Over the past few weeks, I have pondered many a subject to discuss in this month's column. However, the answer came to me several days ago as I walked out of what I believe was a terribly bad OSCE.
It consisted of only one station and involved me, and each of my fellow Keele fourth year students, carrying out an assessment of a simulated patient. We were required to randomly pick one of six envelopes that contained a small sentence about the patient, presentation and location we found ourselves in. For example, ‘…you are working in a minor injuries unit, and you are required to assess a 37-year-old male patient that is suffering from an injury to his shoulder.’ We then had to gather a short and precise history of the presenting complaint, carry out an assessment and develop a diagnosis, and plan for ongoing care, be it a conservative approach or possible referral in line with NICE guidelines etc.
In the days running up to the exam, I was nervous, so I threw myself into revision. I studied the vast array of landmarks I was expected to palpate and name, the multiple special tests that could be required for assessing the difference between a slight tear or possible impingement and various other aspects that were to be involved. The evening prior to the exam, I felt like I could not remember anything. However, on the morning of the examination I felt like some knowledge was slowly coming back and as I was picking my dreaded envelope and hoping for a patient with a hip injury, I felt relatively comfortable with my knowledge – but that feeling did not last long. As I stepped into the examination room and introduced myself to the patient, I felt as if everything I had studied over the previous days and weeks just fell out of my head, onto the floor, and was lost forever. What followed did represent a structured assessment and I did diagnose the patient and develop a management plan for his presenting complaint. However, I am sure I missed a great deal of information, and I am, as a result, beginning to resign myself to the fact that I may have to do it again.
Having studied for previous degrees, I am aware that these incidents are common and that the last few months of a degree programme, be it undergraduate or postgraduate, can become increasingly difficult. One can liken it to competing in a race, maybe some vast ultra marathon. The final stop can be seen on the map, in the next valley. But, to reach it one has to climb another vast hill. The final year of a degree can be long and difficult. The assessments have, once again, become harder and the fear of the next step starts to become increasingly obvious.
Perhaps this is why I am so concerned about my recent exam, and I am so nervous about the ones to come over the next few months. I am also aware of the importance of moving forward and never giving up on one's dreams. If you have an upcoming exam, you are about to complete your studies or you are about to start your first shift on the back of an ambulance, just keep moving forward and don't ever give up!