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 firstname.lastname@example.org 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.
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
As discussed at the Student feedback session these were the Borderline and Fail rates for each Station
|Station||% Fail||% Borderline|
|4b Death confirm||11||64|
|5b Clinical Skills||25||4|
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.
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.