An honor just to be nominated

I took my psychiatry OSCE the other day, my "objective structured clinical exam". It's no coincidence that OSCEs sound like Oscars, because both involve some serious acting. At the OSCEs, you have actors pretending to be patients, students pretending to be doctors, and faculty pretending the exam is 'objective'.

It's been said that OSCEs are the worst kind of exam, except for all the others (apologies to Winston Churchill). Despite the drawbacks -- artificial time constraints, inability to review past records, and patients who hide facts unless certain 'trigger words' are used -- the OSCEs are probably a good thing. Otherwise, we'd spend all our time studying diseases, with no emphasis on interviewing or conveying this information.

The OSCE experience is not unlike my first exposure to standardized patients, the Seinfeld episode called "The Burning":

[Mt. Sanai Hospital. Kramer is on the table surrounded by med students.]

STUDENT #1: And are you experiencing any discomfort?

KRAMER: Just a little burning during urination.

STUDENT #1: Okay, any other pain?

KRAMER: The haunting memories of lost love. May I? (signals to Mickey) Lights? (Mickey turns down the lights and Kramer lights a cigar) Our eyes met across the crowded hat store. I, a customer, and she a coquettish haberdasher. Oh, I pursued and she withdrew, then she pursued and I withdrew, and so we danced. I burned for her, much like the burning during urination that I would experience soon afterwards.

STUDENT #1: Gonorrhea?!

KRAMER: Gonorrhea!

(The lab breaks out in spontaneous applause as Mickey turns up the lights and Kramer takes a bow.)

OSCEs aren't quite like this, but they're not different enough. By the way, one of our professors suggested Cosmo Kramer as an example of someone suffering from schizotypal personality disorder.