OSCE VIDEO 1 (epr malaysia)

This is a sample video which can be helpful for you to imagine how it is like during the exam.

Just for your reference, 

and

credits to the students, doctors and the volunteer from IMU. 

Thank you for making this video. 

Question in the video

**P/s: this is exactly what happens to my OSCE exam when I took EPR OSCE on 2019. Although the venue is different (in USM), the way they conduct the exam is the same.

There will always be a doctor in each room to evaluate your performance and ask you questions after you finish the task.

Make sure you organise your time well. For sample questions you can refer to my other posts here.



Good luck!

Will EPR exam be postponed?

To all readers,

I am sure a lot of you are wondering if Examination of Provisional Registration (EPR) will be postponed this year.
Let me tell you the trend, usually the first batch who took step 1 on March will have their OSCE on July while the 2nd batch is on September and December for step 1 and step 2 respectively. 

It is almost the end of May 2020 now, and there is still no news of the examination date for EPR OSCE. So, there is a high possibility that it could be delayed. Furthermore, with the PKPB - pergerakan rentas negeri restrictions, I don't think students will be able to cross state borders to take the exam if they wanted to host it by July this year.

News about PKPB

Reference: https://umno-online.my/2020/05/16/jangan-rentas-negeri-patuh-sop-pkpb/

https://www.hmetro.com.my/mutakhir/2020/05/580354/jangan-ambil-kesempatan-rentas-negeri-polis

I suspect they could delay the exam and host it around the end of the year (December) or next year on 2021. Just a wild guess since SPM is delayed to the first quarter of year 2021 (news on April 15th).
In the end it is still best for you to ask the person in charge from the MMC office. 

• For any queries kindly contact Ms Fatim Nasuha Badaruddin at fatim.mmc@gmail.com

https://www.thestar.com.my/news/nation/2020/04/15/pt3-upsr-cancelled-spm-stpm-3rd-semester-exam-pushed-to-q1-2021

Since there would not be any OSCE exam soon in the next few months, the hope of having the EPR Step 1 for batch 2 graduates are very slim. 
So there is no confirmation if there will be another theory session this year EITHER.

However all this are subjected to change based on how the Covid-19 situation goes.


What we can do now is pray to God that everything can goes smoothly under this new normal, 
and grab this opportunity to study more and be prepared when the time comes. 

(Those who are not prepared should start preparing soon.😁) 


Stay Safe and Stay home!

Pocket notes - Psychiatry and related diseases

This post is mainly explaining the differences between 

Dementia

Bipolar disorder

Schizophrenia

Depression

& also

some things to take note of when we are asking for patient's history.

I remember them through mnemonics, hope you find it useful too!

Community Medicine - Pre-pregnancy care

Some of my friends asked what is included in this section during my exam, so i decided to share with the others what I know about it. 

Community Medicine is concerned with the prevention of disease, the determinants and natural history of disease in populations, and the influence of the environment and of society on health and disease.

and one of the most common problems in community medicine is 

Pre-Pregnancy Care. 

1. Access risk

• age : <18 or >35
• lifestyle: smoking, drinking, substance abuse, etc.
• Sexual history
• BMI: obese? lack nutrition?
• Pets : cats or birds
• Past history : hypertension, DM, infectious disease(hepatitis, HIV)

Specifically for woman with history of 

- Diabetes
- Seizure
- Hypertension
- Heart disease

you will need to counsel them about the risk for their child and to themselves if they are going to get pregnant with the disease they have. Table below will help you to get an idea what you should counsel them. Each of the patient are different, and it is important that you are able to convey the message clearly.

2. Scenario

If a lady is just here to ask your(GP) opinion about the pregnancy plan you will need to ...

1. General screening
  -  History taking: past history, medications, surgical history, family history and related OBGYn history
  - physical examination
  - access the risks
2. Lab test: Blood tests - blood glucose,etc.
3. Access knowledge about health, pregnancy and child care
4. Referral if there are any abnormalities with the blood test

3. Counsel content:

1. about birth and pregnancy

• folic acid 3 months before pregnancy, stop anti epileptic meds
• breast feed knowledge
• child birth preparation

2. lifestyle changes

• diet : control/refrain from smoking, alcohol, substance abuse, caffeine use
• social life: extreme activities

3. Genetic factor: anyone from the household has genetic disease ?

4. Family planning : COCP

5. Screening: pap smear, STI, DM, Hypertension

Try to calm the lady to reduce their anxiety (if there are any complications that could effect the pregnancy). Always ask if they are comfortable to proceed with the consultation or they need their family to be with them.

6. Are they fit to get pregnant? Do they need constant follow up? 

Set up a follow up date if they really need one. 

Remember to always be caring and be patient with your patients. 😀

Reference:
1. https://www.ncbi.nlm.nih.gov/pubmed/6585101

2. http://www.myhealth.gov.my/en/pre-pregnancy-care-ppc/

Test yourself - Pelvic Bones

Test yourself  - All about pelvic bonesss

You think you know it all? Try these and prove it !

Q1. Name the pelvic lines 

Answer:

A: Ilioischial line

B: Posterior rim of Acetabulum(ischio-acetabular line)

C: Shenton line

D: Iliopectinal line

E: Roof of Acetabulum

F: Anterior rim of Acetabulum (acetabulot-obturator line)

G: Shenton line

H: Tear Drop

Q2. Name the structure below

Answers:

A:  Right hemi-pelvis
B: Left hemi-pelvis
C: Sacroiliac joints
D: Sacrum
E: Pelvic Ring
F: Pubic Symphysis
G: Obturator Foramen

Q3. Name the structure and muscle attached to it

 Answers:

1. Iliac crest - abdominal muscles
2. Anterior Superior Iliac Spine : Sartorius muslce
3. Anterior Inferior Iliac Spine : Rectus femoris muscle
4. Greater Trochanter: Gluteus medius and minima
5. Lesser trochanter: Iliopsoas
6. Ischial Tuberosity: Hamstrings
7. Pubic Symphysis: Adductors

Other Notes:

 Muscles connected to the pelvic bones. 

This is a post specifically to help you revise what you know about the pelvic area, specifically for orthopedics. 

This is very important and popular to be asked in exam. 

I am sure you already know this structures from medical school, hope this exercise helps you to remember them again😁

Good luck!

USM Exam Part II Experience 2019

Examination for provisional registration

Date of exam                      : 3rd December 2019

Date of Intensive class       : 1st and 2nd December 2019

Duration                             : 3 days in HUSM

Transport                            : Flight from KL to Kelantan (around RM 500)

Exam Cost                          : RM 3000 for the exam, RM 1000 registration 

Utility Cost                         : Food RM100, USM Guest House RM 75/night (shared a double room)  

Past Year Question link      : USM 2019 Dec
Things to pack along          : Lab Coat, Stethescope, Pens, Snacks and sweets, Formal attire
                                              (pentorch, hammer will be provided if it is required in the station)

What happens after you pass?

So after you pass, you will need to wait for about 2-3 months before they give you a call to let you know the next exam date. DO NOT wait until they call to start studying, it will be too late >.<

After I receive the call, they send me the letter two weeks later (around 5th November). And we will need to:

 - confirm if we are going to take the exam

 - confirm if we are attending the intensive class

 - make payment

Letter Head of the Offer Letter

Part of the Letter

Accomodation

-They do not provide accommodation for us, so we call a few numbers below to ask for availability. If you know a friend who is taking the exam together, you can share a room with them. It helps to improve the atmosphere, or you will be nervous all the time, plus you will have a study partner too! 

After consideration, we choose to stay in rumah tetamu USM, it was more expensive but the room is bigger.

The double room we had even has a balcony and a pantry area.

I had a picture of the bed below, please ignore the mess we made. XP

Usm Guest House 

Itinerary

We reached one day earlier to settle in and get use to the place. It depends on you if you need it or not.

On the first day we are require to go to this pusat sumber pelajar for a briefing. It was in Hospital USM itself. Remember to bring a jacket, it is quite cold for me.

They also gave us a schedule of what we would be doing for the rest of the day, so we can get prepared. We are being reminded that this intensive course is not a class to teach medicine from A to Z, but a class to help us get use to how the osce is going to be done (such as the scoring, what they expect us to do in the exam venue, quick summary on what the examiner expect when you see them on the exam day). 

The intensive course was really useful, it help a lot to make us get use to the environment and the exam style. 

Intensive course Venue

Schedule for 3 days

Tutorial Hall

Practice Session
We are given some time to practice on manikins in a room (I am not sure what they call it)

Where is our exam hall? 

The pictures shared above is a sneak peak to where our exam was conducted. It was scary at first, but soon you will get use to the flow. I enjoyed the OSCE exam more then the theory, because it reminds me of my days as a student taking my final exam during my university years. So glad to be able to be one step closer to my dream after a year of waiting and studying!

If you want to know about how it was being conducted, check out this link.

Take Home Tips

- Read the questions properly. Think and try to recall the information you want to ask and present. 

- Always start with greeting, introducing yourself and wash your hands!

- Build good rapport and have eye contact with patient, respect the examiner as well.

- Take patient identification data! (name, age, marital status, occupation) follow by their chief complain

- Balance with open and close ended questions about the assessment. especially : mental assessment, suicidal risk, OCD criteria, trauma related. -- they are very important and often carry high points
- Always say thank you to the patient and also the examiner
- I know you will be nervous in the room, but try present your finding as organised as possible, so the examiner can understand you and it helps you with your diagnosis too!

I wrote a post on what came out on that day, you can learn more from here.

So try your best and have fun in the exam! You will meet a lot of new friends who are in the same situation. Get their contacts and keep in touch😁

Enjoy and pass the exam with FLYing colours!

2018 OSCE Past Year for EPR

Past year OSCE 2018

This is the past year topics asked in USM 2018 and specifically for those who took the examination for provisional registration. I didnt have the past years from those who took the exam in IMU, so if there is anyone who took the exam that year and would like to share, you are welcome to share it in the comments.^^



If you are interested in what they asked in 2017, refer to the previous post.

USM EPR OSCE questions 2018

Gynecology
1. COCP
2. Speculum Examination and high vaginal swab

Pediatrics
3. ORS usage advice for children
4. G6PD counseling

Orthopedics
5. neurovascular examination (lower limbs)
6. Elbow Joint Dislocation (interpret the X-ray)

Psychiatry
7. PTSD

Emergency Medicine
8. CPR
9. Mallampati classification + Airway assessment

Internal Medicine
10. Hypertension
11. GI perforation
12. Pneumoperitonium

Opthamology
13. Visual Acuity Test (patient with hypertension and diabeter)

Surgery
14. DRE
15. Colonoscopy consent

Others
16. ABG interpretation and Heart attack evaluation

2017 OSCE Past year

Past Year Questions Year 2017

The topics below are the topics from the students who took the  Examination for Provisional Registration(EPR) OSCE on 2017. I do not have the specific questions but having a main topic is sufficient for me to prepare for exam after knowing the rating rubrics for osce.

Study each topic in detail to make sure you get it.
&
Hopefully it is helpful for you!

P/S: For reference only!

IMU July 2017 OSCE

1. Hemiplegia
2. IDA
3. Cataract
4. AOM (Acute Otitis Media)
5. Rib Fracture
6. Diabetis Mellitus foot ulcer
7. MMSE + Bipolar
8. Constitutional Small gestational Age (SGA)
9. Thalassemia
10. Hepatomegaly
11. PUD
12. Contraceptive methods
13. Nephrotic Syndrome
14. Gall bladder Stone
15. Break bad news (Patient diagnosed cancer)

USM Jan 2017 OSCE

1. Schizophrenia
2. Bipolar
3. GCS and its usage
4. Snellen Chart
5. Nephritis
6. Hepatomegaly
7. Septal Deviation
8. Hemiplegia
9. COPD and Lipoma
10. choledolithiasis
11. Diverticulitis
12. HPN + IUCD
13. Fundal height (Prenatal check up)
14. Dysfunctional Uterine bleeding
15. Knee Physical Examination

Good luck!

How is your OSCE graded for EPR - Part II

The Rating Rubrics of OSCE (Part 2) - for EPR Malaysia

Notes: 

• BOLD: Must do
• Underline: clinical related

Lets continue from what we left in the last post 😁

Part 2 - History Examination

• Uses a structured, fluent and focused approach to history taking, relevant to the station
• Uses a combination of open question and closed questions where appropriate
• Respond to information given by the patient, rather than strictly appearing to follow a standard/ guided formula of questions.
• Obtains key an relevant information and shows the ability to use the information appropriately
• Question reflect the depth of understanding of the clinical condition/ pathology, where applicable.
• Repeats, reflects, summaries and clarifies any misconceptions as necessary
• Allows the patient to ask questions and endaevours to answer those
• Able to ask the patients to give more information missed earlier.
• Avoid premature or false reassurance

Part 3 - Physical Examination

• Wash your hands before starting
• Seeks permission to examine and explains the nature of the examination 
• Asks for chaperone where appropriate
• Does not distress, embarrass or hurt the patient unduly
• Respect patient's modesty
• Asks the patient if any areas to be palpated or moved are painful
• Positions the patient correctly and comfortably
• Uses a methodical and fluent approach indicating familiarity with the examination skill.
• Examines/suggests examining all the relevant areas with the correct technique.
• Completes the task in the allocated time, thanks the patient and covers up the exposed areas.

Part 4 - Procedural Skills

• Introduces and explains the procedure and gains consent
• Ensure privacy - asks for chaperone where appropriate
• Prepares the patient with correct exposure and position for the procedure
• Checks that all relevant equipment are available, appropriate and functioning
• Ensures aseptic precautions and correct methods are taken.
• Ensures correct and safe placement of equipment wherever necessary
• Avoids any unnecessary/ dangerous steps
• Disposes equipment appropriately and safely.
• Thanks the patient.
• Document and/or labels the process or samples appropriately.
• Completes the task in the allocated time. 

Part 5 - Professional Skills

• Explores patient's understanding before providing information.
• Encourages the patient to ask questions and responds appropriately.
• Provides correct information and options without the use of jargon.
• Discover the impact of the problem on the patient's life and acknowledge concerns.
• Respects the patient's autonomy and negotiates with the patient appropriately.
• Reviews the patient's understanding during the interview - clarifies and summaries where appropriate.
• Appears to have a grasp of the issue and its ramifications - minimizing conflict.
• Acts assertively and within the codes of practice and law.
• Reaches and agreement with the patient about a strategy to progress.

Part 6 - Content Knowledge

• Systematic approach in collecting and/or understanding the data/ scenario/ information presented.
• Able to interpret the data or information provided and correlate it with clinical relevant context.
• Able to identify and recognize the pattern of the underlying problem.
• Able to integrate the information provided.
• Able to make a conclusion/ diagnosis / differential diagnosis if applicable.
• Able to apply knowledge to the problem presented such as listing possible complications and management. 

So these are the 5 details that are important and vital for your exam preparation. 

Once you fully understand these, don't forget to practice with the questions in the books (Question samples can be found in sams) !!!

How is your OSCE graded in the each station? -Part I

The Rating Rubrics of OSCE

How did you know how well you did in OSCE ? 

Advantages of understanding the SYSTEM

1. The scoring system is vital to ensure you score on the parts that you can do well, so it could help you with the other parts that you lacking.
2. To understand the flow of thoughts of a doctor, when you are with a patient. 
• Do you know what question to ask next based on their response, which could aid in deciding the final diagnosis?
3. To practice it on the topics that you are studying with a direction, instead of trying to memorise everything into your brain.

      4. Since you know how they give you the score, you will also know which station you didn't do  well. But do not give up, this gives you the opportunity to reflect on what you did wrong, so you can score better in another station.

Practice, Practice, Practice!

The key to passing OSCE is not just about having good basics and knowledge 

but also constant practice either with yourself (using the mirror) or with a friend, 

and the best if you have the opportunity to talk to patients

Scoring Block

It is separated into 6 parts which consist of 

From the table above, you can see there other than the 6 main criteria, there are also scoring based on your performance. 

Each Part will have a total point of 10, 

However in the end of the session, they will add all points together and finalise with a 0-10 score. 

For example: 

A student scored 5 for each part, therefore the total points in the end she get is 5, despite the total score is 30 points/60 points

The scoring board is further explained into detail actions that you should do during the examination.

1. General Approach

• establish rapport early with examiner and patient and maintains it. 
• example: greetings to examiner and patient, try to make them comfortable with your presence with a SMILE :D
• Positive and appropriate body language and eye contact
• It is understandable to be nervous at first, but try to breath in deep breathes to calm yourself before entering the room or do something brash (impolite, talk too fast, not considerate, avoid eye contact) , be polite
• Demonstrate a fluent, coherent and confident approach
• Be like how a doctor should be when talking to patients, reassure them and not being lead astray by their questions. Be patient and explain till they understand
• be confident but humble at the same time
• Able to communicate answers clearly
• it is useful to give some pauses for the patient to think about their condition (especially in breaking bad news).
• Ask the patient if they have any question after your consultation session/ follow up session is complete. -  This helps to understand what the patient do not understand while you are explaining. 
• When relevant
• Clearly explain the purpose of consultation and seeks consent where applicable
• Ensure the patient is safe
• Identification, name , age
• use alcohol rub/ washing hands before and after procedure
• Maintains a courteous and caring attitude
• be concern when patient is crying, hand her some tissues, 
• ask if the patient wants to have some space and breath, 
• ask if the patient wants to her relative to be with her.
• try to understand why the patient is upset/angry/frustrated.
• Listen attentively and acts with Empathy (similar point above)
• Avoids or explains medical jargon and provides accurate information
• do not explain their condition using medical terms!

The detailed criteria above helps the examiner to determine which score you deserve. 

(from 0-10 )

This section is the easiest/ hardest to score, as it depends on the situation,

Tips: 

Stay calm, smile, greet and say thank you.😁

ToBeContinue ... ... in Part 2 ← click here

- History Examination
- Physical Examination
- Procedural Skills
- Professional Skills
- Content Knowledge

The scoring system above is applicable for those who are taking the malaysia medical board exam (examination for provisional registration).

OSCE Books (Examination Provisional Registration)

Which book would I recommend for Part 2 Exam?

This post is mainly about the study materials needed for the OSCE part of Examination for Provisional Registration (EPR) in Malaysia. If you are looking for Part 1(theory) click here.

Resources

There are a few resources I used which I find useful while getting ready for the exam which includes

1. Samson Handbook

2. Oxford handbooks

3. Ten teachers

4.  Books used by local graduates

5.  Online resources

Book References

Samson Handbook of PLAB 2 and Clinical Assessment 

By Dr Samson Chissi

This comprehensive and friendly book is a good guide for the EPR step 2 exam. 

It covers most of the topics and scenarios that you can be tested on in the EPR2 OSCE.

I find it most useful especially in guiding us how we should react and talk in front of the patients. 

This book has a step by step guide on how you start your conversations to your posture and respect for the patient,

Pocket Guide to Physical Examination and History taking

by Lynn S. Bickley

If you graduated from other countries such as: China, India, Indonesia, etc. This book is a good guide for you to understand how the malaysian's expect from you when you are required to do a physical examination.

The sequence(you learn in another country) can be a little different, but there is nothing that you could not overcome with the guidance of this book. 

Oxford Handbook of Clinical Medicine

It doesn't matter which edition you have, the most important is to know the content. 
The medication and prescription they use in this book are quite similar with what the doctors use in malaysia. 
- Good to refer to if you forgot some information about a specific condition.

Oxford Handbook of Clinical Specialties

I love to use this book as a reference for specific subjects like orthopedics and trauma, pediatrics, Primary care and other sub topics like ENT and Opthalmology.

The obstetric and gynecology here is quite good but I prefer to use the ten teachers for reference.

OSCE stations explained!

To read this post you have probably passed your first step of EPR!

Congratulations!

So what should you do next?

Usually you will get a letter, telling you passed the exam "lulus" in a certificate.
Keep the certificate as it will be needed later on when you are applying for Houseman.

After you pass, you can start studying for your 2nd step of EPR, which is the clinical part.

Time is really precious! Its advisable to start studying right away after you know the results but if you want to take a break, go ahead! Make sure you have at least 2 months to study for the OSCE.

When will you get your results?

You will know your result roughly about a month after the exam, if you did not receive any news, EMAIL them ASAP!!! Your results are probably out but you are not being notified by the authorities.

Results collection

You will receive an email to take the results from MMC.

If you could not collect by yourself, you may ask other to collect on behalf for you. 

But, your on behalf MUST submit an Original Authorization letter (prepared and sign by you) while collect the result.
If you fail to follow the guidelines. Your result will not be given.

Application

The application for step 2 is different compare to step 1.

They will give you a call when the venue is decided, usually 3 to 8 weeks before the exam.

I wrote about the schedule for the EPR exam in this post.

• IMU (Usually on July)

IMU provided 1 week course before the exam,
Cost: RM 900

Advantage:
1. If you stay in KL, distance to travel is less.
2. 1 week course to actually make you prepare your materials
3. To know all friends (to be colleagues) to study together!
4. A lot of food around the area

Disadvantages:
1. I heard there are less friendly? But I did not take the exam there, so it is very hard for me to judge.

• USM (Around Dec-Jan)

USM provides 2 days course before exam,
Cost: free of charge

Advantage:
1. the professors are very friendly, they try to answer all question that you have (even the ridiculous and stupid questions..>;<)
2. far from home, no distractions
3. There are guest house in USM university, there are a few places you can choose to stay, the price range from RM 80 - 200 (depends on what kind of facility you want)


Disadvantage:
1.  The location : it is in KUBANG KERIAN, KELANTAN! You will need to take a flight there which probably cost you about RM300 (two ways from subang airport, cheaper if you use KLIA air asia)
2. Food choice are limited, more to malay style. There are a few nice looking shop around but why eat those when we should try the authentic local food?
3. The 3 days course cant prepare you to pass if you didnt study by yourself !!! It is a revision session only to help us recall important key points, and to understand how the exam is conducted.
SO do not depend on the preparatory course they provided.

I will focus on explaining how USM application works in the upcoming post since I took the exam there.


EXAM Format

1. 16 OSCE stations

    Each OSCE station will be about 10 minutes, you have 1-2 minutes to read the question outside your station and later enter into the exam room after you hear the bell. The timer starts once the bell stop. So it is very important that you plan your time properly when you are reading the question. You can start planning what you are going to do once you step into the room.

 *OSCE : Objective Structured Clinical Examination

2. Short or long questions

Short and Long Questions are a must for the local students, therefore they will have a lot of sample questions. If you do have friends in local university, do not hesitate to ask those questions from them. It is useful to help improve the knowledge you need for osce.

DO take note that there are no short or long questions for the practical exam in EPR.  

However I am not sure if they will change the format or not, please ask the person in charge before you take the exam.

3. Skills tested

4. Compulsory Subjects 

No.	SUBJECTs	Stations
1	Surgery	2
2	Medicine	2
3	Orthopedics	2
4	Obstetrics and Gynecology	2
5	Pediatrics	2
6	Emergency Medicine	1
6a	Anesthesiology	1
7	Psychiatry	1
8	Radiology	1
9	Ophthalmology or	1
	Otorhinolaryngology (ENT)
10	Preventive Medicine / Family Medicine	1
	Total	16

All stations have the same weight that contributes to your final pass. So make sure you are able to score as much as possible in each station. This really helps boost your final score and help with the stations that you did not do so well.

I will update more on what materials to study soon in the next post!