MLACases

[Combined] 

Time Management in Combined Stations

Why it’s important to recognise combined stations early: 

It is important that you recognise early on when a station is combined as they require a different approach to 'simple' consultations. It is often not obvious that a station is combined so there are specific signs that you will need to be on high alert for. 

If you do not recognise a station is combined, you run the risk of your history being too long, at the expense of the examination/procedure and management portions of your consultation, leading you to fail a station that you would have otherwise passed. Combined stations in particular require very strict time-keeping to fit in everything within the allotted 8 minutes. 

Combined stations should be your highest scoring stations as they comprise a manageable number of scenarios that you can practise and perfect, yet account for a significant number of stations (2-3) in the exam. 

How to recognise a combined station: 

There are 3 things to bear in mind: 

1. The Bottom of the Task – This may tell you to “perform a relevant examination/procedure” (very often it won’t tell you). 
2. Look Around – Immediately look around the room for manikins as you enter the cubicle. Eye and ear manikins may be uncovered, however, others may be covered with blue drapes and are therefore easier to miss. 
3. Familiarity with Cases – This comes from making sure that you have a clear idea in your mind about which manikin topics are tested, organised according to manikin type and according to the presenting complaint - See Smart Revision Planner.

Caution:

Always follow a logical approach in your consultations and do not take shortcuts because of familiarity with the scenarios, but you should give yourself the best chance of your consultations running as smoothly as possible in a high-pressure exam.

How to approach a combined station: 

Once you recognise that it is a combined station – think 3-3-2 for examinations and 2-4-2 for procedures: 

• 3-2 Mins History – This should be very focused. Do not ask a question if you do not know why you are asking it. For combined examination stations, in your differential diagnosis focus on 1 or 2 conditions not to miss (red flags) and 1 or 2 conditions that are common. Familiarity with the cases helps in that it makes you aware of the most important positive findings and therefore which parts of the history you need to focus more on (but should be used with caution and should not detract away from being a safe doctor i.e. excluding the things you need to exclude and generally following a clear logical sequence).
  • For combined procedure stations where there is more of a practical focus, 2 minutes should suffice. After building rapport briefly you can go straight into explaining the procedure and doing your pre-procedure checks.
• 3-4 Mins Examination / Procedure – includes explaining the examination and what it involves, gaining consent, requesting a chaperone, exposure/positioning/any other preparations e.g. emptying the bladder, eye drops, etc – as well as performing the examination or procedure itself. 
  • For combined procedure stations where there is more of a practical focus, you should allocate a bit more time (4 minutes) to performing the procedure.
• 2 Mins Management – i.e. you should be returning to your seat at the 6-minute bell. You will only have time to address one or two key themes in the scenario. Avoid getting stuck managing one key theme or issue at the expense of others.

Note:

You will find that the notes provided on this platform for combined stations are shorter and more concise than for the remaining stations.

This has been done intentionally to discourage you from going into any detail in these stations.

Lesson Summary

• It is important to recognize combined stations early, as they require a different approach from the beginning.
• How to recognise a combined station:
  • The bottom of the task
  • Look around the room upon entering
  • Familiarity with the curriculum
• How to approach a combined examination station:
  • 3 minutes history
  • 3 minutes examination
  • 2 minutes management
• How to approach a combined procedure station:
  • 2 minutes history
  • 4 minutes procedure
  • 2 minutes management