October 19th, 2011
MedicalEducator.co.uk has teamed up with the Medical Protection Society to offer some free OSCE revision resources for their new Facebook pages. Best of all the resources are completely free, and require no login.
One of our testing medical students said the following about the resources:
“They are simple to use, well-structured and take you through a mock clinical case. They throw in a few curveballs just like you get in the OSCE stations”.
Medical students need exposure to cases. These resources provide an easy way for you to test out some of your clinical knowledge in 14 or so different areas. The cases have input from specialties and from a general practice perspective so you get a little internal medicine, a little dermatology, cardiology, paediatrics, pharmacology, endocrinology, surgery…. a little bit of everything!
One of our Medical Specialist contributors commented:
“I examine medical students in OSCE examinations, the last ones I did were October 2011. It’s clear that stress plays a big part in how students can approach OSCE exams, hopefully this provides a little bit of a taster for the sorts of questions you can get in medical final examinations. We hope its good practice, and a free resource like this can only be good news for students.
Find all the resources on the MPS Facebook pages here.
July 28th, 2011
Before you know it, you’ll be over the huge hurdle of finals and about to face patients as a fully-qualified doctor. Dr Jayne Molodynski, medicolegal adviser at MPS, offers her top ten tips to prepare you for your first day on the wards.
Photo by robbiee
1. Know your limits – Never be afraid to ask for help. Always work within your competencies and if you are unsure about anything, ask.
2. Find out the basics – Make sure you know your way around the hospital and find out about out-of-hours facilities, such as key codes and canteen opening hours. It sounds obvious, but it’s no joke when you finally get to go for that sandwich, only to find the canteen closed at 4pm!
3. Know the ropes – Make sure you are familiar with trust guidelines, for example, in relation to note keeping. In some hospitals they are now completely electronic so you need access to a code or a swipe card to get into the system. See if there is a trust handbook you can read, or if it’s published online.
4. Get organised – It can be a good idea to carry a notebook to jot down useful numbers and information. However, remember that due to confidentiality, if you jot down patient’s notes, you must make sure you securely destroy them before leaving the hospital.
5. Make an impression – Be aware that you will need support, so it is important to have a good relationship with members of the team, especially nursing staff. Introducing yourself and establishing a good relationship from the start will make things easier.
6. Get on top of paperwork – Make sure you’re up to date with your e-portfolio right from the beginning; get assessments filled in as you go along – don’t leave them all to the end. Some of the key meetings need to take place in your first few weeks of the job.
7. Communicate – Arrange to meet senior staff when you start on-call and get to know them. If there are problems, be open and ask for feedback. At the end of a shift, talk through anything you found difficult, and consider how you could do it differently.
8. Work as a team – Don’t be afraid of looking stupid. You are new to the job and will need support from your peers and colleagues.
9. Be on the ball – Make sure you are up to date with national guidelines, eg, NICE and the GMC. Take a look at the GMC’s new online scenarios, Good medical practice in action.
10. Check your rota – Look at the on-call rota and find out what your shifts will be. Find out how to access bleep numbers, and the numbers for your team (I used to write them in my Oxford handbook and carry them around).
If you are really stuck with a medicolegal question, remember that MPS members can speak to an expert adviser by phone, 24 hours a day. Visit www.mps.org.uk for more information.
August 21st, 2010
We’re going to add some useful scores and calculators to the blog. This was following a request for more useful ‘real life’ practical scoring systems which are often not focussed on when teaching medical students. Lecturers often correctly focus on the important pathophysiology a problem or condition. We feel that the use of validated scores (like this one) add practical value to medical undergraduates.
Why not try out some of these scores in your own practice/ when on the wards/ in the GP surgery to try and help identify why that patient has been discharged, or
The San Francisco CHESS algorithm from the Annals of Internal Medicine, 2006, click to enlarge
what the reason was for that particular management plan.
Take Syncope: its a massive subject, but its important for the general physicians to the oncologist treating a patient in outpatients, to the surgeon with his post op patient who has just collapsed. For simplicity we’ll define syncope as a sudden and temoporary loss of conciousness (there are numerous definitions).
A review article in the NEJM defines it as the following
Syncope is a sudden and brief loss of consciousness associated with a loss of postural tone, from which recovery is spontaneous.
Syncope does NOT refer to dizziness/ or other symptoms such as vertigo (the illusion of movement). Its
a really difficult topic to cover the causes are numerous:
- Neurally Mediated (25% of cases)
- Vasovagal
- Situational/ other causes
- Dehydration/ orhtostatic (10%)
- Cardiac (20%)
- arrhythmia/ obstructive cardiac lesions etc
- Psychiatric (probably about 1-2%)
- Drugs (probably about 5%)
- Unknown
This isn’t going to cover all of these things, but lets look to see if there is a score to help us with this. There is! the CHESS score, or San Francisco Syncope rule.
Does the patient have CHESS?
CCF or history of CCF
Haematocrit <30%
ECG abnormal (non sinus rhythm or new changes compared to old ECG)
Shortness of breath
Systolic BP of<90mmHg at triage
As a rule of thumb (you can read the paper) to avoid serious adverse events admit patients with syncope with ANY of the above features: MI, PE, stroke, serious arrhythmia. Click the picture to the right for a full screen shot of the algorithm.
This has a sensitivity of >95% and a specificity of around 60%.
Read more about the study in Annals of Emergency Medicine.
The clinical bottom line: guidelines change and evolve, and your hospital / primary care centre/ doctor may not follow these guidelines. The take home message is there are simple predictive factors that can be used as a rule of thumb that you can keep in the back of your mind when seeing patients with syncope, and these scoring tools are useful as an educational aid. Remember no scores are 100% accurate, and any algorithm like this will lead to the discharge of patients that will go on to have serious medical pathology. Its use is as a guide.
Ref: Ann Emerg Med. 2006;47:455-456
This is the first in a series of articles on simple scoring systems for application by medical students. Why not post comments on other scores you have found useful as a student, with a reference.
