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 between. 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! ;) 1 Here is some stuff I got for the OSCE. Hope it helps. Good luck to you all on thursday and this weekend! ITS ALMOST OLVER!!!! 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 asthma. Station 3: Telephone call on fever and rash This station measured history taking and communicaiton 2 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 hernias. 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 3 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 information: 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. 4 5