnfirth@nhs.net and I will add to this blog. There are a number of points that the students talked about that will be considered for actioning for the next Mock.

Part III will be added later and will consist of the poor performing stations and anonymised “suboptimal students”. All students will be sent a list of stations with their performances and the students that performed sub optimally are aware that their Educational Supervisor will be informed by tomorrow so they can discuss with them any remedial help whilst still at NMUH. Rebecca Gillibrand will give a Death Certification tutorial (not in the Mock but could easily be in the finals) next Tuesday at 3pm in the academic centre common room.

Any comments to me directly through e-mail but cc Charles Spady and Paul Maxwell

PART I Student feedback

Did it go as planned

Yes 55%           No 45%

Didn’t really have a plan just did my best.

Had not prepared for OSCE partly as SjT in same week so did not have expectation of doing particularly well.

Not sure on timings – some were 5 / 10 /30 minutes but not sure which ones

I didn’t really have a plan for the mock exam. I wanted to test how well I could respond to the exam without preparing so that I will plan revision.

Well structured OSCE lots of helpers. My exam could have been better.

Treated it as an exercise to understand my current baseline and how much to prioritise I need before finals.

I hoped that I would pass every station but did not necessarily expect to do very well

Yes in terms of being able to attempt every station but with more preparation I would have improved my performance

Yes – well organised

Very organised with no hiccups in between.

Hadn’t done much revision as SjT was the same week.

I wasn’t really sure what to expect.    Didn’t really know what to expect

Sort of it was difficult to plan how to do each station because the timings were difficult from the actual exam (I am not sure this was a good idea)

How did you feel during the session

Most examiners were really nice and made it less nerve racking. Really good practice

I felt that it was a good representation of the OSCE but informal enough.

Comfortable at level expected

A mixed bag partly calm, partly like I had no idea what to do.

Most examiners were encouraging in feedback so more positive than normal OSCE when progress is unknown.

It was a bad week for me so I was not feeling particularly positive.

Shame it wasn’t a bit earlier in the placement.

Not very happy, particularly didn’t understand why timings were different from exam!

Confused about timings for different stations, wasn’t made clear

Awesome signs. Wish we had known it was going to be so serious with proper patients, etc

Forgetting to present signs that I had picked up on

Slightly frustrated by making easy mistakes, but generally ok

Nervous that timing was all off     Stressed     Nervous but unprepared

Bit nervous but generally OK

Nervous at first but actually it felt like a long teaching session. Very useful.

Nervous but as I settled into the stations I felt more confident.

Nervous and the timing was really difficult to keep up with.

Not terribly confident but I managed to stay fairly calm

Bit sweaty      Bit panicky

Under prepared.   Not as prepared as I would have liked as the SJT was the same week x2

Happy        Good      Great

Good feedback, well supported

I think I should have been in the second group in January as I had only done 5 weeks of DGH.

Good practice for long OSCE

What did you learn from the session

It was great to get a feel of the OSCE and I feel I have a better understanding of gaps in my knowledge.

What the actual OSCE would be like.    Practice long history and presentation

Various examination styles.          How to pace myself during OSCE session

Specific feedback on my examination and what to expect from the finals OSCE

Felt this was a really good learning session as there were lots of real patients with good signs.

Learnt about OSCE timings and was able to practice presenting with good signs

Practicing new format – timings especially and not talking through examination

It went quickly.   Still not sure what the actual final OSCE will be like

Difference of approach between the short history and long history station.

Osce format, a little less anxious now…

Still not sure what long stations are

Good to practice long history

Got a better idea of what the expectations are for finals

Having a range of cases to examine was really useful

Do we fail if we don’t get the diagnosis? That’s what the rheumatologist said.

And others told me not to talk through when I tried to and to present after… Even though we’ve been told it’s up to us.

That I know a lot less than I thought I did             Need more prep

That I’m not ready for finals

Need to improve reflexes                      Good tendon hammer

Some doctors were butting in during examination saying “why aren’t your talking through” when I was going to present after.

Presenting after examination. It was good to see patients with signs.      Patient signs

Useful practicing on actual patients that had signs but quite sparse/not v significant ones

Need to practice exams to time, especially cranial nerves

Need to get a better sense of time especially for long histories

To ignore some of the feedback.           Keep calm and carry on

Really good to have the proper OSCE format over 2 and half hours because this is the first time we have at medical school

Some obvious areas to revise – I need to do a lot more work

I need to be more confident. How to better come to a unifying diagnosis and differentially, given the signs that I elicit.

I know a lot less than I thought I did,  particularly regarding differentials.

I need to practice examinations to improve time management and get more slick.

I learnt about the things not to forget eg signs to present.

Not to waste time in practical skills.      Lots of advice on examination technique

Timing.               Better idea what to expect

If you were doing it again what would you do differently?

Prepare a bit more beforehand (especially going over core examinations).

Prepare more x3                    Prepare more and go back to review the basics.

Look at the wrist band in death certification

Take time to reads the questions

Practice a lot.                   Practice more before hand

Try and be calmer. Think systematically. State the obvious.

How to think systematically during an OSCE

Hone general medical knowledge.

Do two days of mock OSCEs as in real finals- like some of the other DGHs do

Those students who arrive at end of October should have their mock OSCE in January

Mock osce much earlier in the term – we leave in 2 weeks…

Mock OSCE not the same week as SJT, maybe the week after

Please don’t put the mock in the same week as the SJT

Prepped more- wasn’t clear of the setup of the exam (i.e. that it would be so formal and examined by doctor). Ideally would not have had SJT within same week

Not every examiner has provided our result

Asked for the examiners to be told the policy on whether we can choose to talk through our exams or present at the end

Practice the timings e.g. 10 minutes for exam and present in F1 foot teaching

practice presenting & get a better grasp of long histories

Have proper timings

‘Time management’ – definitely need to go faster but I don’t know how much faster

Would realise it’s a serious mock and do more revision beforehand to get more out of it

I would be more prepared       I would revise more beforehand

Revise some radiology cases

Think about  list of possible cases so as not to be surprised.

Nothing major, perhaps examine respiratory more thoroughly

Understand that there can be more than 1 pathology ie phrenic nerve palsy and wheeze

Say everything found on examination.

Be more structured and don’t flap

Be less hesitant and more confident.    Be more confident during presentation

Would have tried to practice presenting better and a better idea of time management

What improvements would you like to see in the Mock OSCE

Open curtains on scleroderma station as it was too dark to see!

Have a clear policy on whether we can present during or after, and tell the examiners.

Not same week as SJT. (x3)   I wish it didn’t happen 3 days before the SjT

Vignette outside station etc.      See the scenario before entering the station.  Blurbs outside (x7)

Timings explained more clearly

30 seconds reading time. X2

Give us the proper timings with the full ten minutes so we can experience proper presenting and the questioning in the last 3 mins

Not being disrupted during the examinations/histories themselves

Over two days like other DGHs

2 days so can cover the full variety of stations E.g. Stats/explaining an article. Also morning people had 2 hand exams would be better to have a different locomotor

Making the timing clear e.g. if we were going to be stopped by the examiner at 17mins in the history

Perhaps not being immediately told that you’d failed? Bit off –putting

Have a station 4/ viva type station.. What happened to the “Station 4 OSCE”

Long histories with enough to discuss

Have full timings for long stations as its new so we really need to practice this

email 1-2 weeks in advance with clear details about what to expect in Mock OSCE e.g. Real patients, what type of stations etc

I wish there was more warning of how serious it was so we could do more preparation.

Making it clear there will be real patients.

More like the real OSCE in terms of timings, expectations of you etc.

Give specific feedback for the group as a whole did in each station and how they could have improved

Before my first station one of the Drs said the findings very loudly.

Some examiners did not give the right instructions

Aware that I need to practice interpretation of CXR/AXR. Death Confirmation, Discharge Summary and ethical conversations.

Nice to have properly times stations so we can practice the viva part of the station. Examiners felt quite rushed on the day.

PART II  EXAMINERS FEEDBACK AS INDICATED ON SHEET GIVEN TO JF

Station 1a 1b 1 c  2a 2b 3B 3C 4C 5B 5C Nothing noted beyond grade

Station 2c          Need to practice more

No mention of PR as additional examination

Get priorities right at beginning

Make diagnosis in the first 30 seconds if possible (that’s what standing back is for)

Don’t forget to turn patient for spleen exam

Dress patient up and use time to prepare presentation

Look at patients face during palpation. Need to be sure patient is not in pain at any point

If you need to present yourself say you are a medical student unless the scenario says you are a Foundation Trainee

Better to present at end not talk through as a) means you can speak to patient b) we don’t do both

Don’t forget at the end say examination of genitalia/rectum and urine test.

Much thanks to Mr Dvorkin for the above

Position the patient correctly

Remember do not miss examining the neck (supraclavicular) and inguinal nodes.

Proper use of the hand in palpation. Deep palpation for masses and aortic aneurysm. Percussion includes Liver Spleen and Bladder.

Non asked the patient to cough eg periumbilical  hernia and other hernia eg through a scar.

Examine the back for scars, renal tenderness and sacral oedema. Check for ankle oedema.

Say you would check for shifting dullness.

Present positive findings first.

See

https://www.ncbi.nlm.nih.gov/books/NBK420/

for an online review

Station 3A          Not completing examination in time

Station 4A          Mixed up Advanced Decision to Refuse Treatment and Advanced Statements

Station 4B          Rebecca and I borderlined any who did not identify the dead patient from his ID wrist band. (Applies across examinations and in real life).

Washing hands before and after death confirmation.

Maintaining dignity after examination

Forgetting to listen to heart or lungs.

Confidence issues.  Doing confirmation in a methodical way

Say you are checking for a pacemaker.

Make it clear what you are doing and for how long

Further consideration after certifying and writing in the notes

Informing relatives         If sudden death discussing with coroners officers

Who will do the MCCD

Station 5a          Borderline where those having a problem with the AXR

Station 5C          Inappropriate unsafe fluid regime and 02

PART III

As discussed at the Student feedback session these were the Borderline and Fail rates for each Station

Station % Fail % Borderline
1a-c History 0 7
2a CVS 8 7
2b Resp 0 11
2c Abdomen 0 11
3a Neuro 15 25
3b Loco 0 14
3c Surgical 0 4
4a Ethics 0 11
4b Death confirm 11 64
4c Resus 14 46
5a Radiology 0 25
5b Clinical Skills 25 4
5c Prescribing 4 25

As previously stated the Death Confirmation station was a bit Hawkish (Rebecca and I !) . But over the years Neurology and Locomotor  are often poor performing station. There was a significant difference between examiners assessment am v pm on the resus station which Sarah may be able to explain

The Mocks are there to give important formative assessment and feedback so the student can reflect on areas for additional learning and practice. Whilst all stations gave verbal feedback Sarah Pocknell  will give out the paper feedback from those examiners that completed them.

My assessment of the group is slightly different as I have for some years been looking at the number of stationed borderline and failed(as above) and in doing this tried to assess “under performance”

I have used a number of cut offs in the past depending on each groups overall performance in the Mocks. Unlike the final exam I ask examiners to indicate Borderline (for BP and BF).

For this group  the cut off is 2 or more fails or 6 or more Borderline + fails.

Time ID (ANON) Borderline Fail B+F
AM A 0 2 2
AM B 2 2 4
PM C 3 3 6
AM D 5 1 6
PM E 5 1 6
AM F 6 0 6
AM G 6 0 6
PM H 6 0 6
AM I 3 4 7

Those that did not attend for whatever reason must do the Mock OSCE next time as from past experience not doing it does not allow assessment, feedback and additional help if necessary.

The aim is to particularly suggest these student meet up with their Educational Supervisor and /or discuss with Sarah Pocknell (Sarah.Pocknell@nhs.net) additional learning opportunities

This does not mean the others should rest on their laurels . The Mock OSCE is an opportunity to reflect on the event and work out ways to address any needs and make good use of all learning opportunities. So :-

  •  Learn for yourself or in small groups.
  • Contact your educational supervisor to meet and discuss
  • Ask Sarah for specific area were you think you should improve
  • Discuss with Charles or Dr Maxwell any areas of concern you would like help with
  • and any areas Dr Gillibrand and myself can help you out or put you in the right direction contact through the usual means.

As an end note please do not leave comments here but  examiners , examinees and others can send comments to johnfirth@nhs.net and copy to Sarah.Pocknell@nhs.net

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