End of 3rd year OSCE

End of 3rd year OSCE
For 2008 (from Henna Tirmizi)
Ok so if you ask me a year from now what the year III osce was like. I will definitely not
remember. So i thought i would type up what i remember now and send it to you, and it is your
responsibility to save this email in your year 3 folder and remember to look for it when the time
comes and share it with any imsa i might have missed. There is info from the 2006 osce in the
email below, but the 2008 osce was a little different. our stations had
1. Heart and Lung physical exam.
2. Right hand pain. H&P (carpal tunnel)
3. Sore Throat. Take History. Counseling on antibiotic use.
4. Pediatric fever and sore throat. Take history from mom. (remember to include immz hx. and
sick contacts)
5. Acute Abd. Pain H&P
6. Write soap note on Acute Abd. Pain
7. Headache. History given. Do complete neuro exam.
8. Low Back Pain. History given. Just do physical exam. (gait, straight leg test etc.)
9. Take prenatal history, and explain genetic test results (she was a carrier for the CF gene)
10. CC: Cant Sleep. Take history.
11. Shortness of Breath H&P
12. Write soap note on Shortness of Breath Each station as 8 minutes long with 2 mins in
So be prepared to do a pretty quick focused H&P for some of them. Really, its not that bad at all.
Just make sure to review the proper way to do a physical on different parts of the body (heart,
lung, abd)... and remember to wash your hands! ;)
Here is some stuff I got for the OSCE. Hope it helps. Good luck to you all on thursday and
this weekend!
The following is a synopsis of the comprehensive OSCE
exam of 2006. As you know, the basic competencies we
assess are history taking skills, physical exam skills
and communication skills. We assess you on this exam
based on on cumulative points you could obtain across
all of the stations, and not simply on a station to
station basis. The essentials of the history
typically revolve around a comprehensive
characterization of the chief complaint, along with
attempts at eliciting immportant associated findings
that would aid in generating a meaningful differential
diagnosis. The physical exam should always be quite
focused, so in some respects limited by time, but
complete enough to again aid in the process, if asked,
to furnish an adeguate differential. The
communication skills are usually the same, when being
measured, from station to station. The behavioral
checklist that the rater has calls for assessing your
skills in greeting, generating empathy or compassion,
appropriate use of open ended/closed ended questions,
giving patients adequate time to collect their
thoughts, and your essential attitude in terms of
engaging your patient. Please take some time to read
the following, and by all means, we encourage you to
ask questions (and make suggestions) that might
benefit you as well as your OSCE committee.
Station 1: Assessment of chest pain
This station measured history taking and physical exam
skills. We were looking for focused questions
characterizing the nature of the chest pain, and
important associated symptoms that could support or
lessen the likelihood of a cardiac problem. The exam
should have included a comprehensive auscultation and
percussion of the anterior precordium, and well as
related exams of the carotids and abdomen.
Station 2: Asthma counseling
This station measured history taking and communication
skills. The focused history should have included
characterization of the dyspnea as well as past
history that would have assessed the severity of the
asthma. The next challenge was to educate the patient
about the mechanism, medications (including how to use
them correctly) and lifestyle modifications related to
Station 3: Telephone call on fever and rash
This station measured history taking and communicaiton
skills. The history had to be comprehensive and
exhausting, as you are not examining the child. the
"phone skills" involved the same broad features
described above. We were most interested in your
gathering the correct information you would need to
decide whether or not this child could be handled
without a physical exam.
Station 4: Abdominal Pain
This station measured history taking and physical exam
skills. Here, the station accentuated your physical
exam skills as opposed to an exhausting history.
Proper draping and respect for a more "sensitive"
portion of the anatomy should have been demonstrated.
This patient had localized tenderness and a positive
Murphy's sign.
Station 6: Pediatric Male counseling
This station measured patient education and
communication skills. The former was assess in
conjunction with a demonstration using the inanimate
model, and the latter by how well you handled another
"sensitive" portion of the anatomy in terms of
effectively (with encouragement and as a teacher)
communicating the improtance of the exam. Special
emphasis was placed on appropriate jargon to reach
your audience. The demonstrtation should have
included a check for signs of STD, tumors, and
Station 7: Headache
This station measured history taking and communication
skills. This entailed a comprehensive
characterization of headache, including associated
history (HTN, smoking, presence of pre-syncope, etc)
that would have allowed you to generate a reasonable
differential if required. Effective communication
here should have also recognized the nature of this
particular patient's discomfort.
Station 8: Low Back Pain
This station measured physical exam skills. We were
looking for a comprehensive exam which included ROM,
motor, sensory, and reflex exam of the lower
extremities, along with gait and assessment and
special maneuvers such as straight leg raising. The
information you derived form a complete exam should
have allowed you to determine nerve root involvement.
Station 9: Pelvic pain
this station measured history taking and communication
skills. The complete characterization of the chief
complain of pelvic pain/bleeding should have been
assessed as well as a complete gynecological history
including screening for STDs, risk of pregnancy and
abuse issues, among others. Special emphasis on
effective use of empathy and reassurance was measured.
Station 10: Anxiety disorder
This station measured history taking skills and
communication skills. The complete characterization
of the headache was important, as well as a
comprehensive PMH and social history (such as life
stressors, alcohol use or sexual history) which would
have focused on risk factors for organic causes of the
symptomatology as opposted to inssures in the
patient's life which might have suggested a
psychological root as the primary problem.
Station 11: Shortness of Breath
this station measured history taking and PE skills.
The complete characterization of dyspnea was important
in order to generate a comprehensive cardiopulmonary
differential diagnosis. The PE specifically should
have included assessment for valvular lesions
(therfore carotid exam) as well as the pulmonary exam.
The SOAP station
The expectation here was that you would provide either
in a bullet form or brief narrative the following
Station 4: Provide the information either handed to
you, when you requested it, such as abnormal vital
signs, along with the tenderness elicted and Murphy's
sign. Provide a meaniful differential diagnosis which
would have focused on cholecystitis and perforated
viscous, but may have included appendicitis and select
other causes, and a plan of attack that would have
necessitated diagnostic tests such as CBC, US, perhaps
CT scans (and others) along with a basic management
including IV fluids, antibiotics, etc.
Station 11: Provide the information either handed to
you, when requested, such as diminished breath sounds,
increased BP and tachycardia. Provide a differential
which would have included, among others, acute
exacerbation of COPD and CHF, and plan of attack
including diagnostic studies such as EKG, BNP, CXR,
etc. as well as the basic management plan such as
oxygen, diuresis, and empiric antibiotics.