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June 29 2012
Newly qualified optometrist Amar-Kaash Gandecha (pictured) shares his tips on succeeding in the OSCEs
“I still have fresh memories of this time last year when I was stuck indoors revising for my OSCE (Objective Structured 34 Clinical Examination). Many of you will be doing the same right now and, if my experience is anything to go by, you will probably be scratching your head as to what exactly you should be doing to prepare. But after experiencing, and subsequently passing, my OSCE, I firmly believe that with a little bit of effective preparation you can do exactly the same.
After passing Stage 2, you have completed all 82 GOC competencies, and there is now nothing new that you will be assessed on. So with the OSCEs, it’s a matter of applying and extracting information that you already know, and using it to develop a plan that suits your patient’s needs.
There are 17 separate stations in an OSCE (14 OSCEs, two pilots and one rest), and you will spend six minutes at each station. Each station will test one of four different areas. When reading the instructions, make sure you know which of these four areas you are being tested on, as each will require a different approach in order to pass the station.
These areas include: history taking, communication, data interpretation, clinical examination and practical skills.
History taking (including diagnosis)
This area covers taking an accurate and relevant history from a patient or a patient’s relative. You may also be required to
give a reasoned diagnosis to the examiner.
A handy way to prepare for this is to develop an order of questions which you will ask when faced with a particular situation.
As you are taking a history, and while reading the instructions, you should constantly be ruling out certain conditions, until you reach your final diagnosis. Preparing a
list of common causes of patient symptoms prior to sitting the OSCEs will help you do this. For example, for blurred/reduced vision you would have the following common causes, split into various groups:
- Sudden, bilateral – stroke, trauma
• Gradual, bilateral – refractive error, cataract, dry AMD, glaucoma, papilloedema, retinitis pigmentosa, hypertensive retinopathy and diabetic retinopathy
- Sudden, unilateral, painless – Central retinal vein/artery occlusion, giant cell arteritis, retinal detatchment and wet AMD
- Sudden, unilateral, painful – closed angle glaucoma, optic neuritis, trauma, microbial keratitis and iritis
- Gradual, unilateral – cataract, dry AMD, amblyopia (longstanding) and glaucoma.
It is essential to remember here that ‘common things occur commonly’.
Here you are observed interacting with the patient, a patient’s relative or a colleague. You will be required to react and communicate effectively to a number of different situations;
eg requesting an emergency referral to a hospital nurse, or giving advice on the most appropriate low vision aid.
Make sure you address all of the patient’s concerns, in a polite and respectful manner, and always ask if they have
any questions. Explain in lay terms and involve the patient in the decision making process. Reassure and advise the patient appropriately by being truthful, but not brutal.
At this station you will be asked to interpret a variety of clinical data, including visual field plots, charts, test results and clinical signs.
Clinical examination and practical skills
Here you are required to perform a practical procedure; eg direct ophthalmoscopy, cover test, focimetry or keratometry – all the things that you do in daily practice.
The only station that will always be present in the OSCEs is the volk assessment. This will be on a dummy eye, so don’t be afraid to turn the brightness up and have a wide beam.
You will usually be required to draw shapes that appear in a specific area of the retina. Perhaps turn the record sheet upside down to mark the shapes on the dummy eye retina.
Make your own sample OSCEs and carry them out as if you were in the situation in real life. Remember, communication is key and confidence can often be the difference between a pass and a fail. Good Luck.
- Mr Gandecha is an optometrist at Optical Express.
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