Presumably the new terminology is intended to further evoke localism and the memory of hospitals being governed by local hospital boards. The legislation does not, however, appear to introduce any material changes to the structure/function of the health service. Hm… Well I guess we’ll be getting another new set of stationery…

The Royal London Hospital (Barts and The London, QMUL)

My first elective term was spent at The Royal London Hospital under Barts and The London School of Medicine and Dentistry (Queen Mary, University of London). The Royal London Hospital is a 650-bed tertiary hospital and the principal facility of the Barts and The London NHS Trust. It is particularly known as one of London’s major (level one) trauma centres and the home of the London Air Ambulance (Helicopter Emergency Medical Service), however a full range of medical and surgical specialties are represented.

I was assigned to the gastroenterology team under consultant gastroenterologist Dr Sean Preston. He was an excellent supervisor and I was lucky to have spent quite a lot of time under his guidance during my elective. Dr Roocroft (the F1 house officer) was also a great mentor, teaching me the ins and outs of being a house officer in the NHS.

Work casual

Work attire in NHS hospitals is very appropriately guided by infection control considerations. In summary:

• no tie
• sleeves rolled-up to elbows
• no watch (most male doctors wear their watch on their belt)

The logic (and comfort) of this policy was such that I continued with this after returning to Sydney, where it was still convention for male doctors to wear ties.

Speaking English

There were a few differences in the medical vocabulary used in the UK, which took a little while for me to get used to. The most prominent ones during my elective were:

bleeper – pager
phlebotomy – venepuncture
OGD (oesophageogastroduodenoscopy) – endoscopy
TTA (to take away) – discharge summary

EastEnders

I alluded in a previous post that I lived in hospital accommodation. Indeed I found myself living in John Harrison House, The Royal London Hospital, Whitechapel E1 2DR for the duration of my stay in London. Whilst relatively cheap (approx. £100/week), it was rather spartan. One of the other JHH residents described living there as punishment for his sins, whilst more colourful language was employed by one of the senior registrars.

One of the unexpected consequences of living in Whitechapel, with its majority non-white population, was the difficulty I had in trying to find a decent full English breakfast. Despite there being half a dozen (halal) fried chicken shops on Whitechapel Rd alone, there were very few decent cafés in the area. Spotting a modern-looking café on New Rd advertising that they served “English breakfast”, I stepped into Zaza’s Café (E1 1HJ)… only to realise that they served a halal version of English breakfast: smoked turkey, beef sausage, egg, baked beans, mushroom & toast. It wasn’t bad, but it’s just not the same! Thereafter I quickly learnt the Arabic characters for halal (حلا).

Queen Mary Hospital (HKU)

My second elective term was spent at Queen Mary Hospital under the Faculty of Medicine, The University of Hong Kong. Queen Mary Hospital (est. 1937) is a 1400-bed tertiary hospital and the principal facility of the Hong Kong West Cluster, with a catchment area population of over 500,000 people.

I was attached to a final-year group undertaking their Specialty Clerkship rotation. This works rather differently from the way our attachments work during clinical years – instead of being attached to a specific medical/surgical specialty team for the duration of a clinical attachment, each group of HKU students is allocated to one general medical ward where they’re expected to clerk patients (with seemingly little direct role in patient care). They take part in case discussions, PBL tutorials, and clinics with consultants from different specialties over the course of the term. Often ward-based tutorials were quite crowded, particularly with the confined spaces inside most hospital wards in Hong Kong (see pic below – I wasn’t standing at the back).

Masquerade

I was in Hong Kong during the 2009 influenza H1N1 “swine flu” pandemic. Following their experience during the SARS epidemic, all Hong Kong hospitals had activated what they termed “pandemic emergency response level E2″. One of the E2 requirements was that a surgical face mask was required in all clinical areas – effectively meaning that staff/students had to wear surgical masks all day!

White coat syndrome

In total contrast to NHS policy, Hong Kong clinical attire convention was still very conservative and included the wearing of a “clean, white laboratory coat”. I’d never previously worn a lab coat in the clinical setting, but noticed two advantages: (i) it was handy having large pockets in which to put my stuff (e.g. Oxford Handbook of Clinical Medicine), and (ii) I got my student/staff discount at the hospital cafeteria and Starbucks without having to show any ID. Nevertheless, once I returned to Sydney I greatly appreciated not having to wear a lab coat.

Finally, I’d like to take this opportunity to acknowledge and thank the Specialty Clerkship group to which I was attached – Fifian, Jimi, James, Vincent, Rosemary, Edgar and Sha Sha – for helping me to fit-in and manage the language barrier.

I was given the honour (and burden) of organising the official year photo for the Sydney Medical Program 2010 graduating cohort during Conference Week. Equipment used: Canon EOS 7D, Canon EF-S 17-55mm f/2.8 IS USM, Manfrotto 7302YB tripod. Thanks to Mian Bi for operating the shutter-release in the Concord photo, Dana Perrignon Roth for operating the shutter release in the whole-year photo, and Andrew Caterson for his crowd management expertise.

The farewell for Concord Clinical School was held at Tintilla Estate – the Hunter Valley winery owned by the clinical school’s Associate Dean, Professor Robert Lusby. It was a great way to finish med school – a relaxing Sunday afternoon barbecue in the leafy surrounds of the prof’s vineyard.

Full-size versions of the whole-year photo and clinical school photos are available on my Flickr photostream. Congratulations again to everyone in the cohort and best wishes for the years ahead!

Old, new, borrowed, blue

I took quite a few photos whilst in London. Inspired by one of the memes from the final episode of Doctor Who this year (The Big Bang), I present here a small selection (with more available on my Flickr “Britannia” set).

Something old – Tower Bridge

Something new – City Hall, SE1

Something borrowed – King’s Library, The British Museum, WC1

Something blue – police box, Earl’s Court SW5

Getting around London

One of the first things to get to grips with when you spend a decent amount of time in London is the arcane British postcode system. Whilst the postcodes may look like bizarre jumbles of letters and numbers (e.g. my address E1 2DR), they’re actually derived systematically – the first half of the postcode (“outward code”) is composed of a letter sequence for the locality and a district number, e.g. OX1 for central Oxford and L4 for Anfield, Liverpool; and is helpfully marked on street signs. Central London is divided into EC (East Central) and WC (West Central), and the rest of Greater London is divided into the eight compass directions relative to the city centre. The “inward code” localises to a specific street/block/building.

The actual process of getting around London is quite an efficient (albeit sometimes painfully slow) process, thanks to city’s comprehensive public transport network (Transport for London). Perhaps the most essential item for the intrepid traveller is an Oyster Card, a stored-value smartcard that can be used on all Transport for London services and most National Rail services within Greater London.

London’s red double-decker buses are one of the city’s icons. Travelling by bus is a great way of absorbing the cityscape. It can also sometimes be a rather frustrating experience, thanks to the notorious traffic congestion in the city centre – it once took me almost an hour to travel 9 km from Whitechapel to Euston aboard the 205. Some routes are operated using “bendy buses” (articulated buses) where, unlike Sydney, passengers are allowed to board through any door – one of my cousins jokingly refers to them as “free buses” since many passengers don’t validate their Oyster Cards when entering through the rear doors.

Routemaster bus, Charing Cross WC2

The other iconic mode of public transport is the London Underground, referred to as “the tube” by locals. The tube was the world’s first metro system and it shows… you very quickly become familiar with the multitude of stairs and tortuous tunnels within the stations. Also, many stations have narrow platforms that aren’t able to accommodate crowds – I did NOT appreciate being caught in stampede on an overcrowded platform at Bond Street Station (initially away from a fight that had broken out between two chavs, then subsequently onto the train once it arrived). Living in Whitechapel, I was often forced to contend with the Hammersmith & City Line, perhaps the worst line in the network for service frequency and reliability – so much so that one of the other medical students at my hospital preferred to commute from Euston on the painfully slow 205 bus (see above). Another other major issue with the tube is that there seems to be no mobile phone reception in underground stations and lines. Nevertheless, the network generally works quite well with mostly frequent and reliable services. I found the deep-level underground lines rather amusing because of the diminutive size of the rolling stock made necessary by the small tunnel diameter (e.g. 1996 Stock in the photo below). It can get quite claustrophobic inside the tiny deep-level tube trains!

Jubilee Line 1996 Stock train approaching Bond Street tube station

Engineering work on the tube network means that train drivers sometimes have to override the digital voice announcement system and make passenger announcements themselves. One time, as I was travelling on a District Line train, the driver decided to employ British dry wit to entertaining effect (much to the confusion of several tourists aboard). A selection of quotes:

“Due to planned engineering work, there is no DLR service from Tower Gateway today. There is a special replacement magical mystery bus service operating.”

“This train will attempt to stop all stations, taking the scenic route to Richmond.”

“Trains do not stop at Cannon Street on Sunday, due to a complete lack of interest. The next station will be Mansion House.”

Life in Whitechapel

Whitechapel in London’s East End has an interesting history. It is associated with such diverse people as Jack the Ripper and Joseph Merrick (the “Elephant Man”). The Salvation Army was founded there. The bells for Big Ben, the Liberty Bell, and closer to home the University of Sydney Carillon were forged at the Whitechapel Bell Foundry. In recent decades the area has become known for its large Muslim population (predominately Bengali), with East London Mosque being one of the largest in Britain. It is an area of historical and continuing socioeconomic disadvantage, and it’s not without reason that Whitechapel Road is the cheapest property on the Monopoly board (see my previous Monopoly photos).

Whitechapel Road, Whitechapel E1

I lived in Whitechapel for over a month and, despite my reservations, gradually became accustomed to the character of the area: traversing through the slum-like Whitechapel Road Street Market to buy my groceries at Sainsbury’s supermarket, the halal adaptation of English breakfast served in the local cafés (turkey bacon, beef/chicken sausages, &c.), the ubiquitous fried chicken stores, the old Bengali man who ran the newspaper stand at Whitechapel tube station from whom I bought my copy of The Guardian every day, the sight of the Gherkin looming to the west, etc.

Catching up with friends/family

During my time in the UK, a few of my medical friends were also completing their electives elsewhere in London and/or dropping by. I variously managed to catch-up with Athina (St George’s Hospital), Martina (Eastman Dental Hospital), Owen (Israel) and Aileen (Germany). It was hilarious sharing our experiences with adapting to the freezing weather conditions (one unnamed friend slipped-over multiple times on the ice outside her hospital), inquisition by the UK Border Agency, jet lag, terrible coffee, language barriers (even in the UK) and just being on the opposite side of the planet in general.

I also caught-up with my English cousins on a few occasions. On the final occasion we had dinner at the London branch of Jamie’s Italian (as in Jamie Oliver) in Canary Wharf E14. The restaurant doesn’t take bookings, but it was well worth the hour-long wait. I still find the British concept of eating spaghetti with knife and fork quite amusing – as with coffee, the Brits clearly don’t have the Italian influence that we have in Australia – but then Jamie’s spaghetti bolognese was actually the best I’ve ever had!

Coffee – rewarding disloyalty

The general standard of coffee served in the UK is rather poor. I should’ve known it was a sign of things to come when my first cup of coffee on English soil was burnt to the point of being undrinkable. The second warning sign was when I discovered that the Brits consider the “flat white”, an ordinary Australian variant of café latte, to be a novel and highly regarded espresso drink. The first part of my salvation came when I discovered a café named “Flat White” (17 Berwick St, Soho W1) . As the name suggests, it’s actually run by an Antipodean partnership – who would’ve thought that we in the “colonies” would be the ones to rescue the Brits from coffee hell.

The second part of my salvation came when I discovered the Prufrock Disloyalty Card, the brainchild of Gwilym Davies (World Barista Champion 2009). Gwilym’s idea was to promote the emerging East London coffee scene with the offer of a free coffee from him for visiting each of the places listed. Most of the places were a bit out of the way for me, however the places I managed to get to (The Espresso Room, Nude Espresso and the Whitecross Coffee Cart) were excellent.

Whitecross Coffee Cart – Pitch 42, Whitecross St, Barbican EC1

The sun never sets…

While the British Empire may be no more, there are certain benefits from once being the centre of the greatest empire the world has seen. One of these is the vast collections of antiquities from across the world that are housed in Britain’s museums. Furthermore, in a rather enlightened public policy decision, entry to all national museums in Britain is free! I managed to spend several full days just at the stalwart British Museum. I also particularly enjoyed exploring the V&A Museum (art & design), the Wellcome Trust collections (history of medicine) at the Wellcome Collection and Science Museum, and the Natural History Museum’s Darwin Centre.

Central Hall, Natural History Museum

Paul & Jill Ruddock Gallery (room 50a), V&A Museum

The Rosetta Stone, British Museum

“Dancing Queen” Virgin Atlantic A340-600

The journey here was a challenge in itself. During the flight I became rather acquainted with Virgin Atlantic’s quirkiness – the plane was named “Dancing Queen”, the safety video contained visual jokes, Virgin Cola was served (not bad, actually), and as we approached Heathrow Airport the pilot remarked that it was a “perky 2°C” and “moist” in London. So after some 23 hours aboard an aeroplane, I found myself in Heathrow Terminal 3 severely jetlagged and feeling deserving of an award for endurance. As for getting into London proper, I knew better than to catch the Tube, but nothing quite prepared me for the swarming sea of commuters when I got off the Heathrow Connect train at Paddington station (mental note: never catch London public transport with luggage during peak hour). Needless to say I gave up on public transport at this stage and caught a taxi the rest of the way to the hospital.

Ooh, shiny… Heathrow Airport Terminal 5 (Terminal 3 was underwhelming)

First impressions? As an Antipodean who’s never previously travelled to Europe, what’s struck me most about being here is how short the winter days are: the sun rises at around 0800 and sets around 1550! I realise that it’s associated with the relatively high latitude (London 51.5°N vs Sydney 33.8°S), but nevertheless I’m already starting to feel SAD (seasonal affective disorder)!

More posts to come later…

Placement sites

I was based at Warrumbungle Medical Centre (59 Cassilis St), with husband/wife general practitioners Drs Aniello Iannuzzi and Eve Tsironis as my principal supervisors. Warrumbungle Medical Centre is the main medical practice in Coona (there are two other medical practices in town), with Drs Iannuzzi & Tsironis, two GP registrars and two registered nurses (RNs). My role at the medical centre was mainly clinical observation and assisting with clinical procedures. I also spent some time at the co-located Orana Pathology Service collection centre (a courier does a twice-daily run to Dubbo with the samples). I learnt a lot about general practice and rural medicine from all of the doctors and nurses, to whom I’m very grateful for the experience. Dr Iannuzzi, a recent candidate for AMA national president, and I also engaged in some interesting discussions about life, politics and medicine…

Warrumbungle Medical Centre

The doctors at Warrumbungle Medical Centre are also visiting medical officers (VMOs) at the local hospital, as is the norm in many rural settings. Coonabarabran Health Service is a 20-bed district hospital (with a 3-bed emergency department) operated by the Greater Western Area Health Service, with the main referral hospital being Dubbo Base Hospital (c. 1.5 hours away by ambulance). At Coona hospital, I was put on-call in the emergency department (ED) for triage categories 3–5 for three 24-hour periods during my placement – in practice, this meant that I’d be called-in by the ED RN to assess the patient then report my findings and clinical impression/diagnosis to the doctor on-call (who would decide on the course of action from there). I also attended ward rounds with my supervisors, assisted in clinical procedures and with the visiting endoscopy service (see below). Incidentally, I was provided with accommodation at the hospital nurses’ quarters during my placement.

Coonabarabran Hospital ED sign

Emergency Department, Coonabarabran Hospital

Nurses’ quarters, Coonabarabran Hospital (N.B. MacBook & monitor are mine)

Medical firsts

It’s almost a truism that rural general practice is where you really get to develop and practise clinical and procedural skills, and indeed this was true for my placement. There were many medical “firsts” for me, including: successful insertion of (many) IV cannulae, venesection using a 16-gauge needle (for a patient with haemochromatosis), venepuncture by needle & syringe (cf. Vacutainer/Vacuette), parenteral (SC/IM/IV) administration of medications, manually pushing IV fluids, local anaesthetic infiltration in a conscious patient, needle thoracotomy and thoracentesis of (>2 litres!) pleural effusions, suturing of a wound (using 6-0 monofilament), surgical debridement (severe tinea + MSSA cellulitis + maggot infestation!), admission of a patient, ophthalmic work-up (incl. slit-lamp exam + fluorescein), assisting in resuscitation and early management of severe trauma (motor vehicle accident), etc.

The flying doctor

When Dr Iannuzzi mentioned that one Dr Peter McInerney was flying into Coona to perform endoscopy at the hospital, I assumed that he must’ve chartered a flight to Coonabarabran Airport (which no longer has regular commercial services). It turned out that Dr McInerney was literally flying in – he piloted the plane himself, flying from his hometown of Scone (c. 175 km away). I learnt quite a bit from Dr McInerney during the day I spent assisting him in the operating theatre, including a quick tutorial on how operate the endoscope. It also turned out that his daughter and I had studied pharmacy together – it really is a small world!

School of Rural Health

One weekend my friend Nilay (on placement in Gilgandra) and I decided to visit Dubbo, which for me involved a drive of just under two hours down A39 Newell Highway. We had some friends based at the School of Rural Health (whom we hadn’t seen since the start of third-year) and also wanted to visit Taronga Western Plains Zoo. After spending several weeks in a small town, the City of Dubbo felt like being back in suburban Sydney – it was a bit of a shock to encounter the first set of traffic lights in weeks. It was great to catch-up with our friends (and interesting to observe the bountiful resources of the School of Rural Health), and the open-layout Taronga Western Plains Zoo was also well worth visiting.

School of Rural Health, The University of Sydney

Meerkat – Taronga Western Plains Zoo

The dinner

One of the traditions for students completing their placement with Drs Iannuzzi & Tsironis is that the students are expected to cook a meal for the doctors and their families at the Iannuzzi residence. I was a little trepidatious about this at first, as I’d never cooked for 13 people before… Fortunately, the other medical students (Kate and Shanela from the University of Notre Dame Australia) and I rose to the challenge, putting in a successful joint effort to cook-up an international buffet. My contributions were miso soup (味噌汁), fried rice (炒飯) and genmaicha (玄米茶) – I had some forewarning from previous students, so brought many of the ingredients (unavailable in Coona) with me from Sydney. Kate and Shanela prepared: green salad, papadums, raita, lamb rogan josh, salmon & teriyaki chicken maki-sushi, Moroccan chicken, kheer, barfi, and mango lassi.

Being mindful of one of the registrar’s preferences, this was also the first time any of us had prepared halal food. I had to email one of my friends in Sydney to clarify which foods were permissible, and we were fortunately able to source some halal chicken meat from Coona Food Suppliers (35 Timor St). Being careful during preparation of the food to avoid any contamination, we were able to make many of our dishes above halal (including both of mine).

Miso soup (味噌汁)

Fried rice (炒飯)

The New South Wales Geographical Names Board database (circa September 2009) entry for Coonabarabran includes the following comment:

“A town of on the Castlereagh River and in the Warrumbungle Mountains. It is 465 km from Sydney having good road, rail and air facilities.”

Whilst the comments regarding transportation may have been true some 20 years ago, alas this is no longer quite accurate. Commercial flights no longer operate to Coonabarabran Airport and the railway service ceased in 1990 (replaced by a CountryLink coach service from Lithgow). There is a good road connection, however, with national highway A39 (Newell Highway, the main Melbourne–Brisbane route) running through town. It was clear that the best option for me was to drive to Coona.

Waiting for the train that never comes… Former Coonabarabran Railway Station

Getting there from Sydney, however, is somewhat indirect. There is no way to drive to Coona on A-roads without lengthy detours via Bathurst/Dubbo or Maitland/Gunnedah. The only reasonably direct routes involve travelling mostly on B-roads and minor roads – the two main routes used by Coona locals are via Mudgee or the Hunter Valley, which I’ve outlined below. Travelling time is around 6–6.5 hours by either route (depending on traffic/breaks).

N.B. The information below is provided as a general guide only and driver discretion is advised – both routes involve driving on minor roads of variable quality.

Sydney to Coonabarabran via Mudgee

West on M4 Western Motorway and continue on A32 Great Western Highway via Blue Mountains, exit onto SR86 (B55) Castlereagh Highway and continue north-west via Mudgee and Gulgong, west on SR86 (B55)/B84 Golden Highway via Dunedoo, north-west on SR86 (B55) Castlereagh Highway via Mendooran, north on Mendooran Road* via Mollyan, north on A34/A39 Newell Highway into Coonabarabran.

Heading west on M4 Western Motorway, near Penrith NSW

Sydney to Coonabarabran via the Hunter Valley

North on M1 Sydney–Newcastle Freeway, exit onto B82 Freemans Drive and continue north-west on B82 via Cessnock and Pokolbin, west on Broke Road, north on Wollombi St, north-west on Charlton Road, briefly east on Singleton Road, north-west on Wallaby Scrub Road, north-west on B84 Golden Highway via Denman and Merriwa, north on Vinegaroy Road and continue on Cassilis Road via Coolah, north on Black Stump Way, north-west on Warrumbungles Way via Binnaway, north on A34/A39 Newell Highway into Coonabarabran.

B84 Golden Highway directional signs, Merriwa NSW

Unfortunately, the original plates were lost over time and the only digital images we had to work with were two low-detail JPEG files (see images below). Even some on the MedSoc Council didn’t realise that our logo featured a lion and waratah on it.

As part of preliminary work for the Sydney University Medical Journal (SUMJ) 2010, I decided to create a detailed vector version of our logo. I looked through our Journal archives to cross-reference the general design and decided to base my new artwork on a print I found on the cover of SUMJ 1965 (vol. 54)…

The vector logos were created using Adobe Illustrator CS4. From a design perpsective, my primary aim was to modernise the appearance whilst remaining true to the original design. Thus my 2009 version employs cleaner lines and revised geometries, which help to emphasise the symbolic elements. For example, text was set in Univers 73 Black Extended after the style of the 1965 version’s sans-serif type.

The 1965 colour scheme was very eye-catching, dominated by scarlet and jungle green, to the point of being described as ‘Christmassy’ by some. I’m not sure whether this was a true representation of Anderson Stuart’s original colour scheme, but in any case I decided that a more subdued palette was preferable for my 21st century refresh.

The new logos were officially adopted at the 2nd meeting of the 124th MedSoc Council.

*Whilst the caduceus is traditionally the symbol for messengers and commerce (the traditional symbol for medicine being the rod of Asclepius), I suspect that Anderson Stuart chose it deliberately to represent the Royal College of Physicians.

Abstract

Background: There is a general consensus that another influenza pandemic is inevitable. Although health care workers (HCWs) are essential to the health system response, there are few studies exploring HCW attitudes to pandemic influenza. The aim of this study was to explore HCWs knowledge, attitudes and intended behaviour towards pandemic influenza.

Methods: Cross-sectional investigation of a convenience sample of clinical and non-clinical HCWs from two tertiary-referral teaching hospitals in Sydney, Australia was conducted between June 4 and October 19, 2007. The self-administered questionnaire was distributed to hospital personal from 40 different wards and departments. The main outcome measures were intentions regarding work attendance and quarantine, antiviral use and perceived preparation.

Results: Respondents were categorized into four main groups by occupation: Nursing (47.5%), Medical (26.0%), Allied (15.3%) and Ancillary (11.2%). Our study found that most HCWs perceived pandemic influenza to be very serious (80.9%, n = 873) but less than half were able to correctly define it (43.9%, n = 473). Only 24.8% of respondents believed their department to be prepared for a pandemic, but nonetheless most were willing to work during a pandemic if a patient or colleague had influenza. The main determinants of variation in our study were occupational factors, demographics and health beliefs. Non-clinical staff were significantly most likely to be unsure of their intentions (OR 1.43, p < 0.001). Only 42.5% (n = 459) of respondents considered that neuraminidase inhibitor antiviral medications (oseltamivir/zanamivir) would protect them against pandemic influenza, whereas 77.5% (n = 836) believed that vaccination would be of benefit.

Conclusion: We identified two issues that could undermine the best of pandemic plans – the first, a low level of confidence in antivirals as an effective measure; secondly, that non-clinical workers are an overlooked group whose lack of knowledge and awareness could undermine pandemic plans. Other issues included a high level of confidence in dietary measures to protect against influenza, and a belief among ancillary workers that antibiotics would be protective. All health care worker strategies should include non clinical and ancillary staff to ensure adequate business continuity for hospitals. HCW education, psychosocial support and staff communication could improve knowledge of appropriate pandemic interventions and confidence in antivirals.

Citation/identifiers

Seale H, Leask J, Po K, MacIntyre CR. “Will they just pack up and leave?” – attitudes and intended behaviour of hospital health care workers during an influenza pandemic. BMC Health Serv Res. 2009;9:30.

doi:10.1186/1472-6963-9-30
PMID: 19216792 (PubMed)

Day 1 stations

• Paediatric gastrointestinal history
• Diabetes history
• Chronic renal failure history
• Abdominal pain history
• Lymph node examination
• Visual acuity examination

Day 2 stations

• Drug & alcohol history
• Arthritis history
• Chest x-ray interpretation
• Neurological motor examination
• Cardiovascular examination
• Respiratory examination

During a USydMP OSCE, you start outside the exam room and have a minute to read the instruction sheet for that station, then proceed into the room and have six minutes to complete the task with the “patient” and examiner. You then rotate to the next station and repeat the procedure until all stations for the day have been completed. The timeframe of the OSCE often makes the task quite rushed and doesn’t allow time to think clearly – you’d be surprised at how hard it is to calculate standard drinks and pack-years under pressure, for example. It’s quite an intense experience!

At my clinical school they often get the international elective students to act as patients for OSCEs. This proved to be quite interesting when: (i) my “patient” for the lymph node examination didn’t really understand English directions, which meant that I had to improvise with non-verbal cues; and (ii) I was initially unsure whether my “patient” for visual acuity examination was actually having trouble reading the letters on the Snellen chart or whether she was just hesitant about the English name of the letters she was reading out.

In any case, ostensibly we’re now on a seven week summer break. Echoing Miss G’s sentiments on the OSCE, however, it won’t really feel like holidays until 12 December when results will come out – then second year will finally be over!