An internal medicine resident at the University of British Columbia in Vancouver, Canada provided some much-needed entertainment for a bored OSCE examiner during part II of the qualifying exams for medical licensure in Canada.
“I think [the resident] was caught off guard. Someone must have told him IPPA – Inspection, Percussion, Palpation, Auscultation – works like a charm for every single physical exam station. Poor guy must have taken it too literally”
When asked for further explanation, Dr. Smith described the resident diligently introducing himself before performing Airways-Breathing-Circulation assessment. His task on the station was to perform an eye examination on a 65 year old lady with acute mono-ocular painless vision loss.
“He even asked for a cardiac monitor, IV access, a 12 lead EKG and a Chest X Ray”, Dr Smith said chuckling, barely able to control herself.
“After that, he proceeded to do ‘extra ocular’ exam ‘just to be thorough’ and started looking for systemic signs of ocular disease. I almost redirected him. But it was too much fun to watch so I let him keep going.”
Afterwards, she describes the resident commenting on general inspection of the eye including comments such as “the eye is open and looking at me” and “there is no spider nevi on the eye”.
He next began percussion of the eyeball but this could not be completed due to the patient’s complaints of discomfort. Nevertheless, the resident was heard commenting, “there is increased tactile fremitus and dullness to percussion, signaling the eye is full of fluid.”
Palpation of the eyeball was also not forgotten by the resident. Dr. Smith describes giving him a palpation on his own eyeball so that he wouldn’t put too much pressure on the patient’s eye and to prevent him from giving the patient a retinal detachment.
“He then proceeded to auscultation of the eyeball. I almost said ‘Noted. Please move on’. But I had to see where it went. Like I said, it was too much fun!”, Dr. Smith recalled.
When asked whether the resident performed fundoscopy, Dr. Smith said:
“Oh I just hid the ophthalmoscope at the right moment when he wasn’t looking. I didn’t want to ruin the experience for any of us”.
When asked to comment on whether the resident passed the station, Dr. Smith replied in a surprised manner:
“Of course he passed! Internists shouldn’t be expected to know all this shit for a needless, money-grabbing exam. I think the LMCC is the loser here. Of course he will make a great internist. Granted I would do the eye exam slightly differently. I would do the auscultation before the percussion.”