Thursday, 12 December 2013

Year 2 exams

It's pretty weird to have your end of year exams only 3 months after starting the new academic year, but that's just the way it worked out since this is an accelerated medical degree. A week before the written papers, we had our practical exams (OSCEs). Here's the breakdown:


Abdominal examination

This station was generally okay. I forgot to ballot the patient's kidneys but aside from that it was fine, and I managed to answer the examiner's questions okay.

History taking - respiratory

Again, another okay station, and with 10 minutes I managed to get through everything just fine. And thankfully, this time (unlike the summer) I remembered to ask the patient if they smoke!

History taking - male urinary

This history taking station was also 10 minutes long and involved asking the patient questions to do with the urinary system and then also taking a sexual history. Taking a sexual history is not something I've ever done before, not in an OSCE and never with a real patient on placement, but generally I think this station was fine too. The patient (really an actor) got a bit offended when I asked him if he'd ever had a male sexual partner, but I think that was just him being in character rather than me asking an inappropriate question!

Clinical anatomy - surface anatomy of the cardiovascular system

Right, this is something which really pisses me off about this medical school - how they enjoy testing theoretical knowledge in (supposedly) practical exams, and practical knowledge in written exams (see Paper 2 below). So this station was a bit of a shambles, but mostly because the question that the examiner asked me (to do with auscultating heart murmurs) was phrased really ambiguously. When I asked the examiner for a bit of clarification, they merely read the question to me again. So essentially, I interpreted the question incorrectly in my mind and gave an incorrect answer despite actually knowing the correct answer (which the examiner informed me of afterwards). This was really irritating, and I'm not particularly confident about passing this station in all honesty.

Clinical anatomy - the spinal column

Again, another theoretical station - this one involved looking at various models of vertebrae, the spinal column etc and picking out different features, and then looking at a couple of X-rays and again pointing out anatomical features. This station was generally fine, no complaints here.

Clinical anatomy - the hip and lower limb

The final theoretical station which didn't actually turn out to be all that theoretical! The station started off like the spinal column one before it, with the examiner asking me to point out different features on a model of the pelvis and the lower limb. And then...out of nowhere, he asked to perform a Trendelenburg test on a patient who was sat behind me. Well...I hadn't revised any clinical tests for this station, so needless to say, whilst I'm fairly certain I got all the theoretical anatomy questions right, I really screwed up the clinical examination. Not feeling very confident about this station either.

Cranial nerves II, III, IV and VI examination

So these are the cranial nerves which control the movements of the eye and the pupillary reflexes. This station generally went well (I quite enjoy the examining the cranial nerves because there's a lot to do and you get to use lots of different tools and equipment), but I don't think I answered the two follow-up questions very well.

History taking - knee pain

Right, this station should have been quite straightforward...but unfortunately it was a five minute station, which made things very difficult and I ran out of time when taking the patient's family history, which meant I didn't get to explore their social history or do a systems review. In clinical practice, I'm almost certain you're never only given 5 rushed minutes to take a history from someone, so I have no idea why we're examined as if we are, but it seems to be yet another quirk of the examination system. I suppose it depends on how much importance the examiners place on actually finishing the station...I ran out of time on the MMSE station last year and still managed to pass it, so maybe I'll get lucky this year too!

Thyroid gland examination seems that with every OSCE I need to have one station where I just completely blank and screw everything up. In my very first OSCE it was using Medline, last summer it was conducting a breast examination, and this time it was the examination of the thyroid gland which let me down. I forgot to percuss for a retrosternal goitre and to auscultate for bruit and to top it all off, I didn't manage to answer one of examiner's questions correctly either. It was just a general fail all around.

Respiratory examination

Generally fine, nothing to comment on here. Forgot to check the JVP, but that's about it, other than that I felt this station went well.

Paper 1

The written examinations took place a week after the OSCEs over two consecutive days. Usual rules: 20 SAQs in total, usually need to pass 12 or 13 SAQs to pass the exam over all (each SAQ is marked out of 20, and the individual pass mark for each question is normally 10-13. Confusing? Try actually sitting the papers).

With previous exams (in January and May), I've found the first paper to be more difficult than the first. Somthing seemed different this time round - this paper didn't seem terrible. Yes, there many little details which I either couldn't recall or just didn't have a clue about, but on the whole, each SAQ was fairly reasonable. There weren't masses of intricate anatomy and physiology questions, and it was generally okay. I just felt a bit relieved really that there didn't seem to be any expectation to give a detailed account of the spinothalamic tract or the basal ganglia (yes neuro, I still hate you).

Paper 2

Before sitting this paper, I'd been naive enough to hope that the "second paper being easier than the first" rule would continue into year 2, and that therefore, since the first paper had been pretty okay, the second one would be even better. No such luck. This paper was really, really tricky. Lots and lots of random questions on social sciences, and what's more, they weren't even well distributed amongst the SAQs. For example, one SAQ (total: 20 marks) had 8 marks to do with a single lecture on carers and the problems which they might face. It wasn't even an easy question either!

The people who are in charge of giving us exam talks during each semester like to reassure us that our SAQs will be "integrated", i.e. the questions will be drawn from lots of different modules and consequently, we'll gain marks by having a broad range of knowledge about lots of different things. But when 8/20 marks in a single SAQ comes from one lecture, I find it hard to actually believe them. Instead I'm just left wondering if they've actually talked to the people who set the questions, because no reasonable person would consider the above to be an example of an "integrated" question.

Anyway, this general trend continued throughout the paper. There was lots of questions on social sciences which leaves me in two minds: if the examiners are looking for me to provide a reasonable answer which is justified well, then I think I've managed to (mostly) do that. If they're looking for me to provide some very concise and specific answers, then I don't think I've managed to do I really really just hope they're looking for an answer that makes sense, rather than a direct quote from the lecture slides...

That was the social sciencey bit. The actual medical science side of things did not go much better. There was a question which involved drawing arrows on a diagram of the head and neck to demonstrate how you'd examine the lymph nodes in that area. Huh? Isn't that why we do OSCEs? No wait, I remember now, apparently OSCEs are where we demonstrate our knowledge of the anatomical features of a vertebra!

On the whole, I'd say that the papers are a bit crap in terms of the knowledge they're trying to test us on. Not a single question on commonly encountered conditions like asthma, pneumonia, Parkinson's disease or angina. But a fairly detailed question on thyroid cancer (total deaths worldwide: 36,000 in 2010). It's almost like they're just looking to catch us out...I was not a particularly happy bunny after sitting this paper.

In conclusion

Anyway, once the horror of paper 2 was over I headed straight to the pub and proceeded to have quite a few drinks on an empty stomach just after midday, something which left me feeling reasonably tipsy when I got back home a few hours later. I then went to the pub again later in the evening and got even more drunk. And I'm going out again tomorrow. It's pretty safe to say that I'm trying my best to forget about exams and results by attempting to improve my (rather poor) social life.

We get our results in just over a week. I really can't say with any degree of certainty how I think I've done, though in all honesty, I won't be very surprised if I haven't passed. I can think of a few things I think I've done okay on, and then I'm reminded of millions of other things I totally screwed up on, guessed or just plain made up. What's worse is that under our weird examination system, you don't pass or fail based on an overall percentage, but rather, how many SAQ sets you've managed to pass. And it's really, really difficult to gauge that with any degree of certainty.

But really, more than anything I just want to pass. I really, really love being on placements, taking histories and performing examinations on the wards, learning from consultants's all so close, it's actually within grasping range. I just really hope I've managed to pass these exams so I can have a break over Christmas and go back to uni in January feeling a bit more relaxed and ready to start the phase of the course which I've been most looking forward to since day 1...but I guess we'll see.


  1. I feel very much the same as you, especially regarding the examination of anatomy in an OSCE station.... Hopefully though, if everyone else also found the exams pretty difficult, the pass marks won't be too high *fingers crossed*
    Good luck!