The OSCE Examination Phase 2b (2021)

The OSCE Examination Phase 2b (2021)

Dr. Amir BurneyPhase 2a/b Co-Director and Academic Lead for Clinical Skills

02/09/2021 © The University of Sheffield

2

Outline

• Overall structure of the OSCE exams

• Information regarding OSCE stations

• Handy tips for the exams

• Q and A

Aim of the Summative OSCE

• The primary aim of the Phase 2b OSCE is to assessyour skills in physical examination, history taking ,consultations and communication.

• You should be able to draw upon your knowledge of medical sciences combined with the experiences gained during the Longitudinal Integrated Clinical Placement. (LICP1).


3

Requirement for entry

• Satisfactory attendance and successfulcompletion of LICP1.

• You must have also passed all previoussummative assessments, completed allClinical Skills assessments and the EthicsSSC.


4

Objective Structured Clinical Examination (OSCE)

• This will be delivered in a sequential format.

• Sequential format: All students are entered for the whole span of testing instead of a first sit followed by a resit.

• I will explain further.


5

Sequential OSCE

• The first test of each sequence is called thescreening test. The aim is to screen forstudents who have not yet demonstrated thestandard required to pass.

• The second test is called the confirmation test.The aim is to confirm which of the studentsgoing forward to this test meet the standardrequired to pass overall.


6

Sequential OSCE

• If you do not reach the required standardin the screening test you will sit theconfirmation OSCE two weeks later.

• This will allow you the opportunity toovercome a ‘bad day’ of performance,and thereby potentially achieve an overallsatisfactory performance in the OSCEacross the whole sequence of testing.


7

You will be required to sit both confirmation and screening tests

• If you have not completed and submitted all ClinicalAttachment Assessment Forms.

• If you have not completed LICP1 satisfactorily.

• If you have not completed, and submitted the 4 Mini-CEXassessments.

• If you have not passed the SSC: Medical EthicsStructured Case Analysis

• Deadline dates are available via MINERVA


8

Important Dates• Tuesday 2nd November 2021 - The Phase 2b Screening OSCE will

take place at EIS (English Institute of Sports).

• Tuesday 9th November 2021 – Publication of screening OSCE.Results will be published directly to student’s ePortfolio.Requirement for a student to attend the confirmation OSCE will beclearly noted within the ePortfolio. A note will be placed on Minervaadvising students to check for results when they become available.

• Students who see ‘Not required to sit the Confirmation’ in theirePortfolio, are NOT required to attend the Confirmation OSCE.

• Tuesday 16th November 2021 - The Confirmation OSCE will takeplace at the Clinical Skills Centre, Samuel Fox House, NGH.

• Tuesday 23rd November 2021 – Examination Board Meeting andrelease of results.


9


10

Overall structure• Screening

• Confirmation

• The OSCE will consist of a fixed number of interactive stations which will be arranged in circuits.

• OSCE (15 stations) x 8 minutes each

• 12 Active stations x 25 marks each

• 3 Rest Stations

The structure

• There will be a one-minute gap between stations. This is broken down into 30 seconds for student movement and 30 seconds ‘Reading Time’.

• There will be a 10-15 minute break half way through the assessment to allow simulated and real patients to be substituted.

• OSCE lasts Approx. 3 hours


11

The OSCE• 5 Physical Examination stations

• 5 Focussed History stations

• 1 communications skills: Risk Assessment station

• 1 communication skills: Assessment of Chronic Disease Control

• 3 rest stations (Water, sweets, toilet break)

• Total number of stations 15

• Active stations 1202/09/2021 © The University of Sheffield

12

Physical Examination stations

• 7 minutes to perform the task at the physicalexamination stations.

• 1 minute to present findings to examiner and in somestations, also answer one short question.

• Real patients with clinical signs in most stations.

• Normal volunteers in some stations. You will not knowbeforehand and must determine this for yourself e.g.normal abdomen, normal respiratory or normal cardiacexamination.


13


• Thyroid examination

• Examination of the hip, knee, shoulder, hand or spine

• GALS musculoskeletal examination

• Peripheral vascular examination (be prepared to examine specific limbs e.g. upper limbs, lower limbs) – No Doppler or ABPI

• Varicose vein and chronic venous insufficiency examination – No Doppler

• Examination of the diabetic foot

• Cardiac examination

• Respiratory examination

• Gastrointestinal examination

• Cranial nerve examination

• Upper and lower limb peripheral nervous system examination

• Cerebellar examination


14

Prepare the following (which can be combined in a single station):

Examples of combined stations

MSK

Examine both Knees and left hip

Examine both Hips and lumbar spine

Examiner both shoulders and cervical spine

NOTE

• Knees, hips and shoulders can also be asked in isolation

• Hand examination is on its own

• Full Spine Examination is not requested


15


• You should interact with the patient as in anormal physical examination e.g. identification,obtaining consent, explaining the process andclear instructions.

• You should not give a running commentary.

• At the end, you will be asked to present yourfindings.

• You may be asked one more question.

02/09/2021© The University of Sheffield

16

Physical examination stations• The emphasis of the assessment is on carrying

out the process of physical examinationcompetently. However, in order to ensure thatstudents are carrying out a full and thoroughphysical examination, up to 10% of the marks ineach physical examination station may beawarded for detection, description andinterpretation of physical signs, when present.


17

Physical examination stations

Some examples of questions by examiners at the end of the task .

• Please summarise your findings.

• What is the most likely diagnosis?

• If you have already mentioned the diagnosis in your presentation of findings then this question is not asked.


18

Examination stations • Marks will be awarded for:

• Logical, competent and safe approach

• The way you interact with the patient

• The manner in which you describe your findings (well-structured, appropriate terminology, professional, articulate, etc.)

• Examiner’s questions


19

Patient contribution to marks

Patients will award marks:

Rapport

Clarity of Instructions

Support

Rapport• Did the student establish rapport? (Defined as a mutual

relationship based on trust and empathy). Were they responsive to you? Did they demonstrate appropriate use of verbal and nonverbal communication?

Clarity of instructions• Did the student clearly explain to you what they needed

you to do at each stage of the examination? e.g. “to sit forward, breathe in and out, then hold your breath”.

• Did they explain it in a way that you could easily understand, without using technical/medical language?


21

Patient contribution to marks

Support

• Did you feel that they were empathetic andsupportive towards you?

• For example, if you had any limitation in yourability to follow their instructions (e.g. if you hadany discomfort in your ankles, did they makeallowances for this and adapt their examination

accordingly?


22

A sample OSCE station – Instructions for student

• Perform a full cardiac examination including an examination of the hands, face, mouth and neck on this patient.

• You should not describe the procedure, or your findings, to the examiner as you go along.

• You are not required to perform the following

• Patient’s blood pressure

• Examine the femoral pulse or perform radio-femoral delay

• Shifting dullness test

• Check for hepatomegaly

• After 7 minutes the examiner will ask you to summarise your findings and ask one further question.

• Use of electronic stethoscopes is permitted*


23

Question 1:• After 7 minutes (but not earlier than this), please ask the

student the following:

• 1. “Please summarise your findings” (3 marks)

A. The student should give a well-structured answer, startingperipherally (e.g. slow-rising pulse), describing the JVP andthen describing their findings on examination of theprecordium. The student should state that the patient has acardiac murmur. The student should state that the murmur isloudest at the aortic area (or right 2nd intercostal space), thatit is systolic, mid-systolic or ejection-systolic and that itradiates to the neck/carotids.


24

Mark scheme• 3 marks = a well-structured summary using appropriate

terminology and accurately describing the clinical signsthat were demonstrated by the patient (rather thanstating the signs they would expect to see in a patientwith a valve disorder)

• 2 marks = a well-structured answer that includesappropriate terminology but the student fails to includesome key positive findings.

• 1 mark = the student demonstrates evidence of rotelearning and lists features that were not demonstratedby the patient during the examination. Most key positivefindings were omitted from the summary.


25

Question 2:

• What is the most likely diagnosis? (1 mark)

A. Aortic stenosis / sclerosis (1 mark)

For other responses award no marks.


26

OSCE Preparation

• Examine lots of patients on the wards and in clinic.

• Do not just examine each other at home (anticipating normal findings in the OSCE).

• Practice presenting your findings to senior colleagues, Foundation Doctors etc.

• The clinical examination handbook is a suitable guide along with your choice of a physical examination book.

Don’t forget• To wash your hands, introduce yourself, identify

your patient and clearly obtain informedconsent.

• To examine the relevant lymph nodes.

• To mention things you would do to complete theexam e.g. iSHRUG after abdomen or examiningthe joint above and below , neurovascular statusafter examining a joint etc.

• To thank, cover/redress the patient afterwards.


28

History stations – 5 stations

• Acute or Chronic Scenario

• 7 minutes to take a focussed history.

• 1 minute of questions from the examiner.

• If you finish your history early, the examiner cannot ask the questions early.

• There will be a bell or verbal prompt for the examiner to ask you the questions.


29

What histories you may be asked to take?

• Cardiovascular (cardiac’ or ‘vascular)

• Respiratory

• Gastrointestinal

• Neurological

• Endocrine (e.g. thyroid, diabetes)

• Urological (e.g. haematuria, urinary symptoms)

• Haematology (e.g. anaemia, lymphoma)

• Musculoskeletal/rheumatology (e.g. osteoarthritis, Gout, RA) etc.


30

History stations – What to do

• Wash your hands – alcohol gel

• Introduce yourself:

• Full name and post

• Check the patients identity:

• Name and date of birth. (Tip) Ask their age.

• Obtain consent to take the history

“Do you mind if I ask you some questions about your medical problem?” e.g. chest pain, weight loss , lump, shortness of breath etc.


31

History stations

The history

• Full and detailed history of presenting complaint

• Start with open questions, then ‘focus’ to reach a diagnosis.

• Don’t just recite a list of questions. Listen to what the patient tells you. Give them chance to speak.

• Ask clarifying questions to get the detail you need.

• If you get stuck, recap the patients history. It may prompt you.

• If there is pain, “do a full SOCRATES” on it

• Include risk factor enquiry where relevant e.g. vascular disease

• PMH, Drugs, Allergies, Family History, Social History

• NO systematic enquiry

• Find out the patient’s “Ideas, Concerns and Expectations”02/09/2021 © The University of Sheffield

32

History stations – example Qs

Examiners questions may include.

• Give the most likely diagnosis.

• Answer a question regarding requesting appropriate investigations (e.g. ECG)

• Deciding appropriate management (e.g. names of drugs).

• Be asked about First line treatment or intervention

• List one diagnostic investigation that will help to confirm the diagnosis?


33

e.g. Cardiac chest pain HPC:• SOCRATES

• Relevant ‘focussed’ questions:

Previous myocardial infarction / angina

Palpitations (regular/irregular; fast/slow; missed beats; associated symptoms e.g. pain, breathlessness, syncope, sweating)

Heart failure (Orthopnoea/ Paroxysmal nocturnal dyspnoea/ ankle oedema)

Rheumatic fever, valve disease and murmurs

Pacemaker and/or cardiac surgery

Peripheral vascular disease (claudication, rest pain)

Cerebrovascular disease (strokes, ‘mini-strokes’, etc)

Aortic aneurysm02/09/2021 © The University of Sheffield

34

e.g. Cardiac chest pain HPC

• Risk factors:

• Smoking

• Hypercholesterolaemia

• Hypertension

• Diabetes

• Positive family history

• Previous investigations and treatment for this condition (if any)


35

History stations

• Past medical history

• “Do you have any medical conditions?”

• “Have you had any significant medical conditions or illnesses in the past?”

• “Have you had any operations in the past?”

• Avoid using a screening list e.g. MJ THREADS only!


36

History stations

• Drugs

• Ask about prescription and over-the-counter drugs.

• Allergies

• Family history

• “Are there any diseases that run in your family?”

• “Does anyone in the family have similar symptoms to yourself?”

• “Are your parents still alive? Are they well? If deceased, what did they die from and at what age?”


37

History stations • Social history

• Smoking (Current smoker? Ex-smoker? How many did you smoke a day? How old were you when you started smoking? How long ago did you stop smoking? Etc.)

• Alcohol (if excessive, do a CAGE questionnaire if not already done in HPC)

• Recreational drugs (where relevant)

• Occupational history (if not already covered as a risk factor in HPC)

• Housing e.g. bungalow versus house with stairs

• Activities of daily living

• Foreign travel (if relevant)


38

History stations

Ideas, concerns and expectations

• The patient might have an underlying concern that they haven’t revealed e.g. “I think I might have cancer”

• What do you think might be happening?

• Do you have any concerns about what it might be?

• What were you hoping that we might be able to do for this?


39

CAGE Questions

• Have you ever felt you should cut down on your drinking?

• Have people annoyed you by criticising your drinking?

• Have you ever felt guilty about your drinking?

• Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)?


40

Remember:

• This is not a list-reciting exercise.

• You are expected to hold a Two-way dialogue with the patient, responding appropriately to what the patient says, and formulating a diagnosis / giving an explanation

Patient contributionThe patient contributes marks as follows:

• Listening skills: Did the student make eye contact, encourage you to talk by using open questions and gestures, summarise what you have told them and respond appropriately to what you have told them?

• Language and explanation: Did they ask questions and explain things in a way that you found easy to understand, without using medical jargon?

• Support and empathy: Did you feel supported and that the student understood your feelings (empathy)?

• These marks are entirely at the discretion of the patient.

Examiner contribution• The examiner will award marks for specific aspects of the

focused history e.g.

• Active listening, patient centred approach

• Taking a history in a logical and ordered manner

• The diagnosis and knowledge-related questions.

• For the accuracy of the history of the presenting complaint. Remember the checklist approach will not suffice.

• Communication

Students will also be asked

• To perform a basic risk assessment for a patientusing a combination of history-taking and datainterpretation e.g. stroke, diabetes.

• To assess a patients disease control (e.g. asthmacontrol), and to establish the impact the illness ishaving on their activities of daily living etc.


44

Communication skills: Assessment of chronic disease control

• You will be asked to analyse data and to ask targeted questions toassess how well a patient's chronic disease is currently controlled(e.g. asthma with diurnal variation in peak flow)

• Establish the impact of the illness of the patients life e.g. mood,ability to work, quality of sleep, social interactions etc. They will also

• Ask focussed questions to establish the patients' adherence withtheir treatment regimen and the factors influencing this.

• The data examined will come from the following list and normalranges will be provided where appropriate: INR, Peak flow diary,spirometry data, HbA1c, inflammatory markers (e.g. ESR/CRP), LFTs,tumour markers e.g. PSA.


45

Communication skills: risk assessment station

• You will use a combination of focussed history-taking and data interpretation to establish a relative risk of developing a disease.

• You will then respond to questions by the examiner regarding behavioural/lifestyle change/counselling etc.

The syllabus for this station is as follows:

• Diabetes risk (diabetes risk score)

• Cardiovascular risk (QRisk)

• Stroke risk in atrial fibrillation (CHADs2VASc)

• Osteoporosis risk (FRAX)

• Risk of stroke after TIA (ABCD2)

• DVT (Wells' score)


46

Examiners markingDetails of Task Performed

competently and

completely

Partially

completed /

inaccuracies in

technique

Barely

attempted

Not attempted


47

OSCE marking:• Once the examiner has filled in the mark sheet they are required to

give a second rating of the student’s performance on the basis of whether they think that student has achieved any of the following rating for the station. This second rating is referred to as a ‘global rating’.

• A global rating is given by the examiner:


48

GLOBAL RATING

(Please circle)

EXCELLENT

PASS

GOOD PASS PASS BORDERLINE CLEAR FAIL

Handy hints and tips

• Pace yourself

• Still loads of time

• See as many patients you can

• Team up with a colleague , work in pairs

• Don’t worry about the diagnosis. First take a history or examine the patient. The diagnosis will follow.


49

On the day

• Dress professionally.

• Clip you ID badge.

• Remember infection control, hand washing.

• PPE if required will be provided.

• Read the instructions clearly. If in doubt read the instructions again.


50

OSCEs• The exam will feel tough.

• No-one expects you to examine the heart like a consultant cardiologist!

• You are a Phase 2b student who needs to demonstrate that you are safe and competent to progress to Phase 3a.

• I will post the lecture slides on MINERVA.


51

You need to bring a watch, stethoscope and your U-card


52

Handy hints: Respiratory• Remember the surface markings of the lungs – make

sure you percuss and auscultate the correct areas (including right middle lobe)

• Remember JVP

• Remember lymph nodes


53

Handy hints: Cardiac

• Identify the JVP and measure it

• Identify the first heart sound by timing it with the carotid pulse in the neck

• Don’t forget the special manoeuvres for the murmurs

• Don’t forget to listen to the carotids for transmitted aortic murmurs or bruits


54

Handy hints: Abdomen• Inspect the patient and their abdomen from a distance

first, near the foot end of the bed.

• Enquire about pain prior to palpation.

• Examine lymph nodes (supraclavicular).

• Without prompting, tell the examiner the ‘end pieces’: “I would also examine the inguinal nodes, stools (if appropriate), hernial orifices, rectum, urine and external genitalia” (I SHRUG).


55

Handy hints: Neurology• Read the question carefully. You will be clearly told which

pieces of the examination to omit.

• Equipment will be provided if needed (e.g. pen torch, tendon hammer, tuning fork).

• Selected cranial nerves will be requested by number (e.g. II,III......).

• If doing a lower limb neurological exam, remember Romberg’s test and gait (If asked)

• If doing an upper limb neuro exam, remember pronator drift.


56

Handy hints: Neuro Cranial nerves:

• Not required to examine blind spot, corneal reflexes, optic fundi, colour vision, gag reflex, smell, taste, jaw jerk

• Visual acuity: Ask “Do you have any problems with your vision that aren’t correctable by wearing glasses or contact lenses?”. Ask patient to put their glasses on if they wear them then count fingers held in front of patient or read magazine text.

• Test visual acuity in each eye separately. (Snellen chart not available in exam).


57

Handy hints: MSK• Remember the screening questions for GALS

• Use appropriate terminology e.g. “The patient has a reduced range of internal rotation or flexion of the left hip”

• When doing an orthopaedic examination don’t drift in to doing a neurological examination. Stay with the look, feel, move, special test format. Neurological and vascular examinations are stated at the end as tasks you would do to complete the examination


58

Some tips

• Don’t tell the examiners or patients that you are nervous

• Read the instructions carefully

• Present in the order you examined

• Mnemonics!


59

Finally......• If you have any extenuating circumstances:

• Submit them early with appropriate supporting documentation

• Inform the Phase 2b team as soon as possible


60

If you are really worried about the exam preparation

• You should discuss this with Dr Joanne Thompson or myself.

• Don’t be reluctant to approach us and ask for support.

• You may email me regarding any queries regarding the OSCEs.


61


62

All the Best


63

Any questions?

Thank you

Date post:	05-Dec-2021
Category:	Documents
Upload:	others
View:	3 times
Download:	0 times

The OSCE Examination Phase 2b (2021)

Documents