awkward OSCE examination

For those of you that are not familiar with the medical field, as medical students we have to take multiple OSCEs (objective structured clinical examinations...yes I googled this) to prove  the adequacy of communicative and clinical skills while working with standardized patients (or mannequins). In first year, we learn how to take a brief history of the presenting illness (HPI). At the time, it seemed so challenging to get all the required parts of the HPI from a patient in 10 minutes. But of course, it only got "harder" in second year, when we learned how to take a full history (which includes HPI, past medical history, past surgical history, allergies, medications, family history, social history and review of systems)....which we had to take in less than 15 minutes. Then came third year with its rotations, endless hours of rounds, presentations, lectures, question banks, etc. At the end of each rotation, we have to take an OSCE (specific for that rotation) and a shelf exam (multiple choice exam provided by NBME). The OSCEs are usually not that difficult, however it brings upon great anxiety because we have to interview/perform a set of clinical skills in front of a grader who is watching your every move (!!!), in addition to our standardized patients (who know everything you should [and should not] be doing). Sometimes, they're even video recorded and played for us afterwards...

Overall, its not a terrible experience. For the most part,  I've learned how anxious I still get right before exams, as well as the mistakes I make under pressure. However...I've also learned about how awkward and weird medical training can be. Today, I'd like to talk about my wonderful experience of my Ob/Gyn OSCE. This mainly consisted of 3 parts: history, differential diagnoses & treatment plan as well as the pelvic exam. By this point, I've learned to cruise through the history taking (that's pretty much all you do during third year). The awkward part is the physical exam. Let's examine the situation....

I knock and enter the room, hand the sticker with my name and student ID to the grader (who happens to be the attending I worked with during my GYN floor month). I then introduce myself to the patient...who happens to be a headless, chest-less, leg-less mannequin. Actually, I cannot even call it a mannequin, it is a piece of plastic in the shape of a pelvis.  I smile and introduce myself to the pelvis (aka the patient) and notify it/her that I will be performing a pelvic exam. I, then, get up to wash my hands and prepare the Pap smear kit.  As, I run the speculum under warm water, I begin to wonder if I should ask it/her about her weekend (I mean, if this was an actual patient, I most likely would not be silent at this part...I then decide not to ask...haha). I walk over to the pelvis and tell it/her exactly what I am about to do, in case you were wondering, she didn't ask any questions. I then place the speculum on to its/her non-existent thigh, asking if the temperature is okay, and continue despite no response. During the Pap smear, I tell it/her she will feel some pressure and to not worry because she/it may experience minor bleeding and pain afterwards. Throughout the exam, I continue to explain exactly what I'm doing, and ask her if she has any questions ....whilst trying to remain professional & not burst out into laughter when she/it doesn't respond. Luckily I got through the examination and passed, but I couldn't help myself from grinning and laughing outside the clinical skills center. 

As much as I appreciate and value our training, there are definitely situations like the one above, when I can't help but smile at how ridiculous some parts of our medical training are.  :)