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Virtual OSCE station on history taking communication skills for MRCS part B lessons learned

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Summary

In this detailed simulated medical session, medical professionals are shown a step-by-step approach to patient consultation and examination. The session begins with an exam candidate, Doctor Abd, assigned the number 22 01, who proceeds with a virtual Aus Station. He reads a scenario and then, under guidance from the examiner, conducts a hypothetical consultation with a patient named John Stuart, who is role-played by the examiner. John, aged 65, has been suffering from severe abdominal pain for the past three days. Doctor Abd, employs a systematic approach to gathering information from John, about the pain and potential causes. He questions John about the pain: its location, onset, duration, character, associated symptoms, aggravating and alleviating factors. During the consultation, Doctor Abd also takes note of John's personal and medical history, which includes diabetes and hypertension. Once the examination concludes, the examiners give feed-back to Doctor Abd, pointing out areas he excelled in and areas he needs to improve upon for better patient interaction and diagnosis. Urging professionals to take a systematic approach to patient consultation and using the appropriate terminology, this session exposes medical professionals to helpful techniques for patient investigation. The concluding part of the session sees another doctor taking over for a similar scenario
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Description

This is a virtual OSCE stationi for MRCS part B examination to train doctors how to pass MRCS safely and to learn from there mistakes online assessed by examiners and to know there marks using an artificial intelligence generated OSCE station , all are welcomed to join free

Learning objectives

1. Understand how to conduct a detailed and thorough patient history, focusing on key details such as onset, duration, location, and severity of symptoms. 2. Develop and implement a systematic approach to assessing a patient's presenting complaint, ensuring that all relevant areas are explored, such as associated symptoms, medical history, medications, lifestyle factors, and social and family history. 3. Demonstrate empathy and sensitivity when dealing with patient fears and anxieties, aiming to build a rapport with the patient. 4. Learn to ask relevant follow-up questions, probe for more details, and ensure that the acquired information is accurate and comprehensive, as well as how to prioritize questions depending on the presenting complaint and time constraints. 5. Develop the ability to summarize and synthesize the collected patient history in a clear, concise and organized manner, and formulate a provisional diagnosis or differential diagnoses based on the collected information.
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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

Uh nice to meet you. I hope that to be easy for the exam. Uh Of course, the exam is run all over the ear all over the world. And uh it's simple and the of this exam is to have a candidate. Ok. Ok. Ok. So, uh thank you very much. Um, best of luck to Doctor Abd. Um We're going to start the nine minutes uh virtual Aus Station. Um And uh you have read the scenario. Doctor ab you've read the scenario. OK. Um uh we better call you candidate 22 01. Ok. Ok. Because uh in the Royal College exam, we don't need to call anyone by their name, call them by their number. You have read the scenario and uh you will open the door and you will have nine minutes in inside. You will find an actor which I will play the actor. And after that, um uh you will have six minutes of taking history and after that, we'll get uh the question answered so you can start uh candidate 22 01. Ok. Uh Hello, I'm doctor, one of the surgical uh 10 year old doctor. Uh Could I confirm your name, please. Yes, my name is John Stuart. I am 65 years of age. Uh hello, Doctor John. Uh could I know what, what, what did you uh came out today? Yeah, I came out today because I have uh abdominal pain in the last three days when I was in my daughter's wedding. I'm sorry for that. Then it must have you during your birth and congratulations for your daughter. Thank you very much. It's nice of you. Ok. Ok. Uh To ask you some questions about that name. Yes, please go ahead. Ok. Uh Could you, could you, could you tell me exactly where is that? The pain started in my lower abdomen more to the right side and it is getting worse since that time. And uh today I felt really very, very bad. So I came to the hospital to see what has happened to this pain because a friend of mine have died. He had uh he had an abdominal pain and I went to the hospital. So I'm a little bit worried. I'm sorry for your friend. It. Ok. Uh Can you tell me when did it start? It started three days ago, three days ago. Ok. It is radiating a little bit to my back, to your back. Uh Does it get low? No, no, no. Ok. Uh could you uh is it like or it's um it's a kind of grinding pain in my lower tummy and it's getting worse. It's, it's not improving by anything. I do. Mm. Ok. Good. Uh, anything, uh, increasing. Um, maybe when I move, when I move out of bed it gets a little bit worse. Not much. Ok. Uh, so is it associated with any fever? Any increase in your? No, II don't think. Um, uh, no, no. Uh, any, did you any vomiting? No, no vomiting, but I feel a little bit unwell. II don't feel, um, good appetite. Ok. Uh, do you look, you, you feel you, you're ok to the disease these days, right? Yes. Yes. Ok. Uh, did you make any, no, no, um, any, any problems with, with, uh, yes, I've noticed yesterday that, uh, urine was, uh, recently. Yes. Yesterday only yesterday. I've noticed that. Yes. Ok. Is there, no, don't feel anything different. No, no. Ok. Uh, any problem, uh, uh, uh, was there any problems with your stool, like increase in frequency of stool? II didn't pass any stool in the last three days, so I'm not sure. Ok. Uh, so how, uh, how does it affect your, uh, daily activity? I can't, I can't do my work. I didn't go to, uh, to work today or yesterday and, uh, I am in constant pain and I did take some, um, cm all but it didn't work, um, una unable to, to continue. That is why I came to the hospital. Ok. Um, uh, is it as with any, uh, uh, is it increasing with me or, uh, anything like that? No, not really. I didn't, I didn't have meal in the last three days. So, uh, uh, I don't feel like eating. I'm sorry? Uh, ok. Mm. Do you think it can be dangerous doctor? We will run, we will, we will run our investigations and we will, uh, do a, to, to try to, can it be cancer like my friend. Uh, I know you are concerned about your friend. Uh, but it's easy to tell something like that. We will do our, uh, we infusions and, uh, to know what is your problem for now. But for now, let me ask you also, do you have any medical condition currently? Yes. You know, you diabetic diabetic type two. And, uh, I've been hypertensive in the last 10 years. I take, uh, my antihypertensive medication. Uh, do you know what's her name or? Yes, it's Concor 2.5 mg. Ok. Uh, and diabetic on insulin. And, um, II take insulin, I take insulin twice a day. Ok. Do you have any other, uh, chronic problem? You, you visit your before, uh, no other than diabetes and hypertension? Ok. Did you underwent, uh, any surgery before I had appendicectomy long ago, 30 years ago. Ok. So, like, uh, do you have, uh, uh, I II read that you have no allergies from any other thing? Uh, ok. It's now, um, it's now six minutes. Ok. So at this point, the examiner will stop you. And the first question is, can you give me a summary of Mister John Stear you? That's a 55 year old male who presented complaining of uh right lower abdominal pain, which started three days ago uh has been uh increasing in, in it is progressive uh of grinding character. Uh It's to his back and then increasing a little uh with activity. Um He is diabetic diabetic insulin and hypertensive. What do you think? What do you think is the cause of his pain? What do you think is the cause of his pain? I hope this is not electricity. Blackout. Ok. Uh What's your diagnosis? Doctor? We asked you, what's your diagnosis? Yes. What's your initial diagnosis? Doctor Abderrahman? Well, uh II think I'm not sure but there is power cut. So uh let me take the opportunity. Number one, you didn't write down Doctor Abderrahman. All the information. And in this station you always have a paper and pen and most Egyptian doctor and Middle East doctors are used to take a history verbally. They don't write it down and when they write it down, they write it down and they stop. Let me start by the comment of my colleague. I think there is cut down of Doctor Abd Rahman when he join in. We can but at least we got to 60 minutes. You as an examiner professor. She, what's your comment? Yes. Uh First he is good in discuss his embassy because when you discuss that you have wedding and you have someone. So it is good for him. But when he analyze him, he forgets he mentioned that radiation duration, what increased appeal? And he left what decreased appeal? And he don't ask about any. So you need to ask you, you need to ask about the uh uh I think some major ma he, he asked about it is urine is common word in English. So we can talk about what is what you don't say something silly. You are watching the movie. So we're going to ask what is, what is it is a good question after that. Uh he asked about social history. And so we need to ask her social history. He don't ask about family history. Uh When he asked about medical condition, he asked you have a medical condition and in we consider it as you need to ask if you have any medical condition like hypertension, diabetes, meal idem or bronchial asthma, maybe in your country, some other disease. I don't know. Uh This is a, this is because in exam, we have a competition, we compared the student to the other. So uh his history is not so good in comparison to others because it is comparison exam. Uh But he is still still like we consider as if you need to ask how to score him so he can be borderline. Of course, he asked some questions not related. Uh And he asked about detail of medication. He was going to need to ask about like what you take of diabetes and this is from his time. So it is important to concentrate of the related topics like alcohol, smoking, family history. You don't ask even about other system, which is important. Yes, you have short of breath palpitation. Uh, any other problem. Uh, that's all. But it's overall, it is not as good. Ok, you're, you're very kind. I know you're very kind. Again. 11 of the comments that I noticed the British candidates. If I tell you, my name is John Stewart. Can I call you John? Is that OK? To continue? It's never happened with Egyptian examiner to familiarize with the patient. All right, John, what is the problem, John? OK. And secondly, when you start to write it down, you always have to write history down and you ask permission. Is it ok with you John to write some remark for you to remember your history and your condition. You ask permission before you write it down. I I've not ii don't see candidate, neither writing history down or taking permission or asking the patient which name they like to be called upon. And you mentioned the uh the, the point of, of having um pain score is essentially uh I think it's essential to, to mention how much pain does he have out of 0 to 10? Is it nine or seven or whatever? And again when, when he made compassionate uh comment, when I said my friend has died, you feel it's a kind of acting. It's not really coming from his heart. And I learned, it says from the examiner, I said, well, it's like like putting a stamp. I am II have an empathy to you, but just let us get on with the exam. Uh It must feel like it is out of his heart. But anyway, um I was hoping to continue the exam with him if it was me. II wouldn't give him fail. Unfortunately, uh He need to really improve a lot. And uh what is really mistake for uh for candidate 22 01? He doesn't have a system to check all the history. You go to chest symptom, cardiovascular system, gi symptoms, urinary symptom, musculoskeletal system, urological system. He doesn't have this system. He, he, he stops a little bit and then what come to his mind? Let us ask about nausea and vomiting. What about nausea and vomiting? And then he stops a little bit. You can't feel that he's having, let us say the check boxes for his history. Did you notice that professor Shari uh you, you're uh, you're muted. Uh You need to unmute. Yes. OK. Yes. All right. So I think you can take a little in the same scenario. OK. To have, uh, do you like, so you can, you can take a history from, you can see the difference. Oh, brilliant. Ok. I will be the acting. You can start so you can start on it. Hi. Uh, good evening. I'm Doctor Matthew. Uh, may I have your name? Yes, my name is John Stewart. Hi. Ok. Um, so can I get your, and what's the reason for coming? I am a 65 year old man, uh, retired worker. All right, nice to meet you. Um, Mister Johnson. So, can I know what brings you here today? Yes, I have an abdominal pain in my lower tummy three days ago, started when I was at my daughter's wedding. Seems to be getting worse. Not getting better. So I came to the hospital today. Ok. First of all, I'm sorry to hear that you're having a tummy pain and so on your. Um, so you're telling me about this tummy pain around your abdomen. Um, it has been about three days. So tell me more about the pain. Does it go anywhere? Yes. The pain is grinding pain. It radiate little bit toward my back. It doesn't radiate anywhere else and it's there all the time. Maybe when I get out of bed it, it is maybe a little bit less, but I'm staying in bed the whole day. Yeah. Does anything you do and give you pain or? No, not really. It's like constant pain and II can't really go to sleep and it is getting worse today. II couldn't handle it. That's why I came to the hospital? All right. Uh, you said it's really painful that you can handle the pain? Can I get you a score of 0 to 10 on the pain? Yeah, I, II would give the pain now, is, is probably nine when it started three days ago. It was about three or four. Right. So, it's gradually do something about it. But before we go there, can I ask if you have any, uh, a, no, no, no. Uh, what about, uh, feeling nausea? Uh II don't feel hungry. Uh, maybe a little bit of nausea, but I haven't vomited at all. All right. No. Vomiting. Any diarrhea. No diarrhea. I didn't go to the toilet, um, for the last three days. Right? So it's only three days. So I don't think you probably have any, uh, on, on, on the sorry and intended weight loss. Uh, no. Yeah, no weight loss. Uh, that I noticed in the last six days, right? I just briefly wanted to check out. Do you have any breathlessness or chest pain? Um, I, II don't feel restless but, uh, my ability to work is diminished but I don't feel breathless. Yeah. Ok. It's been three days. Uh, just one you are if you have any problem. Uh, yes, I noticed yesterday that I passed a very dark urine. Yes, only yesterday. Not before. So you do have dark urine as well, but no pain in urine. Urination. No, no pain. No. Ok. Um, so you told me your worker? Can I know? Um, are you still working? No, I'm, I'm retired. Uh, work, uh, work. Yes. Ok. Uh, can I have not, uh, with you about your, uh, do you smoke? Yes, I smoke two cigarettes a day for the last 20 years, right? And you said you were having some alcohol at daughter's wedding when you were? I say, uh, do you, do you drink a couple of, couple of glasses, uh, every day? But, uh, not necessarily, uh, all weekend, only two glasses a day, two glasses of a chili a night. Yeah. Ok. Um, also I have to know if you have any allergy to any medications. No, no allergy. No, no allergy. No. Uh, do you have any medical conditions that you're aware of? Yes, II, am diabetic diagnosed this three years ago type two diabetes. And I'm also, uh, hypertensive in the last 10 years and I take, uh, my medication. Ok. Ok. I think, uh, that's about it. Um, so, um, I think so. I wanna summarize that. Your, uh, ok. Uh, summarize. Uh, yes, please give me a summary of, of this patient history. I met, uh, yeah, who, uh, experience, uh, uh, for the past three days, which is, uh, a couple of, a couple at the wedding and the pain was constant radiating to the, to the back and it has been increasing scale of 3 to 4 to 9 at the moment and there is no, there is nausea but no vomiting, no bloatedness and it associated uh, and the man is under and uh a smoker and also an alcohol drinker. Ok. And what do you think your initial diagnose? Do you like to continue the examination professor? She uh, no, I just, uh, he's ok. He just forget what. And uh we have forward and when you asked about any medical condition you need to, are you in any medical condition like diabetes or this? But uh the second or the other is OK. So uh you can continue uh doctor uh oh, ok. So what is your initial diagnosis? Matt. Um my initial diagnosis would be uh OK. Number one. And also uh that could be more than 40 cystitis and yeah. Yeah. Ok. And what is your initial investigation? Would you admit this patient to the hospital or not? I would also more and, and moving the patient condition only three days, it could be some sort of a ongoing and also to move on to I so, so around the the uh and the liver area. And also I would like to uh if you need it, I would like to proceed to an M RCP or even an E RCP if indicated. Excellent, excellent man. This is a pass to me. This is the past you took history very well. Uh although at the point that professors would decrease the pain but you can get away. But in the last three minutes. Other than you, you'll give a good summary in, in 1.5 minute. And this skills is not easy to grasp, to summarize exactly where to pinpoint, where is the problem? And you done it very well. And in the other 1.5 minute, you did show me how much knowledge you have about pancreatitis. Also, there was two point was completely mentioned by the, the previous candidate didn't ask about alcohol intake or smoking, which is essential uh because I'm a smoker. And when, when the Egyptian comment about drinking two glasses of wine a day, as he mentioned, patient is alcoholic. This is totally wrong because if you live in United Kingdom, this is most people will drink this. They are not considered alcoholic. Alcoholic is if you are addict to the substance. Uh and this really will make the lay examiner to really get fussy about this name because he probably the lay examiner, drink to two glasses of wine a day. So as if you are calling him an alcoholic, but you did show me good knowledge, you pinpoint what you want to do with this patient and you definitely admit this patient to the hospital because I send him home and this was acute pancreatitis. This is a failure for me. So when you have this condition, how marking are they distributed in to reduce yourself and get the consent is one mark and you don't, this very well. Can I take a history from you? Um can I call you John? I like this to get a little bit of social acquainted with. And um after that history, we get four marks about the amount of history that you are going to have and a communication skills mark. You did show empathy about the wedding. I didn't uh uh send it to you that a friend of mine has died, but he already replied very well. And um that's a straight past for me. What's your opinion? Professor Sheri? Uh Yes, it is. OK, of course. Uh In the exam, every point is recorded because is the exam and uh each station you have at least two months out of 20 is with the patient. And usually in the scenario, we have something like good news or bad news. So you need to react to it. Yes. OK. Uh The main is help to, if you manage time correctly, you have to target it is easier to work. But uh whose failure in exam is bad management of time. So he don't take a time. He don't ask about history or social history or family history or other disease. So he lost in each one, mark, one, mark, one mark. So at the end, he has uh much closer. So it is very important to know this decision. Uh I think you can ask uh any other candidate just ask him after diagnosis of the history and to kind of start one by one started from lab investigation, radiological investigation and see anybody so any volunteer can, uh, can open his mind and you can talk, what is your diagnosis and what you will do? Ok. If anyone, yes, if anyone want to volunteer, uh, it's a great privilege to be examined by Professor Sein Hariri. He has examined thousands and thousands of candidates. Uh, anyway, it doesn't seem to be any volunteer. Let me take this chance. Professor, you've been examined. Yeah, you've been examined in the Royal College of Surgeon in the last, in the last 20 years. If I want you to summarize your advice to Egyptian candidate who has paid 60,000 Egyptian pounds, which is 1050 sterling and they want to work in the United Kingdom. What do you advise them to pass this exam safely? So 1st, 1st, you need to be calm. So if you are in stress at any time of exam, this is would be down because we suppose surgery is a stressful condition. So suppose you are stressing exam. So they usually you examiner and the communication is put you down even though we have correct answer and you need to be sure because sometimes I ask you, are you sure? So you need to be confident and be sure. This is 1st 2nd during presentation, one of the communication skills facilitation, you need to be eye to eye contact with the patient. The examiner usually behind you don't, the examiner and the body language or body response, you need to be much moving just for the examiner don't to be leaning forward. It is difficult to be like this and all this in the English culture and we consider it maybe in other countries consider. But your way your presentation is considered, uh this is very important point to professor in, in my last exam in uh in in hospital. Uh one of the examiner which was from African country, he leaned forward so much that become his chest, his head near the chest of the actor. And we failed him just because of this. He doesn't have the body language, you know, you, you shouldn't be near enough to actor and shouldn't be far away as well. It's an intermediate but this is very important point as well that you show. It is if you look to any in the news at to make usually in a stress, it mean that you are of course some, some candidates, he move his leg and he become a stress, any, any sort. Of course it is a stress exam. I think you much. But if you are, I think that you are stressed, I usually put you down because you know that English culture is different than maybe Middle East culture. This is the second uh no need to say something in the like, don't ask as a patient if your stomach hurt you because the stomach is so much stomach is not uh the abdomen. Um We do his exam and the simulated examiner is usually professional. He work for long, long time. The exam is run about 20 times per year all over the world. So not to say like the first candidate work or your SOMA or all this, you need to speak in normal medical term. Uh Last uh of four. Uh Don't forget to summarize, you need to summarize. Uh don't forget to ask about uh other system. What's happening with his history, usually a candidate in the history like it is a pan, it is acute cholecystitis. He concentrate in everything in acute pancreatitis but he can found one mark to four or maybe mark for other system. Like what is about your heart? What about urine or what any palpitation have a mark history of all. You have a mark, social history, have a mark, family history, have a mark. So you can it is easy to 67 mark and no sense. And you take a very good history. So some students take very good target history or history and they forget to ask about other system. OK. Uh We are going to advise to say at the end what you concern uh what they say what you expected from us to do because I see in many, many many sur especially in Middle East, they asked as a patient, what you expected from us to do. What is your concern? It is not an answer at all. We want to do it in your country. If something you want to do in your country, like big country, like Egypt or any country in Middle East. So if it's not, we don't consider if you work in exam like in your country. So it will, you can easy to pass if you make something. It's not logic. So it is not, not good. So it is, I was surprised to Professor Ha from the question at the end of this abdominal pain, what do you like me to do for you? Um Can you imagine the doctor and all the actors said, just leave my pain. And uh one of the question, what do you think is wrong with you? And uh what do you expect us to do all this question? I II think they are being pushed to candidate from somewhere and you get them wrong, totally wrong. Uh uh And uh even if you think of logic, shall we say to patients come to us, what do you want from me? I want you to relieve my pain to show me what I have to treat me. It's quite obvious and this mistake is getting common and common. I'm really depressed with this mistake. Did you have the same feeling? Professor Harir? Yes. Yes, it is common. But usually nowadays we don't comment in any bad behavior or abnormal behavior with. So just to manage the time to time. So I think if anyone other maybe can take me again, we can ask him uh about investigation. We just start by investigation. So what is the first investigation though? This patient is well known that acute pancreatitis, what is the first investigation you will do? So again, I would like to proceed with the full investigation. Uh I'd like to see the white cell count if there's any. Uh uh So first he mentioned that he looking for full blood count, looking for le if you look to mention looking for leukocytes. So we did have a after that, what if after that uh like the and then also take the liver function test which liver function test. You are looking for this patient jaundice, jaundice. All right. So see the ast the uh you mean liver enzyme? Yeah. So the A A uh yeah. OK. So what is important in obstructive jaundice, jaundice? What what is what liver function test you asked for? So if, if there the A would be and that would be. So, so it is important to concentrate if this patient jaundice may not pancreatitis. In other case is the what else in that investigation? I like to take a and like this, which is more for the pancreas. OK. All right. What other investigation we need to do? Uh radiological, the most common would be the back side abdomen. OK. So it is important information. Ultrasound. You say abdominal ultrasound, we don't accept for you to say ultrasound. So, ultrasound is not the correct answer. It is abdominal ultrasound about this patient is a good bladder disease. What you're looking for, uh gallbladder disease? Look for any stones. So, any from the ultrasound, any uh, yeah, the dilated uh died that uh, it does more than one c so dilated. Ok. A for gallbladder, you're looking for gallbladder, you're looking for very cholecystic uh edema. And of course, you're looking for dilated coma by that. What do you mean by dilated by that? Come about? That would be uh when uh there, there uh some in about that. So the subsequent dilation uh below. So what is, what is normal? Normal will be around six and uh and yes, it is six mi and put it dilated at what level? Uh more than 10 and or one centimeter, one centimeter. OK. So if this patient is obstructive jaundice, what NC do obstructive jaundice? I'd like to do A M RCP or E what is the difference between Mr and the? So MCP is just a pan. So just looking at it whereas E RCP is both therapeutic and diagnostic and how to come with it because if there's a stone, you can try to remove it and put on a set. Uh What does E RCD mean? E RCP. Uh It is endoscopic endoscopy. What is the complication of the uh the complication could be uh perforation uh to the to the pancreatic duct or as a electrogenic injury to the pancreas or can can be acute pancreatitis. Ok. So how to score severity of acute pancreatitis in the patient described by Mr Muhammed severity of that is that criteria. So at the P the pan, the P uh yeah A uh A will be for the, the no A for age above 5555 and N for, for neutrophil and uh T for cr for renal function test. So, PCR E for enzyme. But what diabetes is? Liver enzyme? Uh what is spelling? Ok. Yes. Uh A again for a acidosis and N for sugar. So this is every prognostic factor or uh for acute pancreatitis. Ok. All right. Uh If this patient have acute pancreatitis, what is the cause of this patient? Acute pancreatitis in this patient? It's slightly alcohol. And what are the cause of the acute pancreatitis? Uh It can be caused by uh obstruction. So any, any, any good bladder by that? What if uh it can be caused by uh any infection can be a a uh like a. So the common nowadays is uh G so go to the common by a doctor, doctor, alcohol and a injury by E RCD. Of course, uh hyperlipidemia can cause uh some virus like virus, but in most of the countries they have vaccination. So this is a common cause of bronchitis. Ok. What is the complication of bronchitis, acute bronchitis, uh complication, uh uh could be divided into early, early, early, so early uh most severely the s uh and the you know, so uh uh what is R three? Uh it is respiratory. So it is important to, can decide to look at and degenerate. So look at like acute pancreatitis. Become Coron can be pseudopancreatic cyst, it can pancreatitis and effect like organ failure like R DSA. Other respiratory stress can be acute kidney injury can be coagulopathy can be hypo uh calcemia can be multiple organ failure and can be less. So, pancreatitis is also safe due to stone but can cause a lot of complication and can cause this. Uh acute pancreatitis is important topic in exam because it is common disease and uh is common in or and the gallbladder is common all over the world. So it is important topic. And uh also we can modify the scenario, make it like acute cholecystitis or chronic cholecystitis if the patient has fatty uh fatty dyspepsia or due to fatty meal and have pain. And at this time, we can ask any one of the student, uh what is the character of the acute cholecystitis, pain apart from fatty bur or uh pain uh during fatty meal? What is the character of pain? Any? Yes. So can go to the right shoulder. Ok. I want to ask a question. Yes. You mentioned there are three or four stations that most Egyptian usually fail in from your experience. What are these difficult forestation? Uh, I think, uh, in the clinical, he examines the car nerve. Yes, because Caria nerve is, uh, take time because you have a lot of car nerve. Yes. And he was the time. Something unnecessary. Yes. Uh, the second I think, uh, if he is not orthopedic surgeon, uh, usually you have hip, knee spine is the exam. So if the, if the study is not orthopedic or no experience an orthopedic, usually it is the main problem. Uh after that, the communication scale station. Yeah. And uh lastly, the critical especially uh most of the student not aware much about arterial blood gasses. Uh this is the the common but the other station is easy for all the abdomen exam, uh suture techniques, uh se technique, all this is easy. So, apart from orthopedic communication SCS, the cranial nerve, I think all I would think every time we will fix the time at six P MK time, which is 11 p.m. Malaysia time. What select is the day that you are free? Hopefully it will take two candidates per se. I hopefully we don cross one hour or 50 minutes, something like that in order not to bother them too much. I think you concentrated a lot of very good questions and we have two candidates and the difference in taking history was quite obvious and I hope each candidate takes the courage. Let us volunteer. I have now 11 candidates being booked for a virtual Husky station. We'll go from history to examination to anatomy. We can do a lot of virtual and if you have basic surgical tools, we can also do the surgical skills part as well. So, uh thank you very much, Professor Sheerin. It was a pleasure you like. Is anyone uh of his team is enter the exam before have experience about us or exam? Yes. The first candidate he told me he just failed two months ago. He was in my hospital. Uh, and any, anyone have experience in exam, just tell us. Ok. Uh If anyone, he can unmute himself and speak. Uh, have any, have you passed the exam uh, or went to the exam before? No, I think. Yes. Yes. Yes. Yes. I had, uh my exam two months ago and I had hospital too and I didn't rest. Ok. Ok. What is the d difficulty state that you found? I think the communication skills, phone call was the most difficult one for me. Yeah. Uh, phone call usually it is effective, you know, that we have a full call exam. Uh What is the thing it is about ur or about trauma? It was about tr. So can you tell us what you, I just to take five minutes? Pro uh can you tell us what you tell the examiner? Suppose I the examiner? So you are Doctor Mohammed Dahan and you speak to me about the trauma, what you, what you, what you tell me. Um I think I uh it was a little bit difficult for me to gather all the information in my minutes and you know, to refresh them. Uh No, it is. We don't need to have information, we need to tell us uh what, what you expected to tell. Just to start with me. I am uh my name is she may be different for you. So just to tell me Doctor John. So what, what is your introduction? How to introduce yourself? Number one, you must, you must know whom you are speaking to. So number one, can I speak to the consultant surgeon on call today? Are you Mr So and then can I document it into the notes? Certainly, it, those are your skills. Now we have a station that you read the, you read the patient file for nine minutes and it is ok. Yeah, after that, you go to the phone station. Yeah. Ok. So exam the doctor had you make a summary or not? Yes. Yeah, you make a summary exam, don't think so. Ok. So you, you need to usually usually will ask if you make a phone call to any delivery company like AFC or whatever the company, they usually the who takes the phone at the end? He gave you a summary. So it is important. One of the common I see in the Middle East, they forget to make a summary. So in this patient, uh you uh can you start to just to speak to me? Yeah, just to tell me I am doctor I in consultant. Just a OK. Hello. My name is Han. Uh I'm one surgical doctor. Uh uh I'm just confirming that I'm speaking to the vascular consultant. Yes, I am uh doctor. She, I'm the vascular consultant. OK. So what you need to tell me um I really thought about the scenario. So, no, no, we don't. We don't necessarily to forget to compare the scenario. Just tell I have a patient how old he is and I check and his airway, his breathing, his circulation, his vital sign and I do to him chest X ray, abdominal X ray and the first scan and uh is in a problem in situation. Anyway, I got, I got a message from go that we will finish in a couple of minutes. So we'll, we'll make, we make the next station to be phone station, phone call, phone call. All right, because uh thank you. I really feel bad that Mohammed the who is a very good, very good candidate failed for something simple. It's really simple and just you need to try in eg to fail and phone call by the way. So I, and hopefully we'll, we meet, we haven't fixed the date yet, but we fix it the time to be 6 p.m. Uh but the date we'll see what professor had when he is free. And hopefully next time we'll discuss a phone station and again, we'll put you in a stress situation. I will give you maybe, uh, nine minutes before to see patient notes in PDF, file on the group on telegram and then you volunteer to jump in. Ok. Ok. Ok. Thank you very much. Ok. All the best.