Transcript “OSCE” OBJECTIVE STRUCTURED CLINICAL EXAMINATION Hassan Nasrat

OBJECTIVE STRUCTURED
CLINICAL EXAMINATION
“OSCE”
Hassan Nasrat
Professor of Obstetrics &
Gynecology
King Abdulaziz University Hospital
OSCE
O:
OBJECTIVE
S
STRUCTURED
:
C:
CLINICAL
E:
EXAMINATION
OSCE
 Why OSCE?
WHAT DOES IT TEST ?
HOW TO RUN IT?
Why OSCE?
Antenatal
Labor
History
Obstetric
H/R
Diagnosis of
labour
Physical
Obstetric
Maneuvers
Progress in
labour
Postnatal
Newborn
History of
Gynecology
Post natal
evaluation (
normal and
CS)
Delivery
relevant
complicatio
ns
Tests/investi BPP
gations/proc Routine AN
edures
tests
CTG
Tests in
Instruments complicatio
ns
Resuscitatio
n of
Newborn
Data
interpretati
on
Partogram
CTG
GTT
PET
Communica Nutrition
tion and
Exercise
education
Gynecology
Postnatal
tests:
Rubella. RH
Breast
feeding
Contracepti
on
Instruments
Specific
investigatio
ns
HSG
Semen test
Hormone
profile
Antenatal
Labor
History
Obstetric
H/R
Diagnosis of
labour
Physical
Obstetric
Maneuvers
Progress in
labour
Postnatal
Newborn
History of
Gynecology
Post natal
evaluation (
normal and
CS)
Delivery
relevant
complicatio
ns
Tests/investi BPP
gations/proc Routine AN
edures
tests
CTG
Tests in
Instruments complicatio
ns
Resuscitatio
n of
Newborn
Data
interpretati
on
Partogram
CTG
GTT
PET
Communica Nutrition
tion and
Exercise
education
Gynecology
Postnatal
tests:
Rubella. RH
Breast
feeding
Contracepti
on
Instruments
Specific
investigatio
ns
HSG
Semen test
Hormone
profile
Antenatal
Labor
History
Obstetric
H/R
Diagnosis of
labour
Physical
Obstetric
Maneuvers
Progress in
labour
Postnatal
Newborn
History of
Gynecology
Post natal
evaluation (
normal and
CS)
Delivery
relevant
complicatio
ns
Tests/investi BPP
gations/proc Routine AN
edures
tests
CTG
Tests in
Instruments complicatio
ns
Resuscitatio
n of
Newborn
Data
interpretati
on
Partogram
CTG
GTT
PET
Communica Nutrition
tion and
Exercise
education
Gynecology
Postnatal
tests:
Rubella. RH
Breast
feeding
Contracepti
on
Instruments
Specific
investigatio
ns
HSG
Semen test
Hormone
profile
Antenatal
Labor
History
Obstetric
H/R
Diagnosis of
labour
Physical
Obstetric
Maneuvers
Progress in
labour
Postnatal
Newborn
History of
Gynecology
Post natal
evaluation (
normal and
CS)
Delivery
relevant
complicatio
ns
Tests/investi BPP
gations/proc Routine AN
edures
tests
CTG
Tests in
Instruments complicatio
ns
Resuscitatio
n of
Newborn
Data
interpretati
on
Partogram
CTG
GTT
PET
Communica Nutrition
tion and
Exercise
education
Gynecology
Postnatal
tests:
Rubella. RH
Breast
feeding
Contracepti
on
Instruments
Specific
investigatio
ns
HSG
Semen test
Hormone
profile
Antenatal
Labor
History
Obstetric
H/R
Diagnosis of
labour
Physical
Obstetric
Maneuvers
Progress in
labour
Postnatal
Newborn
History of
Gynecology
Post natal
evaluation (
normal and
CS)
Delivery
relevant
complicatio
ns
Tests/investi BPP
gations/proc Routine AN
edures
tests
CTG
Tests in
Instruments complicatio
ns
Resuscitatio
n of
Newborn
Data
interpretati
on
Partogram
CTG
GTT
PET
Communica Nutrition
tion and
Exercise
education
Gynecology
Postnatal
tests:
Rubella. RH
Breast
feeding
Contracepti
on
Instruments
Specific
investigatio
ns
HSG
Semen test
Hormone
profile
Antenatal
Labor
History
Obstetric
H/R
Diagnosis of
labour
Physical
Obstetric
Maneuvers
Progress in
labour
Postnatal
Newborn
History of
Gynecology
Post natal
evaluation (
normal and
CS)
Delivery
relevant
complicatio
ns
Tests/investi BPP
gations/proc Routine AN
edures
tests
CTG
Tests in
Instruments complicatio
ns
Resuscitatio
n of
Newborn
Data
interpretati
on
Partogram
CTG
GTT
PET
Communica Nutrition
tion and
Exercise
education
Gynecology
Postnatal
tests:
Rubella. RH
Breast
feeding
Contracepti
on
Instruments
Specific
investigatio
ns
HSG
Semen test
Hormone
profile
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
Interpretation of test (Positive for GDM)
Well
Average
2
1
Risks to the patient
Increased risk of high BP (PET)
1
½
Increased rate of infection (urinary/vaginal)
1
½
Polyhydramnios
1
½
Macrosomia
1
½
Operative / Difficult delivery
1
½
RDS
1
½
Neonatal Jaundice
1
½
Other metabolic disorders
1
½
Risks to the fetus
Total
ND
Item
Mark
Interpretation of test (Positive for GDM)
Well
Average
2
1
Risks to the patient
Increased risk of high BP (PET)
1
½
Increased rate of infection (urinary/vaginal)
1
½
Polyhydramnios
1
½
Macrosomia
1
½
Operative / Difficult delivery
1
½
RDS
1
½
Neonatal Jaundice
1
½
Other metabolic disorders
1
½
Risks to the fetus
Total
ND
Item
Mark
Interpretation of test (Positive for GDM)
Well
Average
2
1
Risks to the patient
Increased risk of high BP (PET)
1
½
Increased rate of infection (urinary/vaginal)
1
½
Polyhydramnios
1
½
Macrosomia
1
½
Operative / Difficult delivery
1
½
RDS
1
½
Neonatal Jaundice
1
½
Other metabolic disorders
1
½
Risks to the fetus
Total
ND
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
What does the result of this test shows?
(Examiner to show CBC form)
Low hemoglobin (anemia)
1
1/2
2
1
Thalassaemia and
1
1/2
Sickle cell anemia
1
1/2
Hemoglobin electorphoresis
1
½
Sickle cell test
1
½
What type of anemia
Hypochromic micorcytic
Can it be confused with other type of anemia?
How would you confirm?
What do you think of this result?
(Examiner to show the result of the electrophoresis)
Confirm Iron deficiency anemia
Total
3
2
ND
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
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:
ND
Item
Mark
Well
Average
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:
ND
Item
Mark
Well
Average
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:
ND