How to approach a station in the exam?

By DrSarat Chandra Viswanadh Tata on Saturday, 22 September 2012 at 20:27

This is purely my personal experience and my plan of how to approach a station. kindly use it just as
a guide.
Some of my views may not be the right ones - If so, please say so!!
Believe that you can pass every single station!! (Who can believe? - The doctor who works hard and
prepares well in advance and who can relax on the day before the exam, have a good nights sleep
and be relaxed and focussed on the day of exam)
The Golden Minutes(The 1-2 minutes reading time)
1. Read the question and tasks very carefully. e.g., dont come to conclusions as soon as you start
reading or after you have read just a few lines!! Do not guess but keep formulating your hypothesis!!!
Even when you feel that the case was exactly the same as AMC book/a previous recall, still take time
to formulate and exclude possible dd.
2. Think of critical errors and key zones to perform. E.g., If its a diabetic LL exam think of
Dermatological, Neurovascular examination. Be focused.
3. Try to work out what the examiner is trying to find out E.g.,
A. Diabetic LL PE - Accurate technique of examination? Using appropriate tuning forks? Comparing
findings of both limbs? Missing injuries,ulcers or neuropathy findings?
B. PVD examination Buergers test, peripheral pulses(Technique and accuracy of findings)
4. Do not be over suspicious looking for tricks or pitfalls in the question. However, do not think of very
silly diagnosis too.. Think of all possible things to cover E.g., A child with loose stools/URTI usually is
not vaccinated due to some issues failing to address this issue amounts to clear fail(BIND
approach in children)
5. Logical reasoning may help you answer some questions.
The Deciding Minutes(7-8 minutes)

1. Always wear a gentle Smile on your face. Do not show anxiety(Hide it)
2. Keep track of time preferably using a stop watch (I used a wrist stop watch purchased from
target @ 10 AUD Throughout my last two weeks of prep and during the exam this proved
invaluable for my time management)
3. Greet, thank and remember to wash hands before and after PE.
4. Even if you know the question before and are very sure of the diagnosis, exclude some
common and serious dd - remember they want you to be safe!! E.g., DD in headache - Even
though you are very sure that it is tension headache/migraine you should still r/o

meningitis/sah(Failing to ask regarding n/v in history and BP, neck stiffness and fundoscopy
in PE could be a critical error)
5. Be logical. Let the flow be soft, smooth and clear. Do not rush and throw lots of information.
Remember to use layman terms when talking to the patient(Avoid medical jargon You will
lose precious time if you dont).E.g., (It is better to ask) How about your waterworks rather
than How is your urination? This gives an idea that you are following Australian style of
approach.
6. Follow fixed pattern History, PE, management and counselling and end with 4R approach.
Always provide safety net.
7. Patient comfort and safety is very important. Remember to relieve pain, be safe!!(Red flags,
Refer, Reassure, Reading material and always Review). If it is an emergency station start
with haemodynamics - Ask the examiner - Is my patient haemodynamically stable? and then
start the task.
8. Do not forget to ask about drug allergies. Remember most patients in the exam have
antibiotic and morphine allergy!!
9. Try not to give an impression of clear rote memorization, be natural but at the same time
quick!! (This comes only when you have knowledge at finger tips and PE skills as spinal
reflex)