Tutorial
جراحــــــةد. نشوان
عدد الاوراق (4)
2-12-2012GUIDE LINE FOR OSCE
It means Objective Structured Clinical Examination1- Objective, because examiners use a checklist for evaluating the trainees.
2- Structured, because every trainee sees the same problem and performs the same tasks in the same time frame.
3- Clinical, because the tasks are representative of those with real clinical situations.
4- Examination, because it evaluate the trainees and give them marks.
The OSCE examination consists of about 10 to 15 stations each of which requires about 5 to 10 minutes of time.
The OSCE examination consists of about 10 to 15 stations each of which requires about 5 to 10 minutes of time.
All stations should be capable of being completed in the same time. The students are rotated through all stations and have to move to the next station at a signal.
During the exam, trainees are observed and evaluated as they go through the stations where they interview, examine and treat standardized patients presenting with clinical problem.
Since the stations are generally independent, students can start at any station and complete the cycle. Thus, using 10 stations of 5 minutes each, 10 students can complete the examination within 50 minutes.
In each station there are 2 examiners using a checklist for questions and evaluation of the answers.
The checklist contains the standard questions and answers so there is no bias in putting marks.
What Is Being Tested In OSCEs?
1-Medical knowledge. 2-Clinical skills. 3-Medical practice skills. 4-Developing a management plan. 5-Ethical and professional behavior. 6-Communication skills. 7-Patient interaction skills.
What do I wear and bring to an OSCE?
clean white lab coat.Nametag.
Stethoscope.
measuring tape.
Hummer.
Thermometer.
light source.
Things to be remember
1- Explain every thing you are doing to the examiner.2- Stand in a way to let the examiner watch you.
3-Don't stand in between the examiner and the patient.
4-Explain to the patient what you are going to do, taking necessary permission before you proceed.
5- Pay attention to patient privacy and draping.
6-Don't harm or repeat harmful maneuvers.
7- Interact with the patient and their family in a caring and respectful manner.
8- Effective non-leading approach for history taking.
9- Cover the differential diagnosis: Never focus on one diagnoses even if it is obvious.
10- Pick up a working diagnosis. Suggest the diagnosis but need to confirm with investigations
11- Investigations to differentiate. Use with patient comfort, benefit, risk, and cost in your mind. Always be able to answer why to order this test?
12- Use the scientific language dont jump from English to Arabic ward.
13- Dont say I dont know, better to say I dont remember.
14- Dont cry (for female) this well change nothing.
15- Dont point to the patient by your finger or pin,
16-dont put your hand in your pocket.
17- Dont say that this is what's written in books.
18- Thank the patient after finishing the examination and recover him.
Common Quistions To Be Applied To You During The Evaluation
1-What is your working diagnosis for this patient?
2-What is your three most relevant differential diagnosis?
3-What are the risk factors of this patient?
4-What is your only / three investigation/ you are going to order for this patient and why?
5-What is your initial / short term plan of management?
6-What is your long term plan of management?
7-Interpret this lab findings / imaging...etc.
8-Prognosis? If this patient came back in .. days / weeks with .. what will be your explanation
REMEMBER THAT ALL YOUR ANSWER WELL BE COMPARED WITH THE CHEKLIST
What is the OSCE Examiners' Checklist?
Checklists are organized and standardized questions and their answers used to assess the medical knowledge specific to the station in spot, such as:History, symptoms and signs, associated factors, risk factors, prevalence, complications, prognosis, investigation, management plans, etc
Each station deal with specific medical skills The most faced stations for undergraduate students are:
1-History taking station.
2-Physical examination station.
3-Investigation.(data interpretation)
4-Imaging study station.
5-Instrument station.
6-Minor surgical procedure station.
7-Management station.
8-Communication skills station which includes:
a-Explaining diagnosis, investigation or treatment. b-Involving the patient in the decision-making. c-Communicating with relatives. d-Communicating with other health care professionals. e-Breaking bad news. f-Seeking informed consent/clarification for an invasive procedure or obtaining consent for a post-mortem. g-Dealing with anxious patients or relatives. h-Giving instructions on discharge. i-Giving advice on lifestyle, health promotion or risk factors.
This station is the most difficult one and needs a long learning time and training and may not be included as a full station for undergraduate.
Example of history taking station A 60 years old male presented with fresh bleeding per rectum of 2 weeks duration please analyze his problem.
The checklist contain:
Introduction of the student and taking permission from the patient.````````````````````````````````````````
The time and appearance of bleeding
The blood pass with , before or after the stool?
Is the defecation painful?
Is there any protruded mass at time of defecation?
Is there any change of bowel motion?
Is there any tenesmus?
Is there any pus or mucous secretion?
Dose the patient gut loss of Wight?
Is there any abdominal distension or vomiting?
For each point there is one mark, the total mark is 10.
Example of a physical examination station Task - Examine the scrotal swelling of this patient.
Points in the check list: 1. Does he explain to the patient what he is going to do? 2. Does he take permission ? 3. Does he provide a screen? 4. Does he ask the patient to expose the whole abdomen and genitalia? 5. Does he examine both sides of the scrotum? 6. Does he take care not to cause discomfort? 7. Does he palpate the spermatic cord? 8. Does he palpate the abdomen (for lymphnodes in case it is a patient with a testicular tumor) 9. Does he palpate the supraclavicular nodes? 10. Does he thank the patient and recover him?
For each point there is one mark, the total mark is 10
Task - Examine the Rt breast in this patient.
The checklist contain:
1- Dose student take permission?
2- Dose student uncover both breast?
3- Dose student inspect and examine the nipple and areola?
4- Hands on hips examination.
5- Hands above head examination.
6-Dose the student palpate the whole quadrants?
7- Dose student examine the axillary tail?
8- Dose student examine the axillary LN?
9- Dose student examine other breast?
10-Dose student did liver examination?
For each point there is one mark, the total mark is 10
Example of Investigation station A patient have the following liver function tests
Total serum biliruben:====Direct:=====
Indirect:=====
Alkaline phosphates:=====
SGOT:======
Total serum protein:======
Prothrombin time:========
The questions well be:
1-What is the normal value of this test?
2-what you think this patient has?
3-what other investigations may be of help?
4-what is the sensitivity \ specificity of this test?
5-How you perform a request for this test?
6-Is there any special preparation for this test?
Example of Imaging study station
The examiner well show you
X ray film ULTRASOUND
CT scan MRI
MAMMOGRAPH ANGIOGRAPH
DOUPLLER IMMAGE
The questions well be:
What is this image?
What is/are the obvious finding.
What complication my happen because of doing this image?
How you perform a request for this image?
Is there any special preparation for this image?
Instrument station
The examiner well show the student an instrument (needle holder, retractor, pence, artery forceps extra)The questions well be:
1- What is this instrument?
2- Where you can use it?
3- Who you hold it?
4- What complication may result from bad using of it?
Minor surgical procedure station this may include:
Canulla application
Insertion folyes catheter.
Insertion or removal of chest tube.
Insertion or removal of NG tube.
Insertion or removal of endotrachial tube.
Who to do venesection.
Who to suture a clean wound.
Who to dress an ulcer.
Who to do per rectal /vaginal examination.
Management station.
Till me the treatment options for female aged 25 years with graves disease?Till me the treatment options for female aged 25 years with graves disease?
Medical therapy by carbimazole and propranalol (the dose, duration) or surgery by subtotal thyroidectomy.
The checklist well includes the following questions:
1-What is the advantage and disadvantage of such therapy?
2-what are the possible complications of such therapy?
3-What are the indications of surgery?
4-What are the complication of surgery?
5-Who you follow the patients post operatively?
6-Is radiation indicated in such condition?
What we well gain from such type of evaluation
1-Update our way of evaluation. 2-Avoid bias in giving the marks. 3-Fare evaluation. 4-All the students well face the same questions, patients and other data. 5-The student well become more aware abut attending the medical courses, operative theatre and lectures. 6- Gaining more information about the medical skill level of the student. 7- More than 20 examiners well share in putting the marks 8- This well help the students after graduation if they attend a broad evaluation.
What we well gain from such type of evaluation