OBJECTIVE STRUCTURED CLINICAL EXAMINATION OSCE Hassan Nasrat Professor
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 8 Why OSCE? 8 WHAT DOES IT TEST ? 8 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 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 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 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 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 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 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, P 1 + 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
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