How to pass the emergency OSCE stationBMJ 2019; 367 doi: https://doi.org/10.1136/sbmj.l2414 (Published 01 October 2019) Cite this as: BMJ 2019;367:l2414
All rapid responses
This is an excellent article which provides sound advice for medical students and junior doctors competing for training jobs at interview.
As a core surgical trainee in London, I have utilised almost this exact approach when interviewing for my core surgical post nationally and then subsequently in our pan London CT1 interviews. Feedback from this approach has been excellent.
In addition however, this structured approach is particularly useful when reviewing patients in hospital/in the ‘real world’ as it allows you to think calmly and address issues systematically in an acute setting. Therefore whilst also providing use in an examination setting I believe the article provides sound advice for working doctors in their day-to-day jobs.
Of particular help in this article I believe is the mnemonic provided BOXES.
I have used a slightly adjusted version below which I believe to be as useful and other readers may find useful either in an OSCE scenario or when reviewing acutely unwell patients.
SHE = Summary of History and Examination findings
Often in an OSCE scenario, you may be given the scenario outside the station of:
‘a 34 year old female present with sudden onset cal pain and and shortness of breath. Two days ago she returned from Australia. She has haemopytsis and right calf pain. Please explain how you would approach this situation’
I have found utilising the AMPLE history mnemonic from ATLS secondary survey to be succinct whilst also covering the major points (particularly for surgical patients) . (A = allergies, M = medications, P = past medical history, L = last eaten/drunk, E = events leading up to admission).
Examination should be in the form of an ABCDE assessment as explained in the article.
B = BEdside Tests + Bloods
BEdside = Basic observations + ECG (if not already stated as part of the A-E assessment)
Bloods = 1. laboratory tests 2. Cultures 3. Gases
O = Orifices
Work from the head downwards! - sputum, swabs, urine, faeces
X = Xray and imaging and special tests
Ultrasound/Doppler (including ECHO/FAST if not already stated as part of the A-E assessment)
E = Escalation Plan
Is there a documented escalation plan? Would this patient be for HDU or ITU level care?
D = DNACPR
Is there a resuscitation plan for this patient? Is this something that should be considered?
Overall, this is an incredibly useful article for both medical students and junior doctors alike.
Competing interests: No competing interests