An overview of

Year 2 OSCE

ISoc Academia, Apr 2014

 Practical examination
- 16 stations
+ 4 rest stations

- 5 mins per station

+ 12 mins for long history station

- 2 mins between each station

- Held in the clinical skills centre

(Sheperd’s House)

- scenario/briefing placed outside of each

station – read carefully before entering!!!
 History taking

• 1) Introduce yourself:

“Hello, I am a 2nd year medical

student, my name is _______ . I’d
like to find out a bit more about
what’s brought you to see the GP
today – would this be ok?”
 History taking
• 2) Check the patient’s name & DOB!

“Before we continue, may I confirm

your name and age?”

“And how would prefer to be

addressed?”
 Polite!
 History taking
• 3) Discuss confidentiality with the
patient:

“Before we begin, I would just like to

confirm that everything we discuss today
will stay confidential between myself and
your healthcare team.”
 History taking
• Start with open questions!

“What has brought you to see the GP

today?”

“Could you tell me more about that?”

 History taking
Use your KUMEC history-taking framework as a guidance:

Focussed history (KUMEC) – 5 mins

- Intro
- Presenting complaint
- History of presenting complaint
- Ideas, concerns & expectations
- Past medical history
- Drug history & allergies
- Social history
- Family history
- Closing/summary
 Short Hx – May/Aug ‘13
• Patient with palpitations & chest pain
- SOCRATES, peripheral oedema, SOB

• Patient with respiratory symptoms

- Sputum/ blood/ SOB/ fever/ recent travel?

• Patient with abdominal pain

- SOCRATES, diet, bowel habit
 Long history (12 mins)
The same as a focussed history, plus:

systemic review

“I’d like to ask you a few questions about your

general health..”

“Have you noticed any other problems with

your health at the moment?”
 Long history (12 mins)
Systems to cover:
CNS
Cardiovascular
Respiratory Figure out an
order/approach that
Gastrointestinal works for you!
Urological
Gynae/reproductive
Musculoskeletal
Psych
 Long history – systemic review
• CNS system • Cardiovascular
- headaches - chest pain
- vision - palpitations
- hearing - swelling in hands and feet
- smell
- dizziness/light-headedness
- blackouts/fits
- weakness/numbness/tingling

• Gastrointestinal
• Respiratory
- abdominal pain
- Shortness of breath - nausea
- Wheezing - vomiting
- Coughing  SPUTUM
- bowel habit

“Have you noticed a change?”

Long history – systemic review
• Gynae/reproductive • Musculoskeletal
- regular periods
- menopause? - joint pain
- pregnant? - muscle pain
- bleeding/spotting between cycles? - back pain
- sexually active? - weakness?
- pain/bleeding during/after intercourse
- contraception?

General – important & easily forgotten!!

Weight loss, tiredness, fever

 Long Hx – May/Aug 2013
• ‘Funny turn’ – working Dx: stroke
- One-sided? Previous Hx of CVD? Family Hx?

• ‘Feeling tired’ – working Dx: Type I DM

- Urinating more? More thirsty? Family Hx?

• ‘Hypertensive, but unsure why’

- Explore risk factors: family Hx, smoking, drinking,
diet, exercise etc
- Why is it important to control?
(i.e. complications of HTN)
 History-taking
• Practise!!!

- use family/friends/neighbours/patients
- become fluent with the framework
- patient educator sessions

If you get stuck in your history:

- be calm, avoid getting flustered!

- take a moment to think!
- repeat back to the patient
 Exploring (5 mins)
• Ideas, Concerns, Expectations
May/August 2013:
• Wife sees husband leave GP surgery – “but why was
he there?!”

• Father finds contraception in daughter’s room

• Adherence to inhalers – asthmatic patient

• Diabetic patient worried about needing injections

• Diabetic patient worried about complications

 Explaining (5 mins)
• Explain a medical condition or an aspect of it

May/August 2013:

- diabetes: type 1 vs 2, insulin, complications

- asthma: inhaler use, can I still exercise?

- hypertension: risk factors/causes,

management, complications
 Sensory awareness (5 mins)
• Communicating with a deaf or blind patient

 just like your sensory awareness session

- Always ask if they need any assistance

- Don’t unnecessarily raise your voice or speak

extra-slowly

- Be friendly and natural!

 SA: May/Aug 2013
• Introduce yourself to a blind patient in ‘waiting room’
(i.e. touch forearm)
• Ask for permission to weigh them
• Ask them how their vision is, whether they would like to
be guided and how they would prefer to be guided
• Guide them to the weighing scales, ask them to take
shoes off
• Take them to a hospital couch and ask them to lie down
for their ‘appointment’
• Take them back to the waiting room and check they can
get back home OK
 PRACTICAL SKILLS
• All practical skills have written guides &
videos on the VC – use them!

VC  MBBS-2  Student Resources 

Clinical Skills Guides

VC  MBBS-2  Student Resources 

OLIVE  Clinical skills & procedures 
videos
 Blood pressure (5 mins)
• PRACTISE!

- talk directly to patient, take the BP, then report finding to examiner

- examiner may use a

dual head stethoscope

…so don’t make it up!!

 Blood pressure
• Be prepared to answer questions:
- Risk factors of hypertension?
- What is a normal BP?
- Hypotensive?
- Hypertensive?
- Management (know the NICE guidelines)

May/Aug 2013:
- What would do if the patient had a hypertensive reading?
(Repeat reading, report to GP, ambulatory BP
monitoring/home BP monitoring)
- What interventions for high BP?
(Lifestyle changes first, then antihypertensive drugs)
 Hand hygiene (5 mins)
• Hand-washing  use the NHS technique

• Make sure you use soap and not alcohol

gel!

• Take your time!

• Don’t touch anything once you’ve finished

washing
 Hand hygiene (5 mins)
• Questions at the end about infection
control (May/Aug 2013):

- Common hospital bacteria?

- How to control spread of infection?
- Alcohol gel vs. hand-washing?
- How long do you wash your hands for?
 Resuscitation (HOLOS) (5 mins)
• Same as your basic life support sessions

CPR station & a choking station

• Practise until you are fluent!

• Questions at the end (May/Aug 2013)

- when do you stop CPR?
- what rate of compressions?
- how far should the chest be compressed?
 Asthma
1) Teaching how to use a peak flow meter

 be familiar with a peak flow chart

 be prepared to talk about asthma with patient

2) Teaching how to use an inhaler

 be familiar with the inhaler types & drugs

 be prepared to talk about asthma, side-effects
of inhalers etc
 Urine testing (5 mins)
• Practise  tricky handling bottle lids and sticks!

Don’t forget to take a look at the sample first:

- check name, DOB and when sample was
taken
- note colour, clarity & smell to examiner
- say you would want the sample to be fresh &
mid-stream

 know what a midstream sample is (May/Aug ‘13)

 Urine testing (5 mins)
Know what an
abnormal reading of
each test might signify
& what should be done
next:
e.g. (May/Aug 2013)
- patient scenario: thirsty,
frequent urination
- High glucose levels:
 diabetes mellitus?
- Test blood glucose test,
GTT? HbA1c?
 BMI assessment (5 mins)
• Practise!

• Know how to explain what a BMI is

• Measure weight & height accurately

 don’t forget to zero the scales!!

• Know how to calculate a BMI score

• Know how to read off a BMI chart
 BMI assessment (5 mins)
• Be prepared for examiner’s
questions:

• Health problems associated with being

overweight/underweight? (May/Aug 2013)
• Reasons for being
overweight/underweight?
• Advice to put on/lose weight?
Subcutaneous injections (5 mins)

• Practise! Time management is important

• Use prescription chart
• Always ask about drug allergies
• Never re-sheath a needle!
• Type of needle? Angle of insertion?
Subcutaneous injections (5 mins)
• Disposal: • rest of the waste
- needles in the in the clinical
sharps bin! waste bin!
 Blood films (5 mins)
• Use your blood films lecture & histology
class (Sickle Cell scenario)
• Use histology lab closer to exam

May 2013:
• Given two microscopes  examine 2
slides and answer multiple choice Qs
 Growth charts (5 mins)
• Use your growth lectures (Puberty scenario)

• Be familiar with growth charts

- what they are
- plotting
- use the right chart!
(correct gender, age, weight or height?)

• Be familiar with growth problems

e.g. - reasons for tall stature?
- reasons for short stature?
 Ethics (5 mins)
• Shown a short video clip:
e.g. epileptic patient who refuses to stop driving (2013)
e.g. a racist & verbally abusive patient (2013)

• Examiner asks questions

 marked on how many different

viewpoints/reasons you discuss regarding the
ethical dilemma in the video
 The ABCDE of ethics!!
 ABCDE of ethics
• A = autonomy of patient
• B = benificence
• C = competence, confidentiality
• D = do no harm (hippocratic oath)
• E = equality
Movement disorders (5 mins)

• VC  MBBS-2  Student Resources 

OLIVE  Examination techniques 
Movement Disorder Library
 Anatomy – multiple choice
• Year 1 & 2 anatomy

• Organ anatomy (5 mins)

 given a labelled model
e.g. heart, female pelvic region, mediastinum/lungs (2013)

• Skeletal anatomy (5 mins)

 given a labelled bone
e.g. femur, male/female pelvis, skull (2013)
 Surface anatomy (5 mins)
• Patient and examiner

Examples (May/August 2013):

- identify the position & demonstration of a muscle
e.g. “the action of the deltoid muscle?”

- identify and explore a structure/anatomical position

e.g. “where is McBurney’s point?”
“and what is it’s importance?”

- identify the location for a clinical procedure

e.g. “where would you apply a chest drain?”

- count ribs
e.g. “now show me where you would apply it”
 Surface anatomy (5 mins)
• Surface anatomy booklets!
+ head & neck

• Know your upper & lower limb anatomy!

• Practise on yourself/other people

 More examples – May/Aug ‘13
• Identify sternocleidomastoid/deltoid/biceps/brachioradialis/
soleus & ask patient to demonstrate function
• Liver biopsy/ chest drain / tension pneumothorax (2 nd ICS mid-clav)
application
• Where in an intercostal space would you apply a needle?
• Identify the thyroid gland, importance of cricothyroid membrane
• Identify the jugular notch, identify the pubic symphysis – what line is
halfway between these? (transpyloric plane)
• What does the transpyloric plane pass through?
• Palpate the abdominal aorta
• Locate the posterior tibial artery and palpate the pulse
• Identify the tibial tuberosity
• Which tendons make up the anatomical snuffbox and what are its
contents?
• Locate the masseter, what are its functions?
• Which muscle of mastication is responsible for ‘depression’? (Lat
pterygoid)
 Histology (5 mins)
• Given a picture from your histology booklets! – multiple
choice

• label picture & answer physiology Qs

• Sometimes put in a combination station with anatomy

May/August 2013:
• female reproductive system (ovarian follicles, hormones)
• respiratory tract (trachea, cartilage, goblet cells etc.)
 General OSCE tips
• If you forgot to do something or
remembered you did something wrong – it
is okay to point it out to the examiner

• Be confident in what you’re doing in the

station

• Practise to pass every station!

(i.e. no ‘sacrificing’)