Clinical Reasoning

Well, its been about a week since I finished finals. My last two exams were a multiple choice exam and a practical exam. The practical (OSCE - stands for Observed structured clinical exam??) would have us assess a fake patient in either a physical or mental health aspect. I think I'll just talk about the OSCE now, it was quite an experience. There was actually a lot of material to cover, and in the end we would draw up a piece of paper that would only look at a little portion of that material. Basically, know everything or risk getting something you can't deal with. As well, to pass you had to get a mark of 70% or better. It did seem like an exam that you kick ass in or utterly utterly fail, but there were a few borderline marks.

I got to school about 10:00 am even though my test was at 6:50 pm so I could walk through mock scenarios a few more times under "Exam conditions." I thought it'd be a lot easier to know what to say after going through it with other people over and over again. I'm not sure if I would have done better if I just relaxed for the whole day and then come in near 5 to do the exam. I feel as though I need to go through the day focusing on that one event, even though thinking about the test sapped my energy because of nerves.

Now, the OSCE is set up so if you're doing a physical assessment, you've got about 6 minutes to take a quick history and then determine whats wrong. For a psychosocial part you've got 10 minutes to take a history and then go through an assessment. The physical portion is fairly straightforward, you get someone who "hurt" their right shoulder or left hip and knee. However, the mental health part can be tricky because their diagnosis can be major depression to mania. Depending on how the patient plays it, it can be very tough to handle the situation. In some cases, the patient refused to go though the assessment and other times they would be touching the student and rapidly talking.

Oh yeah, another thing that kind pissed me off was that my test had been moved back 40 minutes, so I said ah screw it, I'll come back later. Of course, when I get there about 7:10, I found out that they had been close to on time and that I got skipped. Crap! So my exam actually did get pushed back 40 minutes, but it was my fault. That was so awesome...

So anyways, I finally walk into the exam room and get my case scenario. Yay, its a mental health and my patient's diagnosis is Major Depression. Now, I kinda had an idea of what would happen. Major Depression would not affect someone's ability to tell you how to perform something, they can and know how to do it physically and cognitively. However, for some reason, there is just this void inside and it sucks up all your energy. Anyways, I walk in, start up the history and ask a few questions. Generally, I'm doing fine although I do need to speak up.

Now for my highlight moment!!

One of my questions is something along, "imagine you are at home and are about to goto bed. What should you do to make yourself feel safe?" Usually people will say check windows or lock the door (correct answer) but my patient says oh I've got a HANDGUN underneath my pillow. Oh fantastic, you're depressed and you have a handgun. Its a wonderful combination that mixes well, like Kool Aid and water....

Afterward we were talking to the evaluator of the OSCE, and he said to me it was funny the way my face looked when the patient said that. He also said he hoped that I acknowledged it in my written portion of the exam. I of course nodded politely and thought, good thing you aren't marking it! I'm so glad I have clinical reasoning...

But yeah, bottom line is that I passed it and am so glad that its done with!!! =D