1. MLA questions ๐ซ: Mapped to the MLA curriculum
2. Taylor francis ๐ง : over 2500+ questions licenced from 18 text-books worth ยฃ191
3. Past examiners ๐ซ: Questions written by previous Medical School examiners
4. Track your performance ๐โโ๏ธ: QBank uses intelegent software to keep you on track
The reviews are in
★★★★★
6,893 users
Don't take our word for it
"The stations you provide are strikingly similar to those I came across during my medical school finals (some even verbatim!), and I have tried many other exam platforms. I'm truly grateful for your priceless support throughout my final couple of years at medical school!"
Raza Q ๐ฌ๐ง
"It has absolutely everything for medical school, so many histories with detailed differential diagnoses, how to approach emergencies, commonly prescribed drugs..every kind go examination youโll ever need in osces"
John R ๐ฌ๐ง
"Thank you SO MUCH for the amazing educational resource. Iโve tried lots of platforms and books with mock OSCE stations and yours is by far and away the best Iโve tried"
Ed M ๐ณ๐ฟ
"Get this right away. So helpful for OSCEs but also general clinical learning and understanding. Wish I had brought it sooner"
Emma W ๐ฌ๐ง
"Without a doubt, your platform outshines all other OSCE resources currently available. In all honesty, I can confidently attribute my success in securing a distinction in my finals to OSCEstop."
Harish K ๐ฌ๐ง
"OSCEstop distinguishes itself from many other platform banks by offering a wealth of questions that mimic the demanding and complex aspects of our finals. This platform played a crucial role in ensuring I was ready for the level of difficulty that awaited me in my final exams."
Membership includes access to all 4 parts of the site:
1. Learning ๐: All notes, viva questions, track progress
2. Stations ๐ฅ: 10 years of past medical school stations. Includes: heart murmurs, ECGs, ABGs, CXR
3. Qbank ๐ง : 2500+ questions from Taylor Francis books, complete MLA coverage
4. Conditions ๐ซ: all conditions mapped to MLA, progress tracking
The reviews are in
★★★★★
6,893 users
Don't take our word for it
"The stations you provide are strikingly similar to those I came across during my medical school finals (some even verbatim!), and I have tried many other exam platforms. I'm truly grateful for your priceless support throughout my final couple of years at medical school!"
Raza Q ๐ฌ๐ง
"It has absolutely everything for medical school, so many histories with detailed differential diagnoses, how to approach emergencies, commonly prescribed drugs..every kind go examination youโll ever need in osces"
John R ๐ฌ๐ง
"Thank you SO MUCH for the amazing educational resource. Iโve tried lots of platforms and books with mock OSCE stations and yours is by far and away the best Iโve tried"
Ed M ๐ณ๐ฟ
"Get this right away. So helpful for OSCEs but also general clinical learning and understanding. Wish I had brought it sooner"
Emma W ๐ฌ๐ง
"Without a doubt, your platform outshines all other OSCE resources currently available. In all honesty, I can confidently attribute my success in securing a distinction in my finals to OSCEstop."
Harish K ๐ฌ๐ง
"OSCEstop distinguishes itself from many other platform banks by offering a wealth of questions that mimic the demanding and complex aspects of our finals. This platform played a crucial role in ensuring I was ready for the level of difficulty that awaited me in my final exams."
The key to all of these stations is good communication. The conversations should be conducted in an appropriate setting and should not be interrupted by bleeps etc. Find out what the patient/family knows already and try to gauge their level of understanding. Ensure you are empathetic, โchunk-and-checkโ, and make use of pauses. Donโt forget to listen to the patientโs/relativeโsย ideas, concerns and expectations.
โDo Not Attempt CardioPulmonary Resuscitationโ (DNACPR) discussions
Background information
Decisions regarding CPR are ultimately taken by the patientโs medical team. A patient can refuse CPR but cannot demand it.
Success of in-hospital resuscitation is around 20% but this may be much lower if there are comorbidities/reasons why it is less likely to be successful. Of those who survive resuscitation, only around half will make it out of hospital.
A DNAR form may be completed for one of three reasons:
Resuscitation is unlikely to be successful
The patient does not want it
It may be successful but would result in a length and quality of life that is not in the patientโs overall benefit
If a patient has capacity, they should be informed of the decision (unless it will cause significant physical or psychological harm)
If a patient does not have capacity, the relatives of the patient should be informed
All DNAR discussions should be clearly documented
โDo Not Resuscitateโ does not mean stop treatment
If the form is signed by a junior doctor, it should be countersigned by a consultant as soon as possible
Approach
It is usually best brought up during a wider discussion about advance care planning
Work your way up to it rather than jumping straight in. Try to build rapport and start by discussing current problems and how they are being treated.
Explain there is always a risk that things might get worse and the patient might deteriorate
Explain what CPR is and what it involves
If CPR would not be successful, sensitively explain why your team feels it would not be appropriate. If CPR might be successful, discuss the patientโs wishes and feelings. Try to determine whether the benefits would outweigh the risks and burdens; and if the level of recovery would be acceptable to the patient.
Stress that a DNAR decision does not mean that the patient will not be treated โ it is only relevant if their heart stops
Do not ask the patient or relatives to make the decision
If the patient/relatives strongly disagree, donโt force it โ escalate the discussion to your seniors or ask for a second opinion
Phrases to help
โOne thing that it is important for us to talk about is resuscitation.โ
โYou are very unwell at the moment and we need to talk about what we would do if you were to get worse despite treatment.โ
โWe feel it would be kinder and more appropriate to ensure he is not in any pain or distress in the last moments of his life. If it were to get to the point where his heart stopped, we would not try to restart it.โ
โWe will still give her every treatment available on the ward. The form just means that if she were to become much more unwell and reach the natural end of her life, we would not do chest compressions and shocks to restart it, because this can cause a lot of pain and distress, and prolong suffering.โ
โHis medical condition means that he will eventually get to the natural end of his life and it is important we talk about this before it happens. Trying to restart his heart in this situation would not be the right thing to do.โ
โWe only have one chance with end of life care so it is important to get it right.โ
โEven if a patient survives resuscitation, they are often more disabled afterwards, and left with a quality of life that they would not want.โ
Other treatment escalation decisions
In addition to decisions regarding resuscitation, decisions should also be made about other invasive treatments where appropriate. These should be documented in the patientโs notes and on a treatment escalation plan document.
The patient can only insist upon things they do not want
It is for doctors to decide which treatments are and are not appropriate, e.g. intensive care admission, non-invasive ventilation, parenteral nutrition etc.
Factors to take into account when considering intensive care admission include:
Diagnosis, severity of illness and prognosis: to warrant intensive care admission, a patient must have an acute reversible condition and a viable treatment must be available
Age, comorbidities and physiological reserve: surviving intensive care and invasive treatment requires a good physiological reserve (e.g. there is no point ventilating patients who will not be able to get off the ventilator)
Anticipated quality of life: there is often a physiological decline after severe illness and it is important to consider if the patient would be left with an acceptable quality of life
Patient wishes: if a patient does not want invasive treatments, then their choice should be respected. If the patient cannot communicate this, it is important to speak to their family about what their wishes would have been.
Explaining to relatives that a patient is at end of life
Coronerโs post mortem: the relatives cannot refuse this (it must be carried out by law)
Consented post mortem (for educational purposes): written consent required from next of kin
A consented post mortem is usually performed when the cause of death is already known. The purpose is to learn more about the condition or effects of treatment, and to help better manage other patients in the future.
It is done in a respectful manner
Incisions will be hidden by clothes/hair
All tissue will be replaced inside the body unless required by the coroner or specified on the consent form
It takes around 3 hours
It is usually done within 2-3 days so funerals need not be delayed
The report will be sent whoever requested the post mortem. The relatives will be informed of the cause of death and can request the full report if required for a fee. They can arrange to meet the consultant or GP to discuss the results, which will contain medical terminology.
Approach
Be respectful and always start by saying you are sorry for their loss
Ask them how much they know about what happened and what caused the death
Coronerโs post mortem: explain that when it is not clear what has happened, we have to notify the coroner, and that in some circumstances they order a post mortem (remember you may be breaking bad news). Explain why it is important to establish the cause of death.
Find out what their concerns about post mortem are โ they may not understand or have misconceptions about what is involved
Brainstem death
Background information
Brainstem death = irreversible loss of all brain and brainstem function
It is confirmed by two qualified specialists who do a series of tests independently to assess brainstem reflexes and breathing
Approach
Use a breaking bad news approach
Explain the patient isdead, despite the machine making it look like they are still breathing
Explain that two senior consultants have done multiple tests to confirm the patient is dead
Explain that we should now turn off the ventilator
Organ donation
Background information
Patients cannot donate if they have HIV, Creutzfeldt-Jakob disease or metastatic cancer
Consent can be from the patient or relative
If a patient has clearly consented before death, the relatives do not have the legal right to override the decision
If a patient has not consented before death, consent from relatives is required
Approach
Explain what organ donation involves
Explain the benefits
Reassure relatives about funerals and the fairness of organ allocation
If the patient has not expressed a wish to donate, find out what they would have wanted