As mentioned here and here, today was my first day on my easter holiday clinical skills placement. It was bright sunny morning, if chill, and the train was even on time. The walk to the GP's was nice, past a park and sports ground and not at all what I expected that area of the city to be like. Maybe my exposure to UPA's in Edinburgh has coloured my views on what they are like?
The format of the clinical skills bit is that there are 2 students, and we get 30 minutes with each patient. We take it in turns to lead each consultation, and take a brief history, then do an appropriate examination, then the other person does the examination, then we get feedback from the tutor.
I was observing consultations 1 & 3 and leading consultation 2.
The first one was a man who was diagnosed with lung carcinoma 4 years ago, but the tumour has not developed in 4 years and the GP thinks it maybe carcinoma in situ. Either that or this was one of the 5% that deos respond to chemo and radio therapy and survives 4 years. He was breathless at rest, but surprisingly mobile for his age (80) and breathlessness!
The second one was one I was leading. The man had had breathlessness on holiday, then 7 days later woken feeling funny, and was admitted to hospital with an MI. He was also found to have a calcified aortic valve and AF (the 3 main causes of which are heart ischaemia, thyrotoxicosis and valvular problems - see I do listen in plenaries sometimes). Hew as quite difficult to pin down on history and was quite vague. On examination he had a quite striking ejection systolic murmur.
The 3rd patient had MS, and so we did a neurological work up, where I managed to miss quite a few of the reflexes...
Then we had 2 normal patients on whom we did BP while they were in seeing the gP. These were not planned patients, and so teh history was often very short - History of Presenting Complaint, a bit of local enquiry, and social habits, then hand them over to the GP.
The GP tutor is very friendly, so hopefully these sessions will mean that I go into the OSCE more confident than I feel now. Especially as I passed last year with a satisfactory, and this year the OSCE is twice as long as it was last year, and although I only need a formative pass, I would hope to do better than I did in 2007.