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OSCE Express Session 1- Ward Round Notes + Examinations



Session recording catch-up content for Ward Round Notes and Physical examination stations led by Dr Nidhi Agarwal.


Catch-Up content for OSCE Express Session 1, where Dr Nidhi Agarwal takes you through how to ace the ward round notes and examination stations of medical school finals OSCEs.

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Learning objectives

Learning Objectives: 1. Identify the key elements of Ward Round Notes and Physical Examination station in the OSCEs 2. Practice taking notes accurately and efficiently during a simulated medical/surgical ward setting 3. Record relevant symptoms and examination findings in medical terminology 4. Recognize safety concerns in patient information and address them according to correct protocol 5. Summarize patient histories and plans concisely using bullet points in written form
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The following transcript was generated automatically from the content and has not been checked or corrected manually.

Ok. Ok. We'll make a start then. Um Can you guys hear me? Yeah, great. So, welcome Iron. Thanks for joining. Uh My name is Sid. I'm one of the fifties if you don't know me and we're joined by Doctor Nadia Gal who is a former student as well. She's not an F one in uh in the northwest scenery. So, um which today we're gonna ease it in um with Os um Osk Express just talking through what the course is actually gonna involve and then we'll go through to the Light Station. So that's drawn notes and examinations. So I'll just do a quick overview of the course kind of why we did it. He was on the team and then we will uh hand over to for the, for the actual stations. So at the end, we'll also just have AQ and a kind of general ask you things if you want to know about and then we'll talk about the cases in future sessions and things. Just before we start, we do have to stick a disclaimer out there that we are not a substitute, um educational resource or uh health care advice resource and if you do find any errors, then we've got our email there that you can contact us but hopefully there shouldn't be any. Mm. So, regarding the course itself and why we put it together as you all probably know by now we have oy, support for year three and year four and there's tailored things. Um, and then when you get to final year it's kind of just general ay, but there isn't too much, um, you know, specific to what we're doing. So I just thought we should probably put something together to address that. So we've got a whole team now of, um, Lester Foundation Doctors, they're gonna talk through all of the uh, final stations that we get and also address just common finals stations that you do get in. Ay, um, all the, all the presentations and cases will be put together by doctors. Um, and they'll be peer reviewed by the entire team and then we'll deliver these sessions weekly every Wednesday from 7 to 830. It shouldn't take 7 to 830. It should be 7 to 8 usually, but we'll put that extra off and hour for kind of question and answer spill over time. Um, and they'll just go over all the stations run common presentations to expect top tips, that kind of thing. Uh And it's not just for us to make sure that we're all well prepared for F one so they can, they can share some of the F one tips as well at the end, if there's time, um I'll be sending out all of the meeting details and things on Instagram, email, uh Facebook med all as well. So if you follow one or multiple of those, you'll be in the loop, all the cases, we will be publishing on sa dot com. So if you don't know about a dot com, a couple of us set up last year um because there's all the, all the resources are paid and we don't think educational resources should be paid. So we set that up and we'll be putting all the case output from here on the. So by February, we should have hopefully over 100 cases uh specifically just for 50 or osteopor that we can then all use for free. So that, that's essentially an overview of the course. We will be taking two weeks out in December um because everyone was done, enjoy the holidays, but including those two weeks that we take out, we started today's first of November and we're gonna finish on the 31st of January. So, um well, before finals, so that, that's, that's a overview of the course. There is the crack team of uh of doctors that are basically putting all of this together minus me, of course. Um So the majority of these people, every, every single person here is a Lester graduate. Um But, and most of them are working within Leicester. So this, this is the team that will put everything together in the next few weeks. And uh I'll hand you over to the first member of the team and a express cofounder doctor and she will talk you through war draw notes and give examinations. Thank you so much, sad and thank you very much to all of you for coming to attend this. Um This is something I've been planning to arrange for you guys for a very long time. Anna Sid was saying, Ay at Leicester are very foundation year one focused. So we wanted to create some resources that were applicable to you guys that will help you towards your ay and help you to essentially become a better foundation doctor. Now, a lot of the stations and the layout of these sessions are extracted from the Lester Osk, but a lot of this content is transferable. So anyone who is joining us from a different university who has a different style of oy, rest assured a lot of this content will still be applicable in order to make you better um doctors and also to help you with your ay going forward. So our first station is Ward Drawn Notes and then we'll be covering physical examinations afterwards. So something nice and easy to uh warm us into these cases and then we'll take it from there. So with water on notes in your exams, it's going to be a simulated setting in a medical or a surgical ward and you will be having a video um covering a medical and a surgical case. But just bear in mind, there could be multiple patients in these videos as well. So these will replicate real life assessments. So there will be a consult, there will be an fy one doctor and then a patient as well. So you will be going through these assessments and you will be asked to take down notes about what is actually happening with this patient's history, what symptoms they have, what investigations have been done so far and any further investigations and medical interventions that are asked of you and then within the station, you will have observation and drug charts available for you to use. Um and just as an overview, once again, if you haven't had a chance to look at the osk slides yet, it will be a 10 minute station and there will be a warning bell which goes off at eight minutes and you should have finished watching all of those videos in the last two minutes for you to collate. And um you know, just make sure all of the notes are in a flow. So if there is anything like signatures or names of doctors, you can put those through at the last two minutes. So some of the top tips for this is it is a very real life focus station. So the examiners are wanting to evaluate your summary of patient history are you able to extract what was discussed prior to seeing the patient? And when the patient is giving you more information about the history, are you able to add it onto your ward round sheet in a logical manner? And then when the consultant is examining the patient, are you able to extract the findings, put them down in a logical setting? So anyone who is coming after you to read those notes, are they able to understand what was the update on the patient's history that day? And then take it forward from then on into the next day with further investigations to come through. And then, um you are essentially asked to record accurate relevant symptoms and examination findings concisely. So in, in these videos, there can be a lot of um um normal layman terms that are being used. So are you able to extract that content into medical terminology and uh make it as accurate to the patient's history as possible? And essentially, we will go through the layout of the ward round notes but do not forget to note down an impression. A lot of, a lot of students go through the history of presenting complaint, past medical history, drug history, social history, but they often forget to note down an impression to make sure you do do that. And towards the end to make sure you are having a clear succinct plan. So one bullet point for each intervention, it doesn't matter if you are coming down to 8, 1015 points. As long as all of these are clear individual actionable points, that's what they are looking for. And then lastly, this is something new for your ear. You will need to keep an ear out for any safety concerns as well. And this can be something like a safeguarding issue, whether there's any alcohol or substance misuse in the background, whether it's a case of seizure, someone with new visual problems, are they driving? You will need to note down whether DVLA will need to be notified. So these kinds of things are being asked of you, which is extra to what is discussed in the video. But otherwise everything else you need to know will be covered in the video. The main thing is are you able to listen and collate into written information on the sheet? So in just a moment, I will be putting through a template for our case during the session, but I'll let you have a read through the top tips in the meantime. Ok. So it seems there is a technical error with teams. So I'm not gonna be able to share the document with you, but there is an image later on. So I'll pause for a minute or two. You guys can take a picture of it if you have your phones or your ipads, take a picture and then we'll carry on from there. So uh this is just going to the example layout. Um at the top of your sheet, you will have some details about which hospital you are at which exact site you are on the ward, as well as uh the name of the consultant. And then on the right hand side, you will have a space for noting down patient details. So this will be essentially three pieces of identity, the patient's name, hospital number as well as their date of birth. Um Sometimes they will prepopulate these fields for you. But if it's not just keep an eye, you will be asked to populate this within the station itself. Um and just keep an eye out for any um section in the document which is asking you to document any allergies because if it is, you will need to document it very clearly that they don't have any allergies. Oh, thank you. So, so it's just shared the file. If you guys can download that, we will go through it when we listen to the file later. Um So just as a run through of what to document when you are going through the ward round notes, firstly, at the top, you will need to document the date and time of the ward round. So this can be um uh you know, the first of e 11th of 2023 and then the time is 945 in the morning and then at the bottom, say it's a ward round and who's the consultant lead as well as your name and any other participants um that will be yourself and any other I MT S, any other registrars and medical students, if they are there, you can also document their name on there. And then first of all, start off with presenting complaint. A lot of this information you can find from previous notes if they have been seen in the ED. If not, you can document this yourself later. And then in terms of the history of presenting complaint, you will need to document exactly the symptoms they have been experiencing for how long they have had um, any aggravating or relieving features for pain. So make an accurate concise history of what is happening with this patient. And then in terms of past medical history, note down anything that's relevant to your patient. If it's a medical case, note down the medical things first and then any surgical past history they have after that, if it's a surgical patient, then note down any previous operations, they've had anything relevant to the surgery and the presenting complaint and then the other diagnoses to come afterwards. And then in terms of drug history, make sure to include all of the medications they're on. And if it's something like asthma medication, epilepsy, medication, they will often tell you what brand name it is and you'll need to note down what brand it is and the specific dose as well when it comes to allergies you can write NKDA because it is a very well known acronym. So no known drug allergies. And if they have any allergies clearly highlight what allergies they are. And if the information is mentioned, what kind of reaction they have? Is it a rash? Is it diarrhea, vomiting or is it something like severe anaphylaxis? Then next up comes social history. This is where you'll want to note down alcohol, smoking, drug history as well as occupation. Um and anything significant in their history uh that you feel is a safety concern as you were talking about earlier with DVLA, those kinds of things would go in this section. Then with the new score, you want to note down what is the total new score and then also break it down into different categories in your actual less stations. This will be prepopulated for you. They will tell you what the respiratory rate is, heart rate is and um then you can carry on from there with the issues. Um This is covering your working diagnosis and any concerns that are active for the patient at the moment. So this can mean it's either a diagnosis which is confirmed for certain, it can be a differential diagnosis or it can be any biochemical findings. For example, if they have hypernatremia, that is a current issue. So you'd want to put it down on there. Um and then you move on to examination findings and this will be updated every single day when you're examining the patient. So main things you want to note are what is their status at the moment? Are they sitting up in a chair in their bed? Are they lying in bed? Are they on oxygen? Are they not on oxygen? Are they alert? Are they confused? Are they drowsy? Are they orientated to time place or person and document each one of these things separately if they are not oriented to time, write down specifically that they are not orientated to time. And then after you have done a general examination of a general inspection of the patient, move onto the examination. So you would always want to go top to bottom. So note down your chest findings, is their chest clear? Is it not clear? What are the heart sounds? Is there any added sounds? Are there any murmurs you can hear then move on to the abdomen. Uh Is it soft non tender or is it a bit distended? Can you hear your bowel sounds? Can you not hear bowel sounds and then move on to the calves? Are they soft and nontender? Is there any uh is there any swelling or is there any pitting edema? You want to note all of these things on that? And then it's always a good idea if you're doing paper notes to do a little drawing on that. So with the lungs, you can draw these two oblong shapes. I like to leave a little bit of space on the left oblong because that's where the heart sits. And then with the stomach, you will want to draw a Hexagon and then with the legs, you can do a picture of two boots and then whenever you draw a line going up and an arrow is coming through that says it's clear. So chest is clear or abdomen is soft, non tender. So you can note down these findings next to the picture and it's a quick visual cue. Um You can review any of these war draw notes on your current placements and see what doctors are actually documenting. And then if you have any questions, you can ask them, how would I for example, document what crackles look like. How would I document what wheeze looks like on a picture? So it's always good to go through any notes on your actual placement. And then as I was saying earlier, note down an impression. So what is your working diagnosis at the moment? And um once you have done this, then move on to your plan, so leave plenty of space. You can um note down everything individually as I was saying earlier, bullet point it and then once all of this is done at the very bottom, you'll want to have your signature put down the date and then also your GMC number in your Lester exams. You're expected to write down your student ID at the bottom and then at the very top. They'll want you to write your full name followed by your student ID as well. And on every single sheet you'd use just to make a note, make sure you're putting down the details of the patient. Um write down that the consultant. Uh you have documented. The first sheet is also present on the second sheet and so on and also include your name on every single sheet. So, um are people having some issues with downloading the file? Is that correct? Some people could not open it? All right. Uh Are you able to take a picture of this slide and then you can work from this one? I'll leave this slide on for a minute or two. Ok. So I hope everyone's had a chance to either download the file or take a picture of this one. If not, don't worry, this is a practice case, it will be uploaded later on. So you can practice on your own time as well. So our first case is a medical scenario. You are the fy one on the acute medical unit at somewhere Royal Infirmary and you will be asked to watch a video of a consultant ward round and the patient has presented with abdominal pain and vomiting. So today we have an audio file but we will be releasing the video with the war down case notes very very soon. So let me know if you can hear this audio file, I'll test it out first if someone can say they're able to listen to it. Yeah, I can see. Thumbs up. All right. So this will be a five-minute case. I'll let you guys listen to it and carry on with the note taking as we talked about earlier. Oh, ok. So that was the end of the audio file and I'm just gonna give you guys two more minutes so you can have the time to wrap up any of your notes. And then we'll go on to an example of how I would go about documenting this for anyone who needs this. This is for reference, just going back to the original file that you will receive in your actual exam. No. So unfortunately, that is one of those things with the station, you cannot replay the video, it will only be played once. So I will come to some of the tips with the station a little bit later. But initially, what I found easier was to shorthand write things on there and make a note separately and then elaborate on it later on when I have the two minutes to come to it again. OK. So I hope that was enough time for everybody to collate their notes about this case. Let's go through how I would go about documenting the station. So, um I have used two s uh sheets of paper for this and I've made sure to populate both of those sheets. Firstly, with the name of the hospital, what department we are in, which is the acute medical Unit. Um And I can abbreviate this because it was the same on the first instruction sheet that we got in the station. And then the consultant's name is Harris in the station. And you might note that it wasn't actually mentioned until much later when the consultant introduced himself to the patient. So it's consultant Harris. Um when I first approached the station, I put down the date the time on initially. And then I also populate the ward round um line with my name, my grade and the consultant and I leave the name of the consultant blank until I actually hear the name. And then I put it in later with uh the way these notes arrange, it's a little bit different because at Lester's ays, you have the new score and the bloods given to you as well as the admission um details to the presenting complaint much you that that is given to you beforehand. And then you are adding on history of presenting complaint, past medical history of drug history much later on. So the layout is a little bit different to how you would do in your own wards in real life, but still try and make sure you're keeping it as structured as possible. So I first started off with the history of presenting complaint and then I said they were admitted yesterday with two weeks of worsening abdominal pain. And I uh summarized abdominal to ABDO and then I also said one out of 52 meaning one week history of vomiting. And then I had quantified the vomiting and made sure to tell them that there were some blood streaks in there initially, which then evolved into a coffee ground type of hematosis. And I have used this as a medical word here instead of vomiting blood to specify exactly what I mean. And then that is what led to prompting their admission. So anyone who's looking back on these notes knows what was the reason that actually brought them into hospital, that they were experiencing these symptoms two weeks prior to coming in. And then I've also noted down any red flag features or anything that would make you very concerned. So there is no Melina or syncope. However, there is ongoing lightheadedness. So this is documented very clearly for people who come after you to note what were their current issues at that time? And then I've also noted there was no previous upper gi bleeds because this is significant for you to know whether this has been an ongoing issue or if this is something new onset and then what have we done for them? So far? We have resuscitated them with IV fluids and this is something you can abbreviate to IVF. And then in brackets I have specified what they actually received. So this was 0.9% sodium chloride. And then also ma department had withheld the Ibuprofen and this is something I documented here quite early on. Then I went on to talk about past medical history. So this patient has osteoarthritis of the knee, they have diabetes, di depression and also acid reflux. So acid reflux wasn't something that we discussed between the consultant and the fy one early on. This was something the patient told you later. So then I went back and I wrote this in the past medical history side because this is something the patient told me. Then when it comes to drug history, I have noted all of the relevant medications. So they are on Metformin, Ibuprofen, SITagliptin and sertraline. So all of these are on there now. And in terms of social history, they are an ex-smoker and they stopped six months ago and they're also a nondrinker. Um They, there wasn't any mention of your occupation driving and these aren't very relevant to the case. So don't worry, the information is not there. You don't need to go out of your way to document this. Um just document whatever is being told to you when it comes to issues. The patient said they still have ongoing abdominal pain. This is why you'll document what the patient is telling you. They also have lightheadedness and they did not tell us they had any more Melena and there's been no further hematemesis as well. Now at the bottom over here, just uh on your first sheet, you'll want to put an arrow and say what done continued. And the same thing we'll repeat on the top left of the next sheet you use. So anyone who's looking back on your notes knows this is continuation of the same sheet. Uh same assessment of the patient, then you will want to document the examination findings and you can do O slash E as an abbreviation because this is very commonly done. Um We said the chest was clear with heart sounds being normal and this heart sounds one plus two plus zero, there was no added sounds and then abdomen was um tender in the epigastrium and it was soft without any guarding. And it's important, you're putting down any important negative features as well. So when you come back to the assessment later, you can compare um especially in surgical cases, whether there is a possibility they could be going to peritonism. Was there guarding or was there no guarding a day back or two days back? So cars are soft nontender and then you might want to add some drawings over here as well as as I mentioned earlier. Then when we come to impression, the consultant said we're gonna treat this as a case of upper gi bleed secondary to peptic ulcer disease. So try and be as explanatory informative as you can in this section when it comes to the plan, um go accordingly to what the consultant is telling you and if there is anything important, make sure you expand with more details on there. So we said the patient is gonna be nil by mouth. We need to chase the OGD. You might want to put down here that we need to call the endoscopy department. You may choose not to um but you have said you're going to chase the OGD today. Continue with the IV fluids. We need to chase the blood including group and save G NS is a very well known acronym. So you can use GNS here and then we've said query transfuse. So depending on the results, we may need to transfuse them later on. Then next point is we need to hold the ibuprofen and sertraline. So you have documented why these medications are crossed off on their paper drug chart later. And then we said continue with the IV paracetamol and just make sure to double check as well what the patient's eating and drinking status is. So we've said here the patient is going to be kept nil by mouth. So that is your justification for keeping them on IV paracetamol and not switching them on to oral medication. So then going on to the Cannula consultant set to put two Cannula in arms and then also we're gonna give them virazole post OGD. So this is our plan for now and then just sign it off with the date and your GMC number at the bottom as well. Um So I'm gonna leave this on here for a minute. If you guys have any questions, let's just go through them very quickly. So, how many patients will you get? So we have two patients in our ay and as you can see these videos will be about four minutes in length and that adds up to eight minutes. I don't think there is any scope for having three or more patients, but I would prepare for three. Anyway. Um Are we going to get the slides out? Yes. So there will be a feedback form that gets sent out. If you fill that through, then we'll have the post session content released. Do we put our student number somewhere on the notes too? Yes. So for the Lester oy, you have to put your student number and your name at the very top. So if you can see my cursor just over here at the top where it says university hospitals of Saint somewhere, you'll put down your name and your student number. Um If there is no mention of allergies, like in this case, what would be recorded? You can put NKDA. Normally it will be mentioned, it's just something that got missed out in this case. But normally they will see whether there are allergies or not. Are you able to pause the videos? No, unfortunately, you can't pause the videos. Once you have clicked play, you cannot touch the screen until the very end when you are moving on to the second video for the second patient. Um And just to mention, you will have all of these preprepared sheets in front of you for both or three patients depending on how many are in your case and you can look through them and organize them. Um And you can, you know, also put down the date, the name of the consultant, um your grade, your name, those kinds of things you can prepopulate. So what I also did was I made sure to give myself plenty of space on the first sheet. So I said HBC underlined it left myself a good chunk of space, then moved on to past medical history, drug history. All of those I knew it would be roughly about one or two lines. So I left myself that much space and then for the examination as well, I picked a second sheet. I prepared that by putting on the hospital name, ward, consultant details, all of that. Then I did my drawings for the examination as well. And then I put some space before I went on to impression left another set another line and then moved on to the plan, left a lot of space for the plan because I know there can be a lot of things that go through this and then um put down my signature and GMC number later towards the end just so that I know I didn't need any extra space for the plan. Um Can you tell us what type of abbreviations you can put? So anything you commonly see inward drawn notes, you can, it's very difficult to say what you can count and can't count as abbreviations. A lot of this comes from practice. So whenever you are in the hospital on your wards, just see the common things that are coming up. So that's the best way to approach this. But my one tip is if you're ever in doubt, write it in full. So for example, initially, when I first started preparing for this station, I wasn't sure I could document IV fluids as IVF. But now I know that it is possible. So that's why I started putting IVF and then in brackets, what kind of fluid that was given to the patient? Do we need to draw the lungs, et cetera or not? It's good practice too. And actually doing a drawing can be really helpful for you to come back to later because if you've just very quickly drawn the lungs prior to actually starting the video, you know, when you're listening out for the examination, you're just putting an arrow through or crackles with the Xs or wheeze with the um musical note signs, then you know, you can come back to an expand and say chest is clear. Heart sounds one plus two plus zero. You don't need to spend time writing it out. It's just a very quick drawing and you can move on, the news values are already filled in and the score usually is calculated. But again, um acies change year on year. So I would make sure you look at all the documents that are available for you at the beginning. If you see there is a news chart available on the table, then it's very likely they might want you to calculate it. So just quickly scan all the documents before you start playing the video, right? So I'm gonna move on to the next station. If there are any questions, we'll go through them towards the end. So let's move on to examinations and this is a very nice station to have. And finally your oy because it is very similar to what you guys have been doing in 3rd and 4th year. So you will be having real patients and these will have real signs. I know things were different in COVID years, but now we're back to having real patients. Um a lot of these patients will have chronic conditions. So you will very rarely find anything that's acute or acute and chronic. So expect any of these examinations as listed below. So gi renal cardiac respiratory diabetic foot, any of these things can come up. And the layout again is very similar to what you've had in 3rd and 4th year. You will have eight minutes to actually do the examination and then two minutes for questions. This is again, the same three questions you have present your findings. What are your differentials and how would you go about investigating or managing this patient? Um I think one of the more niche examinations that I would really recommend you practice are the thyroid diabetic feet renal exam and also the cerebellar exam cause these are some things you don't get to practice quite a lot. Um And we'll just go through some of the top tips for this as well. Firstly, as goes with any of these stations, practice makes perfect. So whenever you have a, a spare moment with your friends, your colleagues uh practice and examination and I think GP rotation is one of the best times to go about it because you have access to a room where you're having your consultations during lunch breaks, you can go there with any of your other colleagues and ask, you know, shall we go through abdominal exam today? Shall we go through respiratory exam practice this, find a way to go about structuring your examination in terms of normal patients. And then as you get more confident with your timings, then you can move on to actual cases. So you can start with OK, let's practice respiratory exam and let's go through listening to auscultation findings. If I heard someone with a stony dull percussion, what would that mean if I heard someone who had crackles in their lung bases? What kind of conditions would that refer to? So, just approach it in a sense of if I heard this finding, what would this prompt me to think in terms of the diagnosis? And then once you have reached that stage, um get around together with each other and then discuss what is the investigation and management and what are, what are the long term care features you'll need to have for this patient as well. So, in respiratory, a lot of questions they tend to ask about revolve around long term oxygen therapy and any changes to their homes. So, occupational therapy and physiotherapy is something they like to focus on for these patients as well. Um And then I would recommend that you aim for seven minutes to complete these examinations because that gives you one minute leeway to position the patient and also uncover and recover them back towards the end of your station as well and then have the other two and three minutes to actually present your findings to the examiner and for them to ask you questions as well. Um Some of the good resources are GKI Medics. Their website is really good for going through these cases. They go through examination findings and how to relate it back to the diagnosis and there are some videos online as well. Um Leicester actually have also released their own guides for these stations, especially for neurology. I found them quite useful. Um They're on all on youtube. So I'd recommend taking out an evening or two to go through them. Um And don't do a lot of these stations in one, go spread them out because it gives yourself a time to forget the station, come back to it and actually really structure your memory and space repetition was a really good way to go about the station. Um And then also ask for supervision of technique and placement. So if you have a spare afternoon or an evening, um ask one of the F one doctors or anybody else who has a spare moment. Do you mind just watching me do this examination for a patient? And it's a really good way for you to learn from the F one and also for them to be able to teach you something as well. So it works both ways really recommend um getting some actual feedback from doctors who are available on your placements. Um So as we were saying earlier, it's very similar to 3rd and 4th through examination stations. You will have patients with real signs. But just to add, if it's something like an ophthalmoscopy station or otoscopy, you are very likely to be given pictures as well. So definitely go through your findings um online, there's lots of pictures available on many different websites. So do look through them. And if you have any questions, you can always reach out to any of the doctors and they can help you find more pictures or more websites that are useful that they found at their time in university. Um We are gonna be releasing a lot more examination cases which will be published on ST dot com. And for a final year specifically, we're aiming to have about 20 stations released later um as the year progresses. So any questions about examination station? Uh so this is something uh that was discussed quite a lot for lesser examinations. Do we talk to the patient as we're going about the examination or do we just do the examination? And then we talk to the examiner and tell them our findings. I think in final year, they're definitely expecting you to not talk through your examination. But there's nothing stopping you from saying to the patient. I'm just gonna tap around your chest to listen to the sound. I'm just gonna have a feel of your tummy if you have any pain, let me know um I'm gonna feel for your liver. So take deep breaths, you can talk to the patient as if you would talk to anyone on the wards in real life. Um But I would keep things like the heart rate was 89 BPM or the Respi rate was 19 rests per minute to yourself until the very end when you discuss this with the examiner. Yes, the questions are very similar to 3rd and 4th year examinations. Um It's going to be, please tell me what your findings are. What is your differential diagnosis? What investigation or what management option would you like to proceed with? What examinations have been tested in recent years? Um A lot of different things. It's quite varied. Um You can have a respiratory exam, you can have a cardiac exam, you can have a peripheral vascular exam. It, it could be literally anything under the sun. So if I just go back to this list, um practice these and it will be one of these stations which come up. Ok. Any more questions about examinations? Yes. So in our year of was testable as well, um Just refer back to your slides again in case there's been any update, um It's very likely you will still be able, you will still be asked to do it. You'll have a model for the eyes instead in front of you and you'll be asked to demonstrate ophthalmoscopy on it and then you'll be shown a picture afterwards if it is an ophth case. Ok, lovely. So that's the end of our first session. If you have any more questions, feel free to hang around and do my best to answer your questions. But for anyone who needs to head off, our next session is going to be on the eighth of November 7 to 8:30 p.m. Again, and we're gonna be going through how to refer patients. So this is going through your sbar technique looking at any investigations like ECG S chest X rays. So it's really good practice and then we'll also be going through how to prescribe safely in medical patients. So do join us for that one next week. And um as we said earlier, we're gonna be having 11 sessions in total every Wednesday with a break for Christmas. And this is the link to our next station. If you can always leave some feedback, we're gonna be releasing post session content on middle. So do keep an eye out on there and we really appreciate you leaving us some feedback because it tells us how to improve for the next session and it really shows that you appreciate our session. Thank you. Yeah, thanks everyone for turning up and we hope to take you through the rest of the OSC as the pause goes on. So from next week, we'll have more, a little bit more stuff to talk about because the examinations is basically the same as it used to be. Yeah, if anyone has any questions, we'll hang around until uh let's say eight. Um Yeah, we'll hang on until eight and then we'll head off as well. Our last slide I think, I think it's just our socials if you guys don't follow us already. Um We have Instagram and Facebook pages. You can find us on Os dot com as well as on me. Mhm. Thanks for waiting. How could we access the link from before? Is this for the war drawn template Christine? Ok. So um I think because it's a SharePoint file. It wasn't able to be accessed by anyone without less your email address. Um, next time, what we'll do is we'll release docs link so that everybody should be able to access it. Um If you hang around, I'll see if I can do it now as well. Yeah, so we'll, we'll send, we'll send things out as actual uh Google Drive links, like nobody said. And um, we can send the one from today to you now and we'll also send the slides out. Yeah, the slides will be emailed. Ok. Yeah. So in order to get the slides and the video recording, if you all leave us feedback on metal, things will go in there first.