OSCE DATE ??/??/201? 1 MEDICINE STATION M1 History Taking Station QUESTION Resources needed One examiner Simulated patient (M/F, 20 - 30, Egyptian) Paper and pens if students wish to make notes Setting up the station Examiners’ chairs should be positioned so that they can observe faces of both candidate and simulated patient. No desk or table is necessary. If one is present, it should NOT form a barrier between the candidate and the patient. DIAGNOSTIC HISTORY INFORMATION FOR SITE ORGANISERS
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MEDICINE STATION M1 History Taking Station - Mans Example M… · MEDICINE STATION M1 History Taking Station QUESTION Resources needed ... 2- Put the patient at ease, let him to lie
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OSCE DATE ??/??/201?
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MEDICINE STATION M1
History Taking Station
QUESTION
Resources needed
One examiner Simulated patient (M/F, 20 - 30, Egyptian)
Paper and pens if students wish to make notes
Setting up the station
Examiners’ chairs should be positioned so that they can observe faces of both candidate and simulated patient.
No desk or table is necessary. If one is present, it should NOT form a barrier between the candidate and the patient.
DIAGNOSTIC HISTORY
INFORMATION FOR SITE ORGANISERS
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M1 – Instructions to the Role Player (Simulated Patient)
Patient’s name ------------------ Question 1 Setting Medical Ward Gender -----
Timing 8 minutes Age 20-30 years
Who are you?
You a faculty students (Arts)
You do not smoke
You are unmarried and you live with your parents
Your mood is anxious
You are generally quite easy to talk to
You are diabetic for thirteen years.
CURRENT HEALTH PROBLEM (COMPLAINT)
7 days ago you developed high temperature 39ºC in addition to burning micturition. You felt progressively weak and unwell
2 days ago you had severe abdominal pain, that nothing could relieve it, developed vomiting, noticed rapid breathing and your parents noticed a strange odor in your breath
You were taken to the emergency room, where blood tests were taken and frequent finger pricks for blood sugars were done. You were given some intravenous fluid and medications over the last 2 days that made you feel better.
BACKGROUND (PRESENT HISTORY):
Answer the relevant questions only when prompted by students
Diabetes was discovered in your early teenage when you passed much urine with excess thirst. You shortly felt extremely unwell with decreased consciousness and were admitted to hospital and received intravenous fluid and insulin. You were discharged after few days, on insulin shots twice daily before meals
You were advised to change the way of your life. You had to give up eating ice cream and chocolate also your family had to change their dietary habits to encourage you.
Now you are on Mixtard 100 IU using pen (which is better than syringe punctures) with dose 25 unites before breakfast and 15 before dinner.
You used to check your blood glucose at home; it usually ranges from 160-180 mg\dl
Sometimes you had palpitation, sweating and headache that may mean hypoglycemia, but you never had coma, which were relieved by sweets or sugary drinks
You have numbness and tingling in your feet
You had eye examination and urine analysis that were normal
Otherwise your health is OK
FAMILY HISTORY No family history of diabetes
You parents are alive and well
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MEDICATIONS Mixtard: 25 units before breakfast and 15 units before dinner
For the last week: Paracetamol and Antibiotics for urine infection
No allgery
FEELING AND CONCERN You heard of and saw patients with diabetic complications like amputations of legs, marked
problem with eyes, kidney disease, and you are afraid to follow the same track.
You are also disturbed very much with the attacks of hypoglycaemia that you sometimes encounter as it may lead to serious consequences
Previous Medical Problems
No significant past history of endemic diseases, operations or hospital admissions apart from
the once stated above.
If asked on anything not mentioned in the above scenario give a negative , neutral answer or
simply “I do not remember”
After ~ 6 minutes of the beginning, insist to ask the student as many questions as possible on:
Doctor, do you think I will have the silly complications of diabetes like amputations,
loss of vision and kidney failure?
How can I avoid the current acute problem in the future
Thank the student
STANDARDISATION ISSUES
As this is an exam, it is important to perform the same role time after time, and for Role Players to
perform the same role on different sites. All aspects of the script have been inserted for good
reasons. Please do not divert from the script. If confronted with questions outside the script, try to be
neutral or negative in your answer but be consistent with all the students. If there is any query of
uncertainty, please take the advice of the examiner on your station before meeting the students.
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History Taking Station
M1 – Instructions to student
This is an 8-minute station. It is set in the Medical Ward. This is ---------------------
He/she, a known diabetic person, has come to the emergency complaining of 2-day of vomiting, fever and severe abdominal pain. The on-call registrar wants you to interview her first. In the next 8.0 minutes take a relevant history of the problem to try to reach a diagnosis. The patient is expected to ask you some questions on the last 2 minutes or so. Do your best to respond appropriately to the patients fear and queries.
The examiner will be monitoring you all the way around and appreciate your areas of excellence. Before your time is up make sure to tell the examiner about the diagnosis of the recent illness and what could be the precipitating factor in this patient.
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History Taking Station
M1 – Instructions to examiner:
The Candidate has been given this information: This is an 8-minute station. It is set in the Medical Ward. This is ---------------------
He/she, a known diabetic person, has come to the emergency complaining of 2-day of vomiting, fever and severe abdominal pain. The on-call registrar wants you to interview her first. In the next 8.0 minutes take a relevant history of the problem to try to reach a diagnosis. The patient is expected to ask you some questions on the last 2 minutes or so. Do your best to respond appropriately to the patients fear and queries.
The examiner will be monitoring you all the way around and appreciate your areas of excellence. Before your time is up make sure to tell the examiner about the diagnosis of the recent illness and what could be the precipitating factor in this patient.
After 6.5 minutes, please give a 30 second warning to close the interview.
In the last minute, ask the candidate to mention the most likely diagnosis of the recent condition that directed him to the hospital and what was the precipitating factors, if not accomplished while talking with the role player.
The most likely diagnoses are 1. Uncontrolled diabetes – diabetic ketoacidosis precipitated by infection
probably urinary tract
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OSCE STATIONS M1
HISTORY TAKING
MARKING SHEET
STUDENT NAME----------------------------------------------------------------------- STUDENT ID
(M/F, 30-50 Yr, Egyptian) A bed for the patients preferable with an elevated head
A clean bed cover Paper and pens if students wish to make notes EXAMINATION GLOVES, WASHING FACILITIES OR ALCOHOL GEL
Setting up the station
Examiner's chair should be positioned so that he can observe both candidate and patient.
A desk or a table is preferable, buy it should NOT form a barrier between the candidate and the patient.
INFORMATION FOR SITE ORGANISERS
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CLINICAL EXAMINATION SKILLS
Instructions to The Patient M2(A)
Use your own name and age
You are coming for a follow-up visit. You had a history of chronic liver
disease and you noticed that your abdomen is progressively enlarged and feel discomfort. You had seen doctors several times and you had blood tests and imaging carried out and you are maintained on some pills but
they did not help to make you completely well
The student will offer to examine you generally and your abdomen in particular
Obey his commands in lying on your back, bending you knees and taking deep breaths in and out when you are asked to do.
You may express inconvenience of pain if you feel so when the student
palpate your abdomen roughly There is no need to give the student any extra information about your
case.
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CLINICAL EXAMINATION SKILLS
Instructions to the Candidate (Student) M2(A)
This is an 8 minute station.
It is set in a Medical Ward. This is a Real patient
He is a ~60-year-old male who has come for a follow-up visit. He has a
history, of chronic disease and noticed recently distension of his abdomen. His plasma albumin is low, liver enzymes normal and
prothrombin time mildly increased. He receives oral pills for the last 3 years
Your consultant wants you to perform appropriate abdominal inspection
and palpation to see if he has got abnormalities – in 6 minutes.
You will be presenting the findings to the examiner while you are doing the examination
then you should o Define the patient's major problem
o name 3 important investigations that should be performed for such condition
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CLINICAL EXAMINATION SKILLS
Instructions to examiner M2(A):
This is an 8 minute station.
It is set in Medical Ward. This is a Real patient who will use his own name and age
THE PATIENT He is coming for a follow-up visit. He has a history of chronic liver disease
and he notices that his abdomen is progressively enlarging and feels
discomfort. It sometimes makes him breathless. He had seen doctors several times and he had blood tests and imaging carried out. He is maintained on some pills but they did not help to make him completely
well PLEASE EXAMINE THE ABDOMEN OF THE PATIENT BEFORE THE
FIRST STUDENT COMES IN AND CHECK THE CLINICAL SIGNS IN ORDER TO MARK THE STUDENTS’ PERFORMANCE
Stop the students if they overindulge in history taking or examination of different systems
The examiner is expected to be observing the student who should:
1- Approach the patient gently greats him and introduce himself asking politely for the
permission to examine the patient. He should state that the reason for the examination
is according to the consultant's orders.
2- Put the patient at ease, let him to lie down in the supine position, make sure that his
hands are clean and warm or warm them by rubbing; otherwise should apologise that
his hands are not warm enough. The abdomen is to be uncovered gently from the
suprapubic area to near the nipple line.
3- Watch the abdomen while the patient taking his normal breathing and while coughing;
looking at it tangentially from the right side and from caudally. He should ask the
patient to try to raise his head and trunk off the bed and notices divercation of the
recti abdominis muscles.
4- Superficial and deep palpation in the classic method
5- Palpation for the spleen, right and left hepatic lobes, sigmoid colon, kidneys and
masses in all areas of abdomen
6- After completing the examination the student should cover the abdomen and the
patient gently, thanking the patient that all has been done and responding to the
patient's comments or queries and stating that he would be reporting the findings to
the examiner to carry on necessary steps.
7- On commenting on inspection of the abdomen he should appreciate if the abdomen is
distended, diffusely or regionally, with full or empty flanks, the site and shape of the
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umbilicus and if there any pigmentation, scars or dilated veins, the distribution of hair
whether feminine of masculine, movement with respiration and its type, bulging at
sites of hernia orifices during coughing and divercation of recti when the patient tries
to raise his head, and lastly if there is superficial masses or visible peristalsis
Answers of the Questions
o The patient's major problem is ??Hepatosplenomegaly as a
complication of chronic liver disease. PS. If the student did not get the diagnosis, the examiner
should tell him the diagnosis in order to carry out the rest of the station for testing his knowledge
o 3 important investigations that should be performed for such condition
Blood biochemistry including liver function tests (bilirubin, enzymes, albumin, Pt/INR), P. Creatinine, electrolytes,
CBC to see if there is pan- or mono-cytopenia,
Alpha-feto protein to exclude hepatoma (HCC), Abdominal ultrasound to define anatomical and gross
pathological changes of the liver and the peritoneal cavity, to see if there are lesions suggestive of malignancy and to confirm the presence and nature of the ascitic fluid.
Liver biopsy in selected cases (probably not this case)
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OSCE STATIONS
CLINICAL SKILLS – M2(A)
MARKING SHEET
Student's Name .....................................................................
Student No.
Check Marks
Conduct of examination Total Mark: /4
Greets patient and introduces self (1) Putting him at ease (1)
Appropriate confidence and pace (1)
Communication with the patient during examination, asking for
permission to examin (1)
Clinical Examination Total Mark: /12
Uncovering the abdomen politely and appropriately at start of
examination (1)
Technique of inspection as detailed above (3)
Superficial palpation for tenderness & superficial masses (2)
Deep palpation for liver and spleen (4)
Confident presentation (2)
Closing Total Mark: /4
Covering the patient at the end of examination and thanking him for
cooperation (1)
Defining the problem of the patient (1)
3 important investigations for the case as detailed above (2)
Grand Total Total Mark: /20
Examinar's Name & Number:...................................................................
Ward....................... Date .......June, 2014 Signature
SPECIFIC COMMENTS FOR THE STUDENT:
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Data Interpretation Skills (Medicine) M3B DATA INTERPRETATION
Instructions to students-2
Data
Serum bilirubin: 6mg/dl, Direct 4.5 mg/dl
Serum Albumin: 2.6mg/dl,
AST: 168, ALT 122 IU, Alkaline Phosphatase 56 KAU (normal range 3-13)
Serum Na 125 mEq/L, Serum K: 3.4 mEq/L, S. Ca: 7.7 mg/dl
Data interpretation Summarizing the data and interpreting the results (0.5 marks each)
- Fluent summery, High bilirubin, High direct bilirubin, Low serum Album, High transaminases, High alkaline phosphatase, High serum creatinine, High Na & low K, Increased prothrombin time, Pancytopenia, +ve serology for HCV, -ve HBsAg while +ve HBsAb,
…………./4
Current status for HCV and HBV
- Active HCV infection while previous HBV infection now immune for HBV
…………./4
Appropriate diagnosis: - Active HCV infection. Immune for HBV. Cholestatic chronic
hepatits. Liver cell failure (execretory and synthetic functions impaired)
……/4
Appropriate next-step investigations (any 2 of the following):
Conservative: salt restriction. K-rich diet. No role for interferon. Diuretics. IV albumin. Therapeutic paracentesis. Liver transplantation
……/4
Total marks for data interpretation /20
Examinar's Name & Number:...................................................................
Ward....................... Date .......June, 2013 Signature
Specific comments on the student:
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OSCE Station General Station M4A
A Clinical Examination Skills
Resources needed?
Patient:
O Real patient having diabetes mellitus for long duration -or a Role Played.
An examination couch, cotton wool pins and tuning forks. are needed with a clean cover, and preferably a box of rubber gloves
Setting up the station
Timing 8 minutes
The couch should be positioned in such a way to allow the candidate to examine the ‘patient’ from the patient’s right side
Facilities for handwashing/alcogel should be available
INFORMATION FOR SITE ORGANISERS
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OSCE Station (General) M4A A Clinical Examination Skills
INSTRUCTIONS FOR STUDENT
This is an 8-minute station, set in the Medical Department.
This is (the real name of the patients)
He has been diabetic for more than 20 years
He complains of Numbness of his feet for the last few moths
The Consultant on charge wants you to perform the appropriate foot examination to evaluate
his case properly.
Please approach the patient and perform the appropriate foot examination in about 6
minutes. Present the important positive and negative findings to the exminer
The examiner will be watching while you are examining the case.
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OSCE Station (General) M4A A Clinical Examination Skills
INSTRUCTIONS to the PATIENT (Role Player)
Please note that you will be approached by medical students in their final
exams.
Each student may interact with you for around 8 minutes.
He is expected to examine your feet and ankles. So, be ready to take off
your socks when asked to do
For sure there will not be any painful, invasive or embarrassing procedure
during the examination.
Please cooperate with the students as much as you can but do not volunteer
to offer extra help or guidance.
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OSCE Station (General) M4A A Clinical Examination Skills
INSTRUCTIONS FOR THE EXAMINER
This is an 8-minute station, set in the renal department
The purpose is to test the examination skills of diabetic foot problems.
The patient has diabetic numbness in his feet.
The students has been given the following instructions:
This is an 8-minute station, set in the Renal Department. This is (the real name of the patient or role player) he has been diabetic for more than 20 years and complains of numbness of his
lower limbs for the last few moths The Consultant on charge wants you to perform the appropriate foot examination
to evaluate his case properly. Please approach the patient and perform the approriate examination of his lower
limbs and feet in about 6 minutes. Present important +ve and –ve findings to the examiner while you are doing examination
The examiner will be watching while you are examining the case.
Please observe the student while performing the examination for
appropriateness, completeness, and order for 6 minutes and allow him to
summerize his findings to you in 2 minutes.
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OSCE Station (General) M4A A Clinical Examination Skills
Student's Name .....................................................................