I posted months back that the NHS had assigned me to take a clinical skills course. I've learned evaluation techniques and history-taking for every system of the body. On Friday it was time for the OSCE (objective simulated clinical examination). We had seven stations and six minutes at each one with one minute for feedback and presentation of a differential diagnosis.
I haven't taken a practical exam in 20 years! A little rescue remedy and I was set to go at 9 a.m. Of my 20 classmates, 14 showed up. Six simply couldn't deal with the stress. The stations were:
1. Cardiac examination;
2. Respiratory history;
3. Respiratory examination;
4. Abdominal history;
5. Social history;
6. Knee examination; and
7. Cranial nerve 2 (eye) examination.
I passed! And rather well with a score of 82 percent. Two of my classmates were not so fortunate and will have to be retested. This was a bit of a stretch for me. I was profoundly annoyed at first that I would be sent to such a basic class with a lot of experience under my belt. I learned that I had forgotten a lot and developed a few bad habits, but also learned areas I have never given a thought to such as the abdomen and eye.
One might ask why a physio should be able to perform an abdominal examination? Very simply, if we are the first point of contact for patients, which I often am, then we should be able to assess any complaint they might have. We might not be able to act on our findings ourselves, but we should know to whom patients should be referred.
I was reminded of the importance of a good history and am pleased to report that I successfully diagnosed the pulmonary embolism, esophageal reflux and stress-related depression and alcohol abuse. Oh, I did the best on the knee overall. I'm still a musculoskeletal man at heart.
And the course isn't done, I still have to write a reflective learning portfolio and a case history as well as provide documentation that I have been observed to perform these examinations and histories in practice before I can say I've passed the course.