Yasmin Sultan What well cover This is probably you at the moment I will give you a structure to aid your revision Types of OSCEs you will get How to approach amp practice for each How the marks work ID: 909529
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Slide1
FRCEM OSCE practice 21/9/18
Yasmin Sultan
Slide2Slide3What we’ll cover
This is probably you at the moment!
I will give you a structure to aid your revision
Types of OSCEs you will get
How to approach & practice for each
How the marks work
And then we will practice in groups of 3.
Slide4Types of OSCE
1. Joint examination
2. History taking
3. Breaking bad news
4. Psychiatry
5.
Resus
scenarios
6. Paediatrics
7. Procedures
8. Miscellaneous
Teaching
is incorporated into (some) of these to add an extra element,
eg
, procedures & examinations
Slide5Joints & Histories
1. Examination -1 per exam
Joints, face, hands. Often includes teaching element.
Ensure you do some (relevant) special tests.
2. History taking –about 4 per exam
Chest pain,
abdo
pain, headache, back pain etc
You need to be thorough –take a medical student history with a full Systems Review. Up to 25 marks for questions
Include your differential diagnosis, management plan & allow time for questions –about 10 marks!
“Difficult” histories:
Sexual history (signpost!) travel history, urology
Hx
, back pain.
Maybe Acute
confusional
state, with MMTS?
Slide6BBN & Psychiatry -1 of each
3. Breaking bad news
Easy –find out what they know, let them talk, use silence (once!), summarise, explore their wishes.
Then summarise
Mx
(using any image provided,
eg
CT) and if asked to, mention organ donation.
4. Psychiatry
Mania (challenging), depression (and screen for domestic violence, suicidal ideation), psychosis, alcohol/drug abuse.
Always ask about suicidal ideation, drugs, alcohol
Be prepared to summarise in 30 seconds –learn the terms to describe each presentation,
eg
“evidence of thought withdrawal, thought insertion” “pressure of speech” etc
Usually you are asked about management if they want to leave (state no
capactity
) & what section of MHA you would use.
Slide75. Resus
scenarios
5. Resuscitation Scenarios-
2 per exam, double stations.
17 minutes each. Almost always one APLS. A LOT of content to get through –move fast. May include interpreting a ABG or CT & referral/explanation to family. 1 mark for each. Total marks about 35.
You will be team leader for one –prime your team with intros, establish skills, allocate roles. At some point you will need to be hands-on though,
eg
talk through how you do a chest drain, apply a splint etc.
You don’t need to pass them to pass overall though.
Slide86. Paediatrics
No actual kids are
used,but
paeds
forms 25% of exam, so either
Resus
Sims, or communication skills OSCEs:
APLS
Neonatal resuscitation
Throws you! Worth having a look at it before your exam.
Talking through
Mx
with parent
Newly diagnosed Addison’s, asthma discharge, D&V, etc
Dealing with a missed fracture
Communication, explanation to parent.
Suspected Non-accidental injury.
Challenging scenario
!
Scenario should make it obvious this is NAI. Retake history, then get facts –who has been caring for child, known to Social services, siblings, say need ages, names, schools, etc.
Explain
Mx
of injury.
Explain that this is suspected NAI & you are legally obliged to investigate, admit, refer to SS &
Paeds
etc.
Slide97. Procedures -1 per exam
1. Ones you actually do:
Aspiration of
pneumothorax
, male catheterisation, suturing, pelvic examination & removal of FB –all of these on
mannikin
.
2. Ones you just talk through,
ie
teach (to ENP, student etc)
femoral nerve block, digital nerve block, haematoma block, arterial line insertion, use of airway adjuncts.
X-ray interpretation,
eg
C spine.
Options are limited by equipment available at the College, and by the fact that the scene needs to be reset for the next candidate in just 1 minute.
“Teaching”
involves adding the following to the basic OSCE:
find out what they know, & set objectives for session
do the actual procedure, examination etc, in an interactive way
Summarise what you’ve told them (if time –ask them to summarise!)
Check for questions, answer questions (they always have one) –quickly!
Set them some targets for practice /learning, and review later –or can do this at start of OSCE
You need to move fast to get through all this. People who like teaching run out of time
Slide108. Miscellaneous -1 per exam
1. CDU ward round-
Listen to histories of patients (3) presented by FY1. Identify any issues with management & give plan to FY1. Try to avoid saying you will see patient yourself. All will have management pitfalls.
Eg
: head injury in alcoholic(?neck CT),
eg
asthma (as per BTS)
eg
OD (now wanting to leave),
eg
Abdo
pain young female (?
preg
test).
2. Triage of multiple patients
limited departmental resources- talk through how you prioritise & use your limited resources. Supposed to test the sort of skills you need to run the Department.
Eg
5 patients in ambulance bay, you give Nurse in charge a plan for each, hampered by an argumentative manager!
3. Major incident /CRBN –
talk through
Mx
of department/incident. Requires some knowledge of processes. Refer to your local practice “in my Trust...” Use a framework to think through issues.
Slide11The candidate information & pie chart:
“clinical reasoning decision making
” -This means your differential diagnosis, and management plan.
History taking
Communication skills
This means asking the patient if they have any questions, & answering them (and in this case, sign-posting SI history and taking history professionally).
You may also see:
Team leadership
Resuscitation skills
Examination skills
Practical skills
Try to look at it and memorise what you are expected to do.
If your examiner suggests you look at it again, you are off-track.
Slide12Any questions so far?
Slide13OSCE demo
An 8 minute OSCE with a volunteer
The candidate information and the mark scheme will be available to the audience.
Slide14Demo
Candidate information:
The patient has been brought by the police after she tried to climb a lamppost while singing operatic songs in the town centre. She states she is a professional singer.
Slide15Demo OSCE
Mark scheme
Slide16Tips for Psych OSCEs
Only 5 possible OSCES –practice them all.
Memorise key phrases to describe symptoms of:
Mania
Psychosis
Depression (& ask about DV, alcohol abuse)
Always ask about suicide,
PMHx
, substance use.
Practice asking the questions while your revision partner tries to be as distracting as possible!
Practice your summary for each condition.
Slide17Slide18OSCE PRACTICE:
Slide19What we are going to do:
Get into groups of 3
1 of you is candidate, 1 is actor, 1 is examiner
Actor –read your briefing info.
Candidate instruction -1 minute to read it.
Off you go..
Examiner please make notes on what goes well & badly –maximum of 3 learning points for the candidate per OSCE. Advise them what they need to practice.
Slide20OSCE 1
Candidate Instruction;
Arthur Johnson is 13 months old. He has been brought to the ED by Jade, his mother, as he is not using his left arm. She denies any history of trauma.
An XR shows a transverse fracture of the
humerus
which is very suspicious for NAI.
Take a history and determine a management plan
Slide21OSCE 1
Slide22OSCE 1 Mark
Slide23OSCE 2
Candidate Instruction:
You are the only registrar in the ED starting the 8am day shift. The other
Reg
is off sick and your Consultant is at a meeting.
There are 15 majors patients and 20 minors patients waiting to be seen.
You have an Observation ward with an FY1.
Do a board round with the FY1, giving him a management plan for each patient.
Slide24OSCE 2
Slide25OSCE 2: Marking scheme
Slide26OSCE 3
Candidate instruction
You are asked to see Mr David Anderson, a 52 year old businessman who is visiting Cambridge today. He tripped on the pavement and injured his ankle and was brought to the ED by ambulance. He has not had analgesia in the ED.
An ENP saw him and has thoroughly examined his ankle as per the Ottawa Ankle Rules. There is no bony tenderness but there is swelling and tenderness over the
anterio
-
talo
-fibular ligament, consistent with a sprain. The ENP explained that he does not need an x-ray and offered him crutches & discharged him. You have seen the notes & spoken to the ENP and are satisfied that this injury has been assessed properly.
The patient has told the waiting room nurse that he is not happy and wants to see a doctor. He is reportedly quite angry.
Please talk to him to resolve his issues.
Slide27OSCE 3
¾ communication
¼ clinical reasoning /decision making
Slide28OSCE 3
Slide29OSCE 4
Candidate Instruction:
Kate is a 45 year old lady with bleeding in early pregnancy.
Take a history from her and make an appropriate management plan.
¼ history taking
½ communication skills
¼ clinical reasoning /decision making.
Slide30OSCE 4
Slide31OSCE 5 –candidate instruction
Jo is a trainee ENP in your ED. He/she has seen a patient with a
colles
fracture of the left wrist.
Teach Jo how to perform a haematoma block to manipulate a
colle’s
fracture.
Communication: 1/3
Practical skills: 2/3
Slide32OSCE 5
Slide33OSCE 6
Task:
Mr Jones has injured his right hand. He has been examined by one of the medical students.
Teach the medical student how to examine hands, and discuss further management.
1/2 examination
¼ communication
¼ clinical reasoning /decision making
Slide34OSCE
6
Slide35OSCE 7
Task:
Harry Peters is a 60 year old man who has dislocated his right shoulder when he fell down some steps today.
Explain the injury and how you are going to reduce it (with sedation) and consent him for the procedure.
You do not need to examine him.
Slide36OSCE
7
Slide37OSCE 8
Candidate instruction:
Miss Harris is a 30 year old woman who has come to the emergency department with abdominal pain.
Take a history from her and discuss further management with her.
Slide38OSCE 8
Slide39OSCE 8
Slide40OSCE 9
1/3 history
1/3 communication
1/3 clinical reasoning /decision making
Slide41OSCE 9
Slide42Now you’ve practised...
Slide43How to revise for the OSCE
Practice in groups of 3 or 4
Time yourselves and give feedback
If communication skills OSCEs are your worst area, memorise phrases.
For history taking, ask every question you can think of. Test each other on “difficult” histories,
eg
haematology, urology, vascular, ID.
Make sure you can teach & complete an examination in 6 minutes.
Unless told not to, always take a bit of history and summarise the management.
Slide44Where to find OSCEs
Slide45Any Questions?
Slide46Summary
We have covered:
Types of OSCE in the Exam
1. Joint examination
2. History taking
3. Breaking bad news
4. Psychiatry
5.
Resus
scenarios
6. Paediatrics
7. Procedures
8. Miscellaneous ........&Teaching
Practised most of them
Tips on how to revise for them
Good Luck!
Slide47The end