My weakness in the MOSLER assessment

At the end of Stage 5 of my MBBS course at NUMed, there are SBA and MOSLER assessments. The SBA is a multiple-choice written examination, while the MOSLER is a clinical assessment with 8 stations where we have to see a patient in each station.

The MOSLER has 6 domains of assessment which are Information Gathering, Technical & Procedural Skills, Communication Skills, Clinical & Diagnostic Reasoning, Management, and Professional Behaviour. For the MOSLER which I took in June 2019, I failed the Management domain and I only scored the bare minimum required to pass the Clinical & Diagnostic Reasoning domain.

What went wrong actually? After reading the feedback written by the examiners in the MOSLER, I think I have figured out that the main problem lies with my method of studying. Basically, I place a lot of emphasis on the BREADTH of knowledge, but not on the DEPTH of knowledge.

Focusing on the breadth means that I always try to study as many diseases as possible in the books. I usually give every disease equal consideration, regardless of how common each disease is. With a few exceptions, I will not leave out any disease in my revision.

However, I do not study each disease deeply. Usually, after revising the signs and symptoms as well as the basic investigation and management plans of a disease, I consider myself done with that disease and I will not explore it further. My thought is that any further knowledge is not important for undergraduates.

My favourite specialty is primary care (general practice). Being the first point of contact for patients, general practitioners need to know a very broad range of diseases, but they do not need to know each disease as deeply as compared to other specialists. My interest in this speciality has a certain influence on my method of studying.

Having the breadth of knowledge is important for the SBA examination as the questions test on many different types of diseases, including very rare ones. My method of studying that emphasises on the breadth of knowledge enables me to perform quite well in the SBA.

But for the MOSLER, the depth of knowledge is important. This is because the examiners usually do not just ask general questions like "How would you manage this patient?". Rather, they would focus on a particular area and ask detailed questions about that. Without the depth of knowledge, it will not be possible to answer many of those questions.

One of my stations in the MOSLER was hypothyroidism. The examiner asked me about the investigations for Hashimoto's thyroiditis, a cause of hypothyroidism. I gave thyroid function test as the answer, but the correct answer should also include autoantibodies test which I did not know because I did not study Hashimoto's thyroiditis detailed enough.

Next, the examiner asked me how I would adjust the dose of thyroxine that the patient was on. I could not answer that question at all, as the only thing I studied about the management of hypothyroidism is giving thyroxine. In the end, I got a score of 0 for both the Clinical & Diagnostic Reasoning and Management domains of that station.

There was a MOSLER station where a patient with COPD came for a follow-up. I knew the bronchodilators and steroids used to treat COPD, but the patient already was on all those drugs. The examiner instead asked me about the prophylaxis against acute exacerbations of COPD. I did not study that at all, so I was unable to answer that question.

In one MOSLER station, the patient had just recently underwent a coronary artery bypass graft (CABG) surgery for MI. The examiner asked me which vessel is used for CABG. As I did not study the details of CABG, I only knew that the vessel is located in the legs but not the name of the vessel which is long saphenous vein.

In the acute care simulation station of the MOSLER, the patient had pneumothorax. After performing ABCDE, the examiner asked about the further management and I answered chest drain which was correct. However, when the examiner asked how should the chest drain be inserted, I could not answer it at all. Again, this is because I never bothered to study chest drain in detail.

Many students who failed Stage 5 of MBBS actually passed the MOSLER but failed the SBA instead. I believe their situation is the opposite of mine, where they have the depth of knowledge but lack the breadth of knowledge. From my observation, many students tend to focus on the more common diseases and study them deeply, while neglecting the less common diseases.

So, in order to pass all Stage 5 assessments, we need to have both the breadth of knowledge and depth of knowledge. In the future, I need to change my method of studying so that in addition to revising a wide range of diseases, I also go deeply when revising each disease.

If you liked this post, you may want to read this too:

https://daniellimjj.blogspot.com/2019/07/my-failure-in-stage-5-of-mbbs.html