Candidate Instructions CAN be your friend! (3 min read)
Primary FRCA OSCE/SOE season has kicked off!
Everyone always talks about types of OSCE station and how to tackle them, but what about the candidate instructions?
Does anyone pay attention to them?
Does the college put much time and effort into them?
Let’s be honest - they aren’t the “showstopper” of the OSCE BUT they are crucial for setting the scene.
Think - if the college has taken time to write them, shouldn’t we pay attention to them?
Let me share with you my best tips to getting the most out of those candidate instructions, or as I will proceed to call them, CANs.
But first, let’s transport ourselves back in time to when we were last in the emergency trauma list.
“Elsa, a 90 year old lady had a fall in the kitchen and needs an urgent NOF repair done. It can’t wait, and she’s bleeding”
Hands up to all the Elsa’s in the world - I only hope I will reach your age and be as mobile! But I digress.
Where does your mind go when you think about this case?
You might be thinking the following…
“Hmm well first there’s her co-morbidities….wonder if she’s got AF. Is she on anticoagulation? Hmmm shame, would love to do a spinal? Gosh I hope she’s not confused. And we’ll need to make sure we cross match some units for her….oh and….“
What you have just done is looked at the scenario given to you, and used the CUES to formulate the questions you ask about Elsa.
Now all you need to do is translate these skills across from your day job to the exam!
Easy right?
For most of you, yes, but some of you will struggle. That’s why I’ve written this post.
When you read the CANs think carefully about what the station is going to be about. Have a “game plan” for the station, before you get in.
This is based on a technique called priming - a game of association which helps you to come up with the knowledge YOU need.
So let’s apply this to some favourite CANs.
“You have been asked to speak to a 38 F who is due to have an elective caesarean section, due to placenta accreta. She is concerned about the requirement for a blood transfusion”
What are the cues or KEY WORDS here?
“Well, this is a patient who is having a planned procedure, with a high risk of bleeding, and is likely to need a blood transfusion”
How can we use these KEY WORDS to guide our consultation? Well first, we need to get our facts straight…
“Hmm, why she is concerned about blood transfusions. Is this a bad experience? Is she a Jehovah’s witness? Does she have an inherited or acquired blood disorder?”
And what else will you need to establish?
“Does she know about the risk of bleeding with placenta accreta? Does she know what options are available for her if she bleeds too much? This is a planned procedure after all”
Anything else you are missing?
“I need to find out what her ideas, concerns and expectations are so we can come up with a shared plan of management. I have to be prepared to discuss this case with a senior and get a wider team involved”
This is HOW to work through CANs and use the cues provided to plan your strategy for the station.
Practice using this structure on CANs that you read, and watch how it transforms your technique!
Remember you have the reading time, so make sure you maximise it!
IDENTIFY KEY WORDS
ESTABLISH THEIR IMPORTANCE
PLAN YOUR STRATEGY
Much like actors in the history stations, the CANS (candidate instructions) serve as your CUE.
You would be a fool to ignore them!
NB: yes some CANs are one line. Can’t have everything after all ;).
