ISCE tips?

**Yixian** · 02-02-2010, 09:52 PM

I've started practicing for ISCEs knowing that it's probably going to be my biggest hurdle this year, and was wondering if anyone who has already done year 2 has any tips that are worth remembering? Good ways to practice? Important things to revise?

**iceman_jondoe** · 03-02-2010, 04:22 AM

Its great that youve started practicing now, no better time really!. Heres what i did:
Ideally get a group of three going. one person to take the history one person to perform the examination, and another person to observe and provide constructive feedback...this doesnt mean pissing about in CSRC cracking jokes (well maybe a bit), but it def means you will make the most out of each practice session and so will the people you practice with.

You'll notice in clinical skills there are ISCE packs...work through one or two a week. Each ISCE pack contains 2 patient histories so you can take truns in your group performing different histories/modifying existing ones. From my experience and the questions i bombarded the CSRC tutors with last year:

1. Your likely to get mental health station so make sure you learn how to perform a Mini mental state examination (which is scored out of 30) AND a mental state examination (i remember the latter using the mneumonic ABC SMITH - Appearance, behaviour, cognition, speech, mood, insight, thought hallucinations).

2. You will EITHER get a CVS station or a respiratory station so you should practice for both you unlikely to get them both but i could be wrong. You'll also probably get a GI station with a digital rectal exam as a skill so practice this.

3. your UNLIKELY to get examined on a skill such as venepuncture, or injections..the tutors say this is because they have insufficient dummy arms for people to be examined on all at the same time.

History taking: Learn the menumonic SOCRATES SAD This stands for Site, onset, Character, Radiation, Aggrevating factors, Timing, Exascerbating factors, Severity, Social history/surgical history, Allergies, Drugs. This will help you with any pathology and any station related to pain! So if someone presents with CVS pain work through that mneumonic and you'll remember what to ask! Always ICE your patient aswell..this stands for Ideas, Concerns, and expectations. This will get you the marks for all that wishy washy stuff that PMS markers want about how the patient is "feeling". Finally each system has a set of questions that need to be asked associated with it. I suggest to learn these questions make up a table. e.g. CVS - Ask about palpitations, SOB, Syncope, chest pain for GI- Ask about bowels, waterworks, blood in stool/urine, weight loss. Sexual health - No. of partners, pill use, protections, STI's etc etc.

Examination: WASH YOUR HANDS....some muppets in my year still forgot to wash their hands in the ISCE despite being taught this time after, time after time. so dont forget to do it. If you do depending on the examiner you will either get a borderline mark for health and safety or a straight fail for the examination part of the ISCE station, so dont screw it up!. Practice your examination techniques. Rather than just performing mindless actions, ask yourself WHY your checking the nails for clubbing, why your percussing the chest, although you wont get asked these questions, it will help you remember the steps you need to do, and once youve developed a routine to a specific exam stick to it.

The ISCE is only a "hurdle" if you dont practice. Last years ISCE stations were GI, Mental health, CVS, MSK GALS (giving information), obstetric (preg abdo exam) and obs ang gynae hx) and a medication review station. Thats 6 stations in total. Ask plenty of q's if your in CSRC...the nurses there are nice enough to give you hints and clues as to what the stations will be...having said that you are told what the stations are the weekend before your ISCE...dont think this will mean you have enough time to prepare for it however, but it'll definately help you focus on what you need to know and put your mind partly at ease the weekend before hand!.

Finally...try your best to pass first time. Having seen approximately 30ish people fail the year last year (the majority because of the isce)...do you really want to have to sit through another boring year of PBL? Keep saying that to yourself everytime you feel lazy and dont want to practice for the ISCE!. The retake ISCE is v difficult to pass as they combine your mark from the first ISCE and take an average of the two. so if your first ISCE mark is low and your second is high you could still fail because of the average mark method they employ.

Hope this has helped and feel free to ask me any futher q's. Just remember practice makes perfect and the ISCE is VERY easy if youve prepared well for it (trust me

).

Good luck peeps

Nav

**Yixian** · 03-02-2010, 03:34 PM

Awesome stuff Iceman!!

I'm in both a group of 3 as well as a larger group, and I def feel like the group of 3 is incredibly useful, and we have the set up you spoke of with an examiner, patient and doctor and rotating.

Definitely systems review is something I need to have structured as at the moment I tend to just chuck out questions randomly like "do you have a headache with that?" etc.

I plan to make a little table/stick man I can draw out on the clipboard as soon as I start each station that can help me stick to a sequence and get everything in.

I heard that about 27 people failed the first ISCE in your year? And then after the 2nd ISCE, even though many passed that in itself, 25 failed on aggregate?

For that reason I am basically treating the ISCEs as a one shot exam.

I seriously hope there is less inconsistency in marking this time though, I cannot express how irritating it is to be marked down in competencies for things that aren't on the mark scheme and are just pet peeves or personal preferences of the examiners..

The perception from the perspective of our year is that it is incredibly easy to fail a station - walk over to the wrong side of the bed? Bam, fail. Fail to show a sufficient amount of sympathy when a patient mentions eg. the death of a relative? Bam, instant fail of the entire station.

Is it really that bad?

I know clinical skills is probably my weakest area and that's why I'm starting so early but if it's so easy to fail a station on a single point then that's kinda worrying.. It seems more like.. ballet, you have to get every word and every movement right, than just getting the overall gist of the station.

It would also be nice if the school released info on past pass rates. Is it the norm for ~25 to fail the ISCEs?

Oh and a quick question - when did most people start practicing in your year?

**iceman_jondoe** · 03-02-2010, 09:12 PM

Originally Posted by Yixian

Awesome stuff Iceman!!

I'm in both a group of 3 as well as a larger group, and I def feel like the group of 3 is incredibly useful, and we have the set up you spoke of with an examiner, patient and doctor and rotating.

Definitely systems review is something I need to have structured as at the moment I tend to just chuck out questions randomly like "do you have a headache with that?" etc.

I plan to make a little table/stick man I can draw out on the clipboard as soon as I start each station that can help me stick to a sequence and get everything in.

I heard that about 27 people failed the first ISCE in your year? And then after the 2nd ISCE, even though many passed that in itself, 25 failed on aggregate?

For that reason I am basically treating the ISCEs as a one shot exam.

I seriously hope there is less inconsistency in marking this time though, I cannot express how irritating it is to be marked down in competencies for things that aren't on the mark scheme and are just pet peeves or personal preferences of the examiners..

The perception from the perspective of our year is that it is incredibly easy to fail a station - walk over to the wrong side of the bed? Bam, fail. Fail to show a sufficient amount of sympathy when a patient mentions eg. the death of a relative? Bam, instant fail of the entire station.

Is it really that bad?

I know clinical skills is probably my weakest area and that's why I'm starting so early but if it's so easy to fail a station on a single point then that's kinda worrying.. It seems more like.. ballet, you have to get every word and every movement right, than just getting the overall gist of the station.

It would also be nice if the school released info on past pass rates. Is it the norm for ~25 to fail the ISCEs?

Oh and a quick question - when did most people start practicing in your year?

Yes something like 27 people failed..this is because they were stupid enough to start preparing a week or two before the ISCE...so its great your starting now! As i recall I did not find any inconsistency in the marking, and in my opinion people only complained of inconsistency when they failed...similarly people magically had "extenuating circumstances" once they found out they had failed aswell. Its not normal for that many to fail and apparently our year had the highest fail rates. The bottom 5% of each year group will ALWAYS be failed, thats a requirement by the GMC, but if your bad enough then more than 5 % can fail. Im sure the tutors in clinical skils will be able to tell you roughly how many passed/failed each year, so i suggest you recommend talking to them regarding having info on past pass rates but i think thats a good idea.

Its actually incredibly HARD to fail a station...most of your marks come from your history taking alone. you will NOT fail if you walk to the wrong side of the bed..(its not like you can walk to the wrong side because each examination bed is placed next to a wall so you can only approach it from one side anyway!) Nor will you fail an entire station if you fail to show enough sympathy...but if you just remember to ICE your patients as ive already described then you should have that side covered

.

I cant really comment on when exactly most people started practicing, but judging by the number of failures and speaking to some of my peers about the marks they received i would say they started practcing too late!. To get an Excellent you need at least a couple of months practice at least...not a copuple of days!. You will find though that people retaking each year will work harder realising their mistake of last year...so those who failed on the ISCE's last year are practicing already infact i know some of them are. JUst make sure you get the right balance between ISCE practice and AMK prep. If you manage your time effectively you should pass with flying colours and will not have to think of an "extenuating circumstance" to pass the year

**Yixian** · 04-02-2010, 12:38 AM

Thanks for the answers! They are really helpful - we plan on practicing every week until the ISCEs, and doing a big mock ISCE for each of us in turn closer to June. I don't care whether I get an excellent or satisfactory, I just can't wait to start Year 3!

**iceman_jondoe** · 04-02-2010, 03:24 AM

Originally Posted by Yixian

Thanks for the answers! They are really helpful - we plan on practicing every week until the ISCEs, and doing a big mock ISCE for each of us in turn closer to June. I don't care whether I get an excellent or satisfactory, I just can't wait to start Year 3!

Year 3 has been the best year by far.. you learn so much provided you put the work in!

**saunders0104** · 04-02-2010, 04:42 AM

Thanks so much Iceman. I'm surprised to hear that pregnant abdo was up - there are 12 ISCE packs available on EMILY, I assumed they could only be from them. Were they up this time last year for you guys? Also medication review: please someone tell me we haven't covered that yet because I wouldn't have a clue what to do!

**iceman_jondoe** · 04-02-2010, 08:39 PM

Originally Posted by saunders0104

Thanks so much Iceman. I'm surprised to hear that pregnant abdo was up - there are 12 ISCE packs available on EMILY, I assumed they could only be from them. Were they up this time last year for you guys? Also medication review: please someone tell me we haven't covered that yet because I wouldn't have a clue what to do!

WEll im sure there is an obs and gynae pack or something similar? Preg abdo is easy anyway..im sure i did a piss porr job in the examination side of the preg abdo and still passed with flying colours so dont worry!.
Yeah the medication review was kind of sprung up on us at the end of the year and it was crap because noone had done it before and we hadnt been taught it!. Basically you get put in a room with a simulated patient with a tonne of drugs and you basically write all of them down on a piece of paper (neatly), write any probs/SE's expereinced by the patient, any allergies, doses of drugs and finally write any recommendations of how you would change the drugs if any...e.g. if an ACEi is intolerable due to a chronic cough you may want to consider an alpha blocker or angitensin 2 receptor antagonist etc etc. Fore more info about the medications review (and whether or not you will be tested on it) speak to the clinical skills staff.

**saunders0104** · 05-02-2010, 01:24 AM

There's a gynae pack but no OB - just makes me worry in case they could come up with something totally unexpected and mentioned in passing. Oh well, that's the Peninsula game!

**iceman_jondoe** · 05-02-2010, 04:22 AM

Originally Posted by saunders0104

There's a gynae pack but no OB - just makes me worry in case they could come up with something totally unexpected and mentioned in passing. Oh well, that's the Peninsula game!

Well think of it this way..the ISCE can examine you on anything which youve done in the first two years. However its unlikely to ask you to do something like a venepuncture or injection. As i recal the skills i had to perform were a rectal examination for the GI station, a preg abdo exam for obs/gynae, a BP measurement for the CVS exam, mini mental state and mental state examination for the mental health station, and recording of my GALS examination on the MSK station. Its also important to review how to fill in a prescription chart and how to document your findings e.g. signing things off as "your name" then your position "second year medical student"