Mock Objective Structured Clinical Examination Universal Marking Template Section 1 — Interaction with the Patient (Universal) Criteria Done Well Not Done Well Not done 1) Hand Hygiene or Washing oO a a (and/or Universal Precautions) 2) Introduces Self D a 0 3) Uses Patients Name a a ao 4) Interacts with the patient ‘well’ a a o Section 2 — The Clinical Skill Tested (This is likely derived from MINI-CEX or other Source) NB: Write in the space criteria you wish to ‘examine’ Criteria Done Well Not Done Well Not done 1) Asks patient whether they a a a are in pain/comfortable before starting 2) Qo a a 3) 0 a 3 4) a 0 a 5) a oD a 6) a a oO 7) 0 a o | 8) 0 ao a 9) a 0 a - Other Criteria a a o 10) Reports findings concisely and accurately at end: o a oO | Feedback Comments for Candidate: | - 3 Good Things: - 1 or 2 Things to do next time:STATION 1 Vets PROP FOR ASTHMA SPACER STATION (Provide Spacer and Inhaler for OSCE Exam)FACEM OSCE 1FACEM OSCE 2 — Cc Global RatingFACEM OSCE 3 Global Rating | 4 ] 2 Very Good __|FACEM OSCE 4 [Candidate Number: [DateSTATIONS Wobsuecr OSCE Station Station 5: Time Allowed — Approx. 7 mins You are the ED Doctor on Evening Shift Your Medical Student was keen to practice Blood taking on this after hours shift She inadvertently has pricked herself with the needle removed from the patients arm First aid including 5 minutes washing has been applied The student is very worried about catching HIV as a result of this injury She is visibly upsetFACEM OSCE 5 Candida Number [iver Date [Year of Study : STATION 5 -NEEDLESTICK INJURY [ppopdate introduction (I=full name und role), asks for student's name (1) 1 Brotins purpose of iterview and checks students happy o discuss recent situation with junior doctor well, Tmadequately, O=poorly or not done) Establishes Current Situ fo etches iar redical student bos jus sustained a needlesGck injury (1) and takes ref account of the incident () : sable Tonio me since the event (and iype of exposure Le. percutaneous or mucocutaneous (1) quires air which patient the stoden was atierptng to lake blood from (I) and what the ude ot oth ai ey air the event (wether Iey dsposed ofthe sharps sppropriately so oer staf would no Sustain a needlestick injury as well) (1) Establishes that student has had thei full course of hepatitis B vaccinations priorto medical school Taformation Giving Regarding Management of Needlestick Injury Adviser smden if ot already done 50, 1 squeez= wound s0 blood comes out and wash under tap water (1) WITHOUT scrubbing wound (1) ‘Advises student to contact ceupational health for urgent advice Explnns that irik for infective ranmission i rom «high risk patient (i.e HIV positive then por ssperor eae CPEB) inte ors of tiple therapy of entreovraldrags (1) shouldbe stated win | Hove mm Injury (1) B Tas tia PEP consists of 035 day course of antretrovira drugs (I) and ater three months the stent willbe Feapirodio have a blood testo check HIV. bepaiisB and C stats () Taivines student o practice safe sex (1) and not to donate any blood within his ime CI) TSuates chat PEP ean reduce the risk of HIV wansmission by 80% (1) and is normally only given in high ssk Satstions ifthe risk of HIV transmission is thought to be high (1) Fenssures sudsat tha sk of peronaneous HIV transmission fom a patent with known HIV Is no sbi hefshe may think (3 per 1000 injuries) Tapia he side effets of turting PEPE. navea, vomiting, lrzhoea, beaches, diazines (1) and ia 5 Explains the sie O spetanlial bu should no put stent off completing the PEP course should this be started by ‘occupational nalth (1) ‘Management of Patient in Aceldent and Emergency Popes that sade shoud 9% go bak otk blood fom patent (1) and offers to perform ask or aang nother health professional todo ihis 1) i Canvidate states they will document the exposure in the patient's noves and on incident form ‘Examiner to ask: “What information would you like to know about the patient?” Candidate sates they would lke to ask/check patents infective status (12, HIV stawus, hepatitis B and C stanis) (Gastatesal three, I=states to diseases, =one oF none) sree rdais nates hey would like to "isk assess’ patient i infective status unknown (ie, whether the patient cancion ether ey an itravenous drug abuser, if have they ever had previous Semis) #e8 ceo, wether the patent has mule leringtatoos, what tek country of nin ee.) Q- suggestions, Estions, O=0ne oF no suggestions) Saas unknown and risk assessment is high then soggestsesking patient's permission to ake Blood sample for bopatitis B,C and HIV testing ‘Communication Skills Tmites questions (1). Listens actively and responds appropriately (1). Gapaised approach o information giving (eg. systema, summarises, sigznpous change i oens of question) Simulated patient score (2=very good, I=satisfactory, O=poor) [__[otat Score - 7 oe = a 5 aba Ratin Global Rating | Ctear Fail Borderline_ ‘| Clear Pass Very Good Outstanding— STATIONG Wetsuccr OSCE Station Station 6: Time Allowed — Approx. 7 mins You are the ED Doctor on Day Shift Your Patient Mrs Scarlett, a 29 year old female, has come in today by ambulance having had Chest Pain while at the supermarket She has had an unremarkable work up with normal ECG and Blood Tests in the context of no cardiac risk factors Your Resident Medical Officer (RMO) is concerned about some Red Flags in Mrs Scarlett’s personal circumstancesFACEM OSCE 6 iniversity Year of Sindy’ - DOMESTIC VIOLENCE ail e.g lives with husband, busba Global Rating 1 Clear Fail 2 4 Borderline Very GoodFACEM OSCE 7 [Candidate Number: —_] University: Date: [ear of Stuy: CARDIOVASCULAR EXAMINATION Appropriate introduction (Infullname and ole). checks patien’sname () [ Explains examination appropriately and obtains consent (2=does well, [=adequately,0 Appropriately exposes patient (down to underwear | Applies aleogelto hands before and afte examination (both) _ General inspection around the bed Tor ECG monitor, medication, intravenous Grips, external pacing wires, warfarin measurement books [General inspection of patient at end of bed for shortness of breath, mitral facies, pallor, obesity, peripheral | edema, stemotomy sears, pacemaker, added sounds of artificial valves (2=any three obseFvations: any tv Deone or none) Examines hands Tor peripheral stigmata of cardiac disease such as clubbing, splinter haemomthages, peripheral cyanosis, Janeway lesions, Osler’s nodes, slow capillary refill me, nicotine staining, tendon xantheana any tee observations, !=any two,0=oe oF one) Examines radial pulse (rate, rhythm, raio-radial delay, radio-Temoral delay) (all aspects, Isonly tres of he four aspects, 0=tWvo or less) "Examines brachial palse for volume and character of pulse (1) as well as gently raising ann above bead to assess fora collapsing pulse (1) (Offers to measure BP — examiner to sate this mol necessary Examines eyes for anaemia, xanthalasma, comes! arcus) Assesses carotid pulse bilaterally (commenting on volume (1) and character (I)) = must be bilateral to get the points. and not dane at the same time an both sides simultancously [Assess jugular venous press (1) ih patent ng supine on al mad aged 5 gs Inspects precordium (seas, visible apex beat) ies precordium (forheaves and this) Localises apex beat (1), Comments on whether tis Gsplaced (1). s withthe bell of stethoscope a the apex and with patient in expiration, tmned on left side For mitral 10s (1). Also listens for radiation of murm into axilla (1) |Auscultates with Diaphragm of Stethoscopein the Remaining 3 Areas: gin all areas, candidate simultancously palpates the carotid pulse to me potenlal murmur Aomtic area with patent leaning forwards in expiration (1), Checks for radiation of murmur into neck (1), Pulmonary area ‘Tricuspid are pant forward and Hes to areal ung bases Examines for dependent sacral and ankle oedema Treats patient with consideration throughout (2=does wel Gives cleat instructions to patient during exami adequately, Examiner to ask: “What else would you like to do to complete your examinat Offers to perform Tull peripheral vascular examination, inspect the abservation chars, perform fandoseopy, ECG and aurine dipstick (2=any three suggestions, !=any to suggestions, O=one or none) ‘Examiner (o ask: “Please present your findings and offer a diagnosis.” Cancidate presents findings (1) in logical and structured manner (I) [ Cendidate presents offers a suitable diagnosis (1nd differential (1) Global Rating 1 2 3 4 Clear Fail Borderline Clear Pass Very GoodON 8 — You are the evening ED consultant[ear of Study STATION 8 -THE IEHOVAETS Wr information)OSCE Station OSCE Station 9: Time Allowed — Approx. 7 mins You are the ED Doctor on Day Shift Mr Linkin. A Category 5 ATS patient has asked the nursing staff to see a doctor urgently. He is triaged as having “back pain for months”. He appears agitated and anxious. His has stated to the ge nurse that the usual GP, Dr Rafiis away. The ED NUM has asked for you (the Senior ED doctor) to see him because he is upsetting patients in the w. From a distance he is visibly upsetiduie Number: FACEM OSCE 9 iG SKILLS - 4 Very Good, Global Rat— STATIONIO CGbsuect OSCE Station Station 10: Time AHowed — Approx. 7 mins You are the ED Doctor on Evening Shift Your Patient Mr Ryan Sandy has been admitted to ED with SOB The respiratory consultant has seen the patient and asked for a Chest Drain (Pig Tail Catheter) to be inserted The Nurse asks you to talk to Mr Sandy before the procedure as her has a few concerns] Please address Mr Sandy's concerns, obtain consent and show on the model the landmarks for chest tube insertion.FACEM OSCE 10 Global RatingOSCE Station OSCE Station 11: Time Allowed — Approx. 7 mins You are the ED Doctor on Evening Shift Your Resident Medical Officer has diagnosed Mr S h, a 30 year old Caucasian female with a left leg DVT. After consultation with the local haematologist it has been decided to commence Warfarin therapy Please review this patient in regard to starting warfarinncy ( auto fail) | Global RatingVA ON ¢ 0 U MAD iN fell ea woUUIEE HOUTUTOD Jo auaLNVAN ay 10} 91018 px “moy Ang Ax NOK suonesedaid spnjouy Aden unysen sot yp anay KOK] 10 I>YseUNDdNs YMovuneyd Hou deur yong suonwoipayy Japtuseyd amok x0 Adesoyy upzeprva nod Butzo3;uoW 5 OH Zo} 0P 241 ts yp2q EUI9P 40 40290p w Ag Paquiosazd jr uono ‘ANIOIAW ANY uppe o10;0q “Megyrem Supp are nok wiotp p91 0 waeoduy $131 “sjputtuieyd 20 asnuap ‘s0390p 2n04 asia nod ways 4971004 wSENELLL Vel UOT SNOLLILSNI LNVINOANT Ad VUTHL INVIQOVOOLINY,, O91 (pm uon: ou pOunfue9 Ur pear aq pinoys a (99109 NOLLVAOANI TVNOLLIGay SafeUOd yayea] sty, Puu Advsoyp uprepavas mod ypra 9193303 Avex ypiqes sourorpow Sura AOVWHVHd JO LNSWLYVd30 TWLIdSOH avawisam HLTVSHOMSN | ie .@ bsiect OSCE Station Time Allowed — Approx. 7 mins You are an ED Doctor You have just picked up Mr Smith who is in a single unmonitored room He is a Category 2 Chest Pain patient@Fsitect Patient is Unresponsive Danger / Response / Send for Help Marks Open Airway, Check for Breathing +/- Pulse = Commence CPR Marks Part 2 Patient now has Basic Life Support on going by a team of trained rescuers. The Defibrillator has arrived Demonstrate two possible positions for the Defibrillation pads Marks What are the Pros and Cons of the 2 positions Marks. Part 3 Demonstrate Safe Defibrillation (COACH) Marks What are the Pros and Cons of Checklists/Cognitive Aids? Marks Patient has ROSC, GCS 11. ECG presented (STEMI) ~ What are your 3 pr $s Now? (Cath Lab, ABCDEFG, Cooling) Marks“oc Basic Life Support pa 2 A Start CPR 30 compressions : 2 breaths ‘f unwiling / unable to perform rescue breaths continue chest compressions fp) Attach Defibrillator (AED) as soon as available and follow its prompts Continue CPR until responsiveness or ie normal breathing return ct NOILVLS December 2010Preparing for Rhythm Check COACH C: Continue compressions O: Oxygen away (1 meter away) A: All else clear > Charging (top, middle, bottom clear) C H: Hands off— STATIONI3 Sebsuec OSCE Station Station 13: Time Allowed — Approx. 7 mins You are an ED Doctor You have just picked up Mr Smith who is in the Resuscitation Bay He is a Category 2 patient with Symptomatic Bradycardia The Resus Nurse has sought you out to show you the 12 lead ECG (the ECG is attached)OSCE 13STATION 13 bsitect OSCE Station 13: Part1 Patient is responsive — symptomatic Bradycardia Review the ECG — Describe the ECG (Mobitz 2) Marks 3 2 4 0 The patient is now in Complete Heart Block on the monitor ist your options for managing this Bradycardia Marks 3 2 14 0 List 5 possible causes of this patients presentation Marks 2 41 0 Part 2 Reversible causes including Hyperkalaemia have been addressed. The Defibrillator / Pacer is available: Blood pressure is 78/40. HR 30 after 1.2mg of Atropine You elect to mechanically pace the patient Demonstrate two possible positions for the Defibrillation pads Marks 3 2 1 0 Part 3 Demonstrate Safe Pacing (Operation) Marks 3 2 1 0 Check for Effectiveness of pacing (Mechanical / Electrical Capture) Marks 3 2 4 0Instructions to Actor/Actress You have recently been drinking hea’ and now have pain in the abdomen. You work as a decorator and drive a van and recently ‘fell asleep’ at the wheel on a day where you were sweating and had tremor two days after a week long ‘binge’ session. You consume around 3-4 large bottles of Vodka a week and get stressed easily. You feel depressed and the alcohol sometimes helps. Your family are critical and this makes you angry. You have 2 children. You smoke and occasionally smoke heroin and ‘ICE’ when the opportunity arises. You are worried about alcoholism and stigma.AiCono MOSCE Session - 2014 Mock Objective Structured Clinical Examination Universal Marking Template | Section 1 — Interaction with the Patient (Universal) Criteria Done Well Not Done Well Not done 1) Hand Hygiene or Washing 2 5 a (and/or Universal Precautions) 2) Introduces Self Q a o 3) Uses Patients Name o a a 4) Interacts with the patient ‘well’ a a 0 Section 2 — The Clinical Skill Tested (This is likely derived from MINI-CEX or other USyd Source) NB: Write in the space criteria you wish to ‘examine’ Criteria Done Well Not Done Well Not done Explain the purpose of the exercise to the patient — o o Tobacco history o BD Current (quantitate) = g a a Past (quantitate) - Atcohol -4a oO a How much and how often a a D Total duration <5 aq a Last drink. — Other Drugs (what, when, how much) —o a 0 Problems (if more than 2 daily drinks or other drug use) Socialirelationship a Q a Medical - oO 8 QoQ Employment - oo a a Financial -a oD 2 Legal a a a Dependence (CAGE) - Tolerance - 65 5 o Priority of use over other activities a cares 246 6 @ ;ompulsion ~ Continued use with problems 9 g a 10) Reports findings concisely and accurately at end: a a o Feedback Comments for Candidate: - 3 Good Things: - 1 or 2 Things to do next time:OSCE Examinations An OSCE (Objective Structured Clinical Examination) consists of a series of short ‘stations’ at which you will be expected to undertake a clinically related task under examination conditions, Your performance is marked against specified criteria and you may be given immediate feedback on how you have done: General Tips for OSCE Examinations and Finals ‘Make a list of the most common OSCE stations well in advance of the exam. Look at any checklists for the tasks that you are expected to perform. There are several textbooks that help with this... Try and prepare your own checklists. Make a list of the key steps that will be involved in each clinical task, and cheek this with colleagues, The exact sequence is less important than ensuring that you try to cover everything required within the allotted time. Having said this, don’t ‘worry too much if you miss out one or two things at a particular station as you can still achieve very high overall marks. Start practising and rehearsing the tasks well ahead of the exam. Practice with friends and flatmates and ask for feedback. Concentrate your ‘revision’ on the type of stations where you feel less confident. Ifyou are unsure how to do something then ask someone or find out. Ask people in the same year (or years above). They have done the OSCE exam you are doing! Many cases / stations will be the same from year to year... If you are competent in the general outlines of history, examination and explanation as this will get you a pass even if you miss pathology. When revising for examination, expl ation and history stations go through a set routine until it becomes second mature (eg. for CV exam always do a full examination rather than only feeling the pulse or auscultating the praecordium) ‘Memorize opening and closing statements for your presentations. Keep a clear head on the day. Dress smartly, act naturally and follow the examiners lead. They are expecting you to be nervous so avoid the beta blockers. OSCEs can be ‘a rewarding and educational experience.’ Be positive. (Approach to exam questions} bout Management {) Explanation to patient 2) Investigations 3) Treatment and informed consent | (Bloous, Imaging etc.) (Surgical and Medical)