OBJECTIVE STRUCTURED CLINICAL EXAMINATION

“OSCE”

Hassan Nasrat

Professor of Obstetrics & Gynecology

King Abdulaziz University Hospital

OSCEO : OBJECTIVE

S : STRUCTURED

C : CLINICAL

E : EXAMINATION

Why OSCE?

WHAT DOES IT TEST ?

HOW TO RUN IT?

OSCE

Why OSCE?

Antenatal Labor Postnatal Newborn Gynecology

History Obstetric H/R

Diagnosis of labour

History of Gynecology

Physical Obstetric Maneuvers

Progress in labour

Post natal evaluation ( normal and CS)

Delivery relevant complications

Tests/investigations/procedures

BPPRoutine AN tests

CTGInstruments

Tests in complications

Resuscitation of Newborn

Instruments Specific investigations

Data interpretation

CTGGTTPET

Partogram Postnatal tests: Rubella. RH

HSGSemen testHormone profile

Communication and education

NutritionExercise

Breast feeding Contraception

Antenatal Labor Postnatal Newborn Gynecology

History Obstetric H/R

Diagnosis of labour

History of Gynecology

Physical Obstetric Maneuvers

Progress in labour

Post natal evaluation ( normal and CS)

Delivery relevant complications

Tests/investigations/procedures

BPPRoutine AN tests

CTGInstruments

Tests in complications

Resuscitation of Newborn

Instruments Specific investigations

Data interpretation

CTGGTTPET

Partogram Postnatal tests: Rubella. RH

HSGSemen testHormone profile

Communication and education

NutritionExercise

Breast feeding Contraception

Antenatal Labor Postnatal Newborn Gynecology

History Obstetric H/R

Diagnosis of labour

History of Gynecology

Physical Obstetric Maneuvers

Progress in labour

Post natal evaluation ( normal and CS)

Delivery relevant complications

Tests/investigations/procedures

BPPRoutine AN tests

CTGInstruments

Tests in complications

Resuscitation of Newborn

Instruments Specific investigations

Data interpretation

CTGGTTPET

Partogram Postnatal tests: Rubella. RH

HSGSemen testHormone profile

Communication and education

NutritionExercise

Breast feeding Contraception

Antenatal Labor Postnatal Newborn Gynecology

History Obstetric H/R

Diagnosis of labour

History of Gynecology

Physical Obstetric Maneuvers

Progress in labour

Post natal evaluation ( normal and CS)

Delivery relevant complications

Tests/investigations/procedures

BPPRoutine AN tests

CTGInstruments

Tests in complications

Resuscitation of Newborn

Instruments Specific investigations

Data interpretation

CTGGTTPET

Partogram Postnatal tests: Rubella. RH

HSGSemen testHormone profile

Communication and education

NutritionExercise

Breast feeding Contraception

Antenatal Labor Postnatal Newborn Gynecology

History Obstetric H/R

Diagnosis of labour

History of Gynecology

Physical Obstetric Maneuvers

Progress in labour

Post natal evaluation ( normal and CS)

Delivery relevant complications

Tests/investigations/procedures

BPPRoutine AN tests

CTGInstruments

Tests in complications

Resuscitation of Newborn

Instruments Specific investigations

Data interpretation

CTGGTTPET

Partogram Postnatal tests: Rubella. RH

HSGSemen testHormone profile

Communication and education

NutritionExercise

Breast feeding Contraception

Antenatal Labor Postnatal Newborn Gynecology

History Obstetric H/R

Diagnosis of labour

History of Gynecology

Physical Obstetric Maneuvers

Progress in labour

Post natal evaluation ( normal and CS)

Delivery relevant complications

Tests/investigations/procedures

BPPRoutine AN tests

CTGInstruments

Tests in complications

Resuscitation of Newborn

Instruments Specific investigations

Data interpretation

CTGGTTPET

Partogram Postnatal tests: Rubella. RH

HSGSemen testHormone profile

Communication and education

NutritionExercise

Breast feeding Contraception

This station is to test your ability to take relevant history

Mrs. Fatma is 38 weeks pregnant lady complaining of headache

Grade Failure Border line Pass

Marks 0 0.25 0.5

1. Age of patient

2. Duration of symptoms

3. Location of headache

4. Respond to pain killers

5. Nausea or vomiting

6. Blurred vision

7. Swelling of hands, feet and face

8. Pain in upper abdomen ( epigastric)

9. Previous pregnancies (i.e. obstetric history)

11. Menstrual History (regularity)

12. LMP

13.Past medical history

14. Past surgical history

15.Family history

This station is to test your skill in doing abdominal examination and building differential

diagnosis

38 years old, P1 + 0 was referred to Gynecology clinic because of recurrent lower abdominal pain

• Do systematic abdominal examination

• What is the differential diagnosis

Grade Failure Border line Pass

1. Introduce him/hers self & ask patient name 0.5

2. Position patient properly for examination 0.5

3. Describe systemic general examination (not to do) 0.5

Inspection

4. Scars 0.5

5. Hernia 0.5

6.Hair distribution 0.5

7. Movement of Abdomen 0.5

Palpation

8. Ask about pain and start away from site of pain 0.5

9. Superficial palpation : start away from pain 0.5

10. Deep palpation 0.5

11. Feel for renal angles 0.5

Describe Mass

12. Site 0.5

13. Size 0.5

14. Surface 0.5

15. Mobility 0.5

16. Tenderness 0.5

Differential Diagnosis

17. Ovarian mass 0.5

18. Fibroid 0.5

19. Pregnancy 0.5

20. Bladder 0.5

Grade Failure Border line Pass

1. Introduce him/hers self & ask patient name 0.5

2. Position patient properly for examination 0.5

3. Describe systemic general examination (not to do) 0.5

Inspection

4. Scars 0.5

5. Hernia 0.5

6.Hair distribution 0.5

7. Movement of Abdomen 0.5

Palpation

8. Ask about pain and start away from site of pain 0.5

9. Superficial palpation : start away from pain 0.5

10. Deep palpation 0.5

11. Feel for renal angles 0.5

Describe Mass

12. Site 0.5

13. Size 0.5

14. Surface 0.5

15. Mobility 0.5

16. Tenderness 0.5

Differential Diagnosis

17. Ovarian mass 0.5

18. Fibroid 0.5

19. Pregnancy 0.5

20. Bladder 0.5

Data interpretation

A 38 years old patient, Gravida 8 para 6+1. Her previous delivery ended by cesarean section due to failure to progress.

Her family doctor have ordered a GTT and she brought the result for you for advise

Instruction for the Simulated Patient (Examiner)

Doctor can you tell me is my GTT result normal or not?

Is there any danger (complications) for me from this condition?

Is there any risk for my baby?

Item Mark

Well Average ND

Interpretation of test (Positive for GDM) 2 1

Risks to the patient

Increased risk of high BP (PET) 1 ½

Increased rate of infection (urinary/vaginal) 1 ½

Risks to the fetus

Polyhydramnios 1 ½

Macrosomia 1 ½

Operative / Difficult delivery 1 ½

RDS 1 ½

Neonatal Jaundice 1 ½

Other metabolic disorders 1 ½

Total

Item Mark

Well Average ND

Interpretation of test (Positive for GDM) 2 1

Risks to the patient

Increased risk of high BP (PET) 1 ½

Increased rate of infection (urinary/vaginal) 1 ½

Risks to the fetus

Polyhydramnios 1 ½

Macrosomia 1 ½

Operative / Difficult delivery 1 ½

RDS 1 ½

Neonatal Jaundice 1 ½

Other metabolic disorders 1 ½

Total

Item Mark

Well Average ND

Interpretation of test (Positive for GDM) 2 1

Risks to the patient

Increased risk of high BP (PET) 1 ½

Increased rate of infection (urinary/vaginal) 1 ½

Risks to the fetus

Polyhydramnios 1 ½

Macrosomia 1 ½

Operative / Difficult delivery 1 ½

RDS 1 ½

Neonatal Jaundice 1 ½

Other metabolic disorders 1 ½

Total

Data Interpretation

28 years old Gravida 10 Para 9+0 at 13 weeks of gestation came to the clinic complaining of: Palpitation and shortness of breath.

A complete blood count (CBC) test was performed.

You are require to interpret the result of the CBC

Item Mark

Well Average ND

What does the result of this test shows? (Examiner to show CBC form)

Low hemoglobin (anemia) 1 1/2

What type of anemia

Hypochromic micorcytic 2 1

Can it be confused with other type of anemia?

Thalassaemia and 1 1/2

Sickle cell anemia 1 1/2

How would you confirm?

Hemoglobin electorphoresis 1 ½

Sickle cell test 1 ½

What do you think of this result? (Examiner to show the result of the electrophoresis)

Confirm Iron deficiency anemia 3 2

Total

Postnatal Examination

You are the house officer in the ward and in the morning round you came across this patient who had delivered 24 hours ago.

How would you assess her?

Item Mark

Well Average ND

Initial approach to the patient (introduce him/her self, explain what he/she will be doing)

1 ½

Mode of delivery 1 ½

Delivery outcome (the baby) 1 ½

Lochia / Bleeding 1 ½

Bladder function 1 ½

Perineum/excessive pain (episiotomy) 1 ½

Check vital signs 1 ½

Breast feeding 1 ½

What important investigations you would like to review before discharge

CBC 1/2 1/4

Blood Group (RH factor) 1/2 1/4

Rubella test 1/2 1/4

Hepatitis test 1/2 1/4

Total:

Item Mark

Well Average ND

Initial approach to the patient (introduce him/her self, explain what he/she will be doing)

1 ½

Mode of delivery 1 ½

Delivery outcome (the baby) 1 ½

Lochia / Bleeding 1 ½

Bladder function 1 ½

Perineum/excessive pain (episiotomy) 1 ½

Check vital signs 1 ½

Breast feeding 1 ½

What important investigations you would like to review before discharge

CBC 1/2 1/4

Blood Group (RH factor) 1/2 1/4

Rubella test 1/2 1/4

Hepatitis test 1/2 1/4

Total:

Item Mark

Well Average ND

Initial approach to the patient (introduce him/her self, explain what he/she will be doing)

1 ½

Mode of delivery 1 ½

Delivery outcome (the baby) 1 ½

Lochia / Bleeding 1 ½

Bladder function 1 ½

Perineum/excessive pain (episiotomy) 1 ½

Check vital signs 1 ½

Breast feeding 1 ½

What important investigations you would like to review before discharge

CBC 1/2 1/4

Blood Group (RH factor) 1/2 1/4

Rubella test 1/2 1/4

Hepatitis test 1/2 1/4

Total: