Medical teaching: simulation vs on the ward

Much happy, I have just helped as part of a team of 6 (plus several supporters) to win the London Simulation competition. It was fantastic to be working with the others, and actualyl the whole thing was everything I had hoped medical school would be, from the adrenaline rush of being in the simulation to the hours of preparation and rehearsing scenarios.

I have long felt there should be more simulation, and fewer of the traditional methods i.e. didactic lectures (see here for a beat poem expressing how silly this is for mainstream school) . Having now experienced 2 and a bit years of ward placements, I am also firmly of the belief that being on the ward is of limited use as well.

There are advantages, and to its credit as a methodology it can work. However, it takes almost as long to settle into a new firm as the actual length of the placement. Furthermore

Being on the ward to learn medicine was great for a certain era, when books were experensive and the internet a century or two off

Third penultimate year mock OSCE

So last Wednesday I ran the third of the mock OSCEs for the year.

It built on the feedback of the first and second (sadly I did not blog the second), and in terms of smoothness I'm happy, with a few points.

Organising
Firstly the organising changed - In the first OSCE I wrote all nine stations, in the second I wrote five and this time around only wrote one.

Advantages:
- Less time on my part
- More variation in approaches

Disadvantages
- They should all have been proof-read, but
- The mark schemes were variable in how readable they were and this was noted by participants. Readability is key as there is a quick turnaround.

Stations
Previously stations were randomly allocated and people got random stations depending on what I had written, this time I allocated topics to different people and so it was easier (as far as dictation goes) to get certain stations ready.

Overall
It ran well, finished almost on time and there were many thank yous at the end. I gained from it and the format seems to work.

Phew, just organised my first practice OSCE station (Where you are put in a clinical situation with actors and need to work accordingly) for my year (4th year currently) - it was rather harder work than I thought it would be at the start, and I'll probably still wake up sweating for a few days.

Nonetheless I am really grateful to everyone's participation, including those in my year who treated it well (and adapted to a few of my lapses), two thyroid clinicians (Paul Dent and Dominic Pritchard), and Josephine Saramunda (a 3rd year), who all volunteered at very short notice to fill in when some of the patient-actors and examiners who could not make it.

Several points for me:
- I need a little more assistance next time, there were a few snags on the day which I didn't quite adapt to so well.
- The sheets need more proof-reading, as there were a few inconsistencies that became apparent.
- The actors felt they needed a little more time to prepare.
- A few people suggested a little more feed-back time, as it was an informal event.
- Some of the stations, particularly in neurology were a little too specific and maybe beyond 4th year level.

Nonetheless, of the three rounds I did, the last one ran pretty smoothly, and in the feedback the participants graded it positively 4.5 out of 5, so with a little more organisation the next one (eeep) should be even better.

The scenarios were:

Round 1
Upper limb exam	Syringomyelia
Acute neurology hx	Delerium tremens
Msk hx + exam	Hand arthritis
Round 2
Cranial nerve exam	Parietal stroke
GUM history	Sexual history
Endocrine hx + viva	Medication review
Round 3
Thyroid exam	Thyroid exam
Acute neurology	Seizure + DVLA
Hearing hx + exam	Drug induce Hearing loss