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    (Original post by RollerBall)
    Could you justify why you'd want to test more microbiology/immunology as opposed clinical knowledge? Could you justify why an FY1 doctor would need to understand underlying pathology vs clinical scenarios?
    Cos basic sciences underpin clinical knowledge?
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    (Original post by Tech)
    Does anyone actually carry the BNF around with them on the wards? Seems like it'd be a pain to juggle that with OHCM/notepad and pen too.
    No way. You'd look like a pharmacist. And probs wise to drop the notebook too. Just use bits of continuation sheet if you need to take notes.
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    (Original post by digitalis)
    Cos basic sciences underpin clinical knowledge?
    Shh, I'm making him justify it, not questioning his decision
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    (Original post by Medicine Man)
    It would be with a legitimate patient. Granted it won't be standardised as an OSCE but it does give examiners a chance to see how soon to be doctors would treat patients holistically. Maybe I could alter the way the long cases are done and use actors as opposed to real patients, although then you could be undermining the authenticity of the assessment. Then again OSCEs which are like the gold standard use actors sometimes so maybe thats not such a bad idea...

    True point about the overlap. Hadn't thought about it - maybe an OSCE station on prescribing (which I imagine already happens at most medical schools anyway?). Apparently most errors with junior doctors seems to be down to prescribing and this was my rather feeble attempt at trying to solve that! :p:

    The only reason I wanted an extra pathology exam was because it is really underrepresented in the current medical school exam system. I think Imperial had (still have?) that extra pathology exam students sit in the 5th year - so it'll test stuff like microbiology, immunology etc.
    We have real ill patients in our 4th year OSCEs and a prescribing station (last year they asked students to prescribe blood - I can do antibiotics, warfa/heparin, insulin stuff, saline etc but don't think I would learn blood transfusion unless I'd known about it as I do now).

    I would be against using actors in finals - granted the standardisation issue, but when you get to 5th year you should be competant in doing the examinations and you should be using patients who are ill because this is the last time you'll be assessed before going out into the 'real' clinical environment. Besides actors are much easier to examine than ill patients so you'll be able to see how students perform under stress.

    Perhaps use double ended steths in blood pressure/CVS exams to make it fairer. We had double ended steths for blood pressure which made it fair as the examiner could check you were listening rather than making up a blood pressure value or saying that their pulse was weak etc.

    What do you mean about the pathology exam - as in ordering tests?
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    (Original post by Tech)
    I'm regretting being stuck in a two year contract with a rubbish phone! Although after it's up I'll definitely get an iphone. Cheers for the heads up!

    Yeah it's Futurama New series this year, hope it lives up to the rest...
    I thought so! That was one of my favourite episodes! I haven't seen it for about a year though
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    (Original post by Supermassive_muse_fan)
    We have real ill patients in our 4th year OSCEs and a prescribing station (last year they asked students to prescribe blood - I can do antibiotics, warfa/heparin, insulin stuff, saline etc but don't think I would learn blood transfusion unless I'd known about it as I do now).

    I would be against using actors in finals - granted the standardisation issue, but when you get to 5th year you should be competant in doing the examinations and you should be using patients who are ill because this is the last time you'll be assessed before going out into the 'real' clinical environment. Besides actors are much easier to examine than ill patients so you'll be able to see how students perform under stress.

    Perhaps use double ended steths in blood pressure/CVS exams to make it fairer. We had double ended steths for blood pressure which made it fair as the examiner could check you were listening rather than making up a blood pressure value or saying that their pulse was weak etc.

    What do you mean about the pathology exam - as in ordering tests?
    Very good idea about the double steths, we used them in our B/P examination but the clinician examining us didn't put his one on.

    The big issue with the standardisation in my head is would you be okay accepting a patient with a very discrete, difficult to notice murmur (using this example as my presentation is on this ) where in real life you'd shout for a consultant if you expected to hear one vs a patient with a very pronounced murmur? As this is in an examination it's unfair in my eyes for student X to have an easier time than patient Y.
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    (Original post by RollerBall)
    Very good idea about the double steths, we used them in our B/P examination but the clinician examining us didn't put his one on.

    The big issue with the standardisation in my head is would you be okay accepting a patient with a very discrete, difficult to notice murmur (using this example as my presentation is on this ) where in real life you'd shout for a consultant if you expected to hear one vs a patient with a very pronounced murmur? As this is in an examination it's unfair in my eyes for student X to have an easier time than patient Y.
    Hmm I'd expect examiners to be a bit stricter for finals.

    Screen patients before recruitment so there aren't issues with borderline postivie clinical tests... but then you start to question the validity of the whole thing, if you're picking the 'healthier' ill patient - then that won't be representative of treating ill patients, but then again it's unfair on the patient too. However I don't think medical schools will be picking very ill patients.

    Therefore (after a good deal of waffling) recruit patients for OSCE through a lax screening process so they are ill with fairly positive signs, and use double ended steths in BP/CVS stations.
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    (Original post by RollerBall)
    Very good idea about the double steths, we used them in our B/P examination but the clinician examining us didn't put his one on.

    The big issue with the standardisation in my head is would you be okay accepting a patient with a very discrete, difficult to notice murmur (using this example as my presentation is on this ) where in real life you'd shout for a consultant if you expected to hear one vs a patient with a very pronounced murmur? As this is in an examination it's unfair in my eyes for student X to have an easier time than patient Y.
    We have double ended steths routinely for OSCEs. I've also seen double ended eyepieces in ENT - so you can directly see what the consultant sees, fantastic for teaching, and far better than standing in the back of theatre with a view of someone's arse all afternoon...

    Murmurs real or otherwise is quite good IMO - it's relatively straightforward to check whether the student can do a safe CV examination - then if they don't know exactly what the murmur is, they can be asked to describ it and see if they can come up with a plausible answer. + OSCEs, althought often use real pts with real signs, you can actually use a normal healthy pt and still elicit the exam in a uniform fair way. - In many ways when students start out in clinicals - it's more important to first recognise what is normal - if you have no idea of that, there's no chance of differentiating pathology.
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    (Original post by digitalis)
    Cos basic sciences underpin clinical knowledge?
    Agreed. Knowing pathology and the causes of things is the only thing differentiating medics from the lady in Sainsbury's armed with wikipedia. The whole point is that we're supposed to know a bit more than the patients. The whole point of medicine - as opposed to Sainsbuy's lady 'oh he looks ill' is to systematically assess and quantify how ill and why. That's what you're paid to do - diagnose and treat. If you don't understand how the system is meant to work, and how it goes wrong, you cannot practice medicine - that would be called guessing.

    The problem is (as I'm finding out in my bsc) that causality if very difficult to pin down...and the treatments are even harder
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    Bbr, gonna chunmder in a bin.
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    http://tinyurl.com/covkxpw

    :ninja:
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    (Original post by RollerBall)
    Very good idea about the double steths, we used them in our B/P examination but the clinician examining us didn't put his one on.

    The big issue with the standardisation in my head is would you be okay accepting a patient with a very discrete, difficult to notice murmur (using this example as my presentation is on this ) where in real life you'd shout for a consultant if you expected to hear one vs a patient with a very pronounced murmur? As this is in an examination it's unfair in my eyes for student X to have an easier time than patient Y.
    I doubt they would give you a difficult murmur in finals, let alone second year OSCEs! Either way, in real life with even the sniff of a murmur, you'd be shouting for an echo not a consultant...consultant can't tell you accurately the degree of stenosis/regurgitant flow, related dilation/hypertrophy/ejection fraction etc etc.


    LOL


    (Original post by Wangers)
    Agreed. Knowing pathology and the causes of things is the only thing differentiating medics from the lady in Sainsbury's armed with wikipedia. The whole point is that we're supposed to know a bit more than the patients. The whole point of medicine - as opposed to Sainsbuy's lady 'oh he looks ill' is to systematically assess and quantify how ill and why. That's what you're paid to do - diagnose and treat. If you don't understand how the system is meant to work, and how it goes wrong, you cannot practice medicine - that would be called guessing.

    The problem is (as I'm finding out in my bsc) that causality if very difficult to pin down...and the treatments are even harder
    Great post. Can't rep again
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    (Original post by RollerBall)
    The only issue I'd have with real patients is that patient X could have a really discrete murmur where as patient Y's murmur could be really obvious. If you were only assessing how they treated patients as opposed to what they're treating then it would work. For example, would it be okay in the exam for a student to say "I couldn't hear a murmur" as long as they checked for one? Realistically they would call for a consultant to double check if they thought they would have one but that's not available in an exam situation.

    So, if you're assessing something like attitude as opposed to knowledge then the full patient examination would be fine. Otherwise I'd question the validity of it. Actors would eliminate that and for examinations you could present them with scenarios. So, you could have a patient who you take a history and examine. Then you could be presented with information from the examiner like "imagine when you examined that patient they had a mid systolic low rumbling murmur".

    While pathology is under-represented couldn't you just adjust the EMQ exam? If it's covering basic science and knowledge just slightly reduce the amount of basic science and add in more pathology? This is only suggestions though. Could you justify why you'd want to test more microbiology/immunology as opposed clinical knowledge? Could you justify why an FY1 doctor would need to understand underlying pathology vs clinical scenarios?

    I think one of the major **** ups of junior doctors isn't due to the prescribing but due to interactions as well. Feel free to correct me as I can't source it at the moment. You could pitch scenarios such as this is patient X with A/B/C conditions what would you prescribe them? I think this would be a very useful examination but it would be done in a sort of SAQ style which is less efficient to the EMQ style of examination. I think it would be difficult to incorporate prescribing interactions into an EMQ style exam but maybe that's something you can work on.
    The scenario type prescribing exam could work well I think, even with SAQs. They aren't the most accurate examination tools, but because it is only testing prescribing skills, that should make it a lot easier and fairer to allocate marks. It also means that you are testing a students ability to actually think of an answer and not just use the process of elimination to select an answer.The exam won't be worth a lot, but it would be still assessed so that doctors are still prescribing accurately.

    By interactions. are you referring to comm skills? If so, that would be covered on one station in the OSCE or something. By final year though, you'd probably have had a lot of comm skills assessments by then - I'd much rather assess more practical skills.

    (Original post by Supermassive_muse_fan)
    We have real ill patients in our 4th year OSCEs and a prescribing station (last year they asked students to prescribe blood - I can do antibiotics, warfa/heparin, insulin stuff, saline etc but don't think I would learn blood transfusion unless I'd known about it as I do now).

    I would be against using actors in finals - granted the standardisation issue, but when you get to 5th year you should be competent in doing the examinations and you should be using patients who are ill because this is the last time you'll be assessed before going out into the 'real' clinical environment. Besides actors are much easier to examine than ill patients so you'll be able to see how students perform under stress.

    Perhaps use double ended steths in blood pressure/CVS exams to make it fairer. We had double ended steths for blood pressure which made it fair as the examiner could check you were listening rather than making up a blood pressure value or saying that their pulse was weak etc.

    What do you mean about the pathology exam - as in ordering tests?
    The pathology exam would literally be testing specific aspects of your basic science (microbiology, immunology, haem, etc) because people just forget that useful side to medicine. Ordering tests will most likely fit into the prescribing exam or the one OSCE station or in the long case examination.

    (Original post by Supermassive_muse_fan)
    Hmm I'd expect examiners to be a bit stricter for finals.

    Screen patients before recruitment so there aren't issues with borderline postivie clinical tests... but then you start to question the validity of the whole thing, if you're picking the 'healthier' ill patient - then that won't be representative of treating ill patients, but then again it's unfair on the patient too. However I don't think medical schools will be picking very ill patients.

    Therefore (after a good deal of waffling) recruit patients for OSCE through a lax screening process so they are ill with fairly positive signs, and use double ended steths in BP/CVS stations.
    Done. :p:



    Bearing what you've both said, I suppose the best plan would be to use real patients in finals who have VERY obvious symptoms. The whole point of finals is to produce safe junior doctors who are recognising these signs, not necessarily tricking them. A patient with a murmur and a double ended steth for each patient could work quite well. Only issue is I will be neglecting other aspects of medicine if I choose to use this for the long case examination (they'd only have one). I really like the idea of watching someone do everything in an hour and following them through in addition to the usual 10/15 mins OSCE stations.

    I still think it'd be quite useful to have this extra path exam. So many people forget their basic microbiology, immunology, haematology etc. after preclin years and that's probably the most useful bit we are taught in years 1 and 2 imo.

    This is actually so much more difficult than I imagined. :s:
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    The life of a vagrant is almost over. Just waiting to move out of one set of accommodation to go to my last. ever firm.
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    On the long case front...why does it matter if the cases are not very similar provided they are of similar 'difficulty' (how you asses that I don't know though...) because it really doesn't matter what comes through the door you should be able to deal with it.
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    (Original post by Medicine Man)
    The scenario type prescribing exam could work well I think, even with SAQs. They aren't the most accurate examination tools, but because it is only testing prescribing skills, that should make it a lot easier and fairer to allocate marks. It also means that you are testing a students ability to actually think of an answer and not just use the process of elimination to select an answer.The exam won't be worth a lot, but it would be still assessed so that doctors are still prescribing accurately.

    By interactions. are you referring to comm skills? If so, that would be covered on one station in the OSCE or something. By final year though, you'd probably have had a lot of comm skills assessments by then - I'd much rather assess more practical skills.
    I was referring to drug interactions as opposed to comm skills. I was pretty drunk when I was posting this (I'd take anything after ~11pm with a pinch of salt) so most of it is utter crap.
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    (Original post by Medicine Man)

    The pathology exam would literally be testing specific aspects of your basic science (microbiology, immunology, haem, etc) because people just forget that useful side to medicine. Ordering tests will most likely fit into the prescribing exam or the one OSCE station or in the long case examination.

    Spoiler:
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    Bearing what you've both said, I suppose the best plan would be to use real patients in finals who have VERY obvious symptoms. The whole point of finals is to produce safe junior doctors who are recognising these signs, not necessarily tricking them. A patient with a murmur and a double ended steth for each patient could work quite well. Only issue is I will be neglecting other aspects of medicine if I choose to use this for the long case examination (they'd only have one). I really like the idea of watching someone do everything in an hour and following them through in addition to the usual 10/15 mins OSCE stations.

    I still think it'd be quite useful to have this extra path exam. So many people forget their basic microbiology, immunology, haematology etc. after preclin years and that's probably the most useful bit we are taught in years 1 and 2 imo.

    Ah I see, hmm kinda split about this. On one hand perhaps better to add more microbiology etc in the written paper as another subquestion in clinical scenarios? (Aren't all the questions clinical scenarios - here at Leicester we get clinical scenarios and then subquestions across the board.)

    E.g. lady presents with chest pain.
    a)question about ECG change with angina
    b)Relevance of dental abscess and bacterial causes of pericarditis
    c)you send off a gram stain test, doesn't grow anything - what pathogens could it be?
    d)The obvious health psych/social question.
    e)Epidemiology calculation

    And we have to pass a number of subquestions to pass the main questions (66% of subquestions correct means you pass the main question, and then 66% of the main questions (24 in total) means you have attained a satisfactory for that exam. This way ensures students don't selectively learn for example more physiology and skip the anatomy (or the health psych/social in my case...), as the questions are a mix and you have to pass the subquestions in order to pass the question. Also each time we have an exam, we're tested on anything from day 1 of the course so you have to continually go back and make sure you've learnt all past modules. (A pain the first two years but then very helpful for the major exams as you get used to remembering everything and building up your knowledge).

    That way you're covering it in a clinical picture BUT on the other hand, my viewpoint is by 5th year you can be tested on anything you've covered (but not stuff like draw a replication fork, think that would be a tad futile) so why not add it in as a subquestion in an OSCE as microbiology and immunology are very important. However my thinking (right or wrong it may be) the OSCE should be more focused on the practical clinical stuff and management whereas keep the theoretical side more in the written exam.

    (Original post by RollerBall)
    I was referring to drug interactions as opposed to comm skills. I was pretty drunk when I was posting this (I'd take anything after ~11pm with a pinch of salt) so most of it is utter crap.
    Please post responsibly :awesome:
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    (Original post by Supermassive_muse_fan)
    Please post responsibly :awesome:
    I need to learn to do that...
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    How do you guys present clinical histories? I've been told that it should be broken into significant positive and negative findings. I was under the impression that this format is only for examinations and I'm not quite sure how it would be applied to history taking (risk factors, maybe?)

    Any tips?
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    (Original post by GodspeedGehenna)
    How do you guys present clinical histories? I've been told that it should be broken into significant positive and negative findings. I was under the impression that this format is only for examinations and I'm not quite sure how it would be applied to history taking (risk factors, maybe?)

    Any tips?
    Don't do that for history presenting.

    Start with the presenting complaint. So a sentence or a few sentences on the presenting problem. Then go to history of presenting complaint, where you elaborate on the back story of the presentation. Then go to each heading (past medical, drug, family, social, then systems review). Then it's often worth doing a summary.
 
 
 
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