2015 Year 5 osce stations PDF

Preview

Summary

MED5008 – Year 5 OSCE – Tuesday 24th February 2015Station 1: Ectopic PregnancyHistory taking, management, diagnosis and communication of results and diagnosis to patient.General examiner feedback to studentsGenerally a good performance with many students communicating well and using open questions a...

Description

MED5008 – Year 5 OSCE – Tuesday 24th February 2015 Station 1: Ectopic Pregnancy History taking, management, diagnosis and communication of results and diagnosis to patient. General examiner feedback to students Generally a good performance with many students communicating well and using open questions and demonstrating empathy when breaking the bad news and explaining the diagnosis. Generally poor discussion of the investigation results. Some students were poor at taking the gynaecological and obstetric history (often disjointed). Very few students took a smear history. Some students wanted to delegate the bad news telling to the nurse. Very few students suggested group and save of blood. Some students did not recognise the need to treat early. A few students incorrectly stated that the pregnancy test was negative. Only a few students advised that patient would be admitted to hospital and many students did not ask about associated bowel/urinary symptoms. Main learning points/concerns 1) Always check the patients details against those printed on the results to make sure you have the correct results for the correct patient. 2) Appropriate investigations for a patient with left iliac fossa pain and a positive pregnancy test are observations (BP, pulse, RR, SaO2), full blood count, Group and Save, sem HCG and anaginal land. 3) Correct explanation of HCG: T da ag em HCG a 1200 IU; da (48 hours later) expect it to be 2400 IU. However it is only 1500 IU meaning pregnancy is not developing appropriately and could be a miscarriage or ectopic pregnancy. 4) A patient with an ectopic pregnancy needs to be admitted to hospital to have it removed. This is a potentially life-threatening situation. 5) Read the instructions to the station clearly. This patient was being assessed in an early pregnancy clinic and this should have helped to direct your questioning.

7.6% students did not achieve the cut score (pass mark) in this station

Station 2 a and b: Acute Asthma (17 minute station) History, examination, investigation and management of an unwell patient. Also, working with a nurse. General examiner feedback to students Generally very good performance and most students reacted appropriately to the situation. The vast majority of students did not introduce themselves to the nurse. Some examiners noted that students who introduced themselves properly to the nurse also tended to do better overall. Several students did not introduce oxygen at an early stage and took a detailed history before correcting the hypoxia. Very few patients asked to see the asthma protocol. Well-performing students took a brief initial history and assessed the most recent observations. They recognised that the patient was acutely ill and sat them upright, asked for high flow O2, IV access and a monitor. They then took a more detailed history and performed an examination to establish the diagnosis and then instigated appropriate investigations (ABG (type 1 respiratory failure), ECG (sinus tachycardia), CXR (hyperinflated chest), FBP, U&E, CRP, lactate, LFTs, glucose (normal)) and treatment (2.5mg or 5mg Salbutamol nebulised, 100-200mg Hydrocortisone IV or 30-50mg Prednisolone PO). The station specified that students should perform a respiratory examination (inspection, palpation, percussion, auscultation, include front and back) as part of their assessment, however many students did this as part of an appropriate ABCDE examination which is also a safe and correct approach. The written prescription of medication and the SBAR handover were done reasonably well.

Main learning points/concerns 1)

Always introduce yourself clearly to the patient and to any staff working closely with you, even in an emergency/urgent situation.

2) When a patient is hypoxic, sit them up if appropriate and apply oxygen immediately before moving on to further history and examination. Reassess oxygen saturations regularly. 3) Make use of all the information available including the NEWS chart. 4) Never examine a patient through their clothes!! Please adhere to the basics of appropriate exposure. Also, do not prescribe nebulisers and steroids before auscultating the chest. 5) Reassess, reassess, reassess

11.3 % of students did not achieve the cut score (pass mark) in this station

Station 4: Weight loss/Nutrition This station aimed to assess he den abili  aach niinal aesment in a systematic fashion. The student was expected to identify a central line and TPN infusion, a nasogastric tube, catheter, cannula and an ileostomy. The weight chart showed a >10% weight change and the BMI was now in the underweight category. The fluid balance chart showed nil/negligible stoma output, vomiting followed by high NG aspirates when NG placed, normal urinary output, TPN prescription and poor oral intake. General examiner feedback to students Generally well done. Most students checked the details and overall chart features properly. Many students had an excellent rapport with the patient There was some concern as many students interpreted a 200 ml negative balance as a significant deficit. Main learning points/concerns 1) Remember which part of U&E most important  few students mentioned potassium/magnesium (low levels) 2)

Some students thought the wide-bore NG tube was used for feeding (incorrect). Some students also failed to comment on very low oral intake (60ml) and absent stoma output (10 ml). 3) Most students mentioned weight loss -but not the significant amount of weight loss (>10% body weight). Lots of students did not mention paralytic ileus. 4) Some students did not recognise TPN despite it being written on the bag 5) This patient needed nutritional support as they were underweight/malnourished and had had significant weight loss and vomiting and the stoma was not working. The patient hadn eaten enough for 10 days so would not be able to eat enough or absorb nutrients now. There may have been an obstruction or ileus. 6) TPN is chosen rather than using the enteral route as we are unable to use oral/enteral route due to vomiting and stoma not working. Eating food or NG feeding would not be absorbed. 7) The abdominal X-Ray showed dilated small bowel and small bowel obstruction

8.8 % of students did not achieve the cut score (pass mark) in this station

Station 5: Rheumatology This station aimed to assess the studen abili : x Take a musculoskeletal history x Differentiate between inflammatory and non-inflammatory joint pain x Suggest an appropriate diagnosis and explain it to the patient x Devise and discuss with the patient an appropriate management plan

General examiner feedback to students Generally well done. Some students got mixed up about treatment protocols, especially long-term management goals. Some students ignored a lot of social history and few asked about back pain. Some did not give the patient time to ask questions about their condition.

Main learning points/concerns 1) The following were the most likely diagnoses: Rheumatoid arthritis, Psoriatic arthritis, Sero-negative arthritis

x x x x

2) Students were expected to explain that : It looks like an inflammatory arthritis It is an autoimmune condition It is unlikely to go away by itself It is likely to get worse without treatment 3) Appropriate initial investigations were both inflammatory markers (ESR and/or CRP) and serology (Rheumatoid Factor and/or anti-CCP). Hand X-ray is also acceptable. 4) Initial management plan would be to offer both pain relief (simple analgesia  paracetamol) and NSAID (orally or topical). The patient MUST be referred urgently to a rheumatology early arthritis clinic. The patient is likely to need long term treatment with immunosuppressive drugs / disease modifying drugs such as Methotrexate.

5.5 % of students did not achieve the cut score (pass mark) in this station

MED5008 – Year 5 OSCE – Wednesday 25th February 2015 Station 1 Counselling a patient with AF about taking warfarin prior to DC conversion History taking and communication/patient education station General examiner feedback to students Students in general had good communication skills Main learning points/concerns 1. Important to take a history to determine if patient may not be suitable for warfarin treatment : recent head injury, recent surgery, GI blood loss etc 2. Warfarin can stop after successful DC conversion 13.4% of students did not achieve the pass mark

Station 2 Innocent Murmur Communication with parent of a child to reassure them about incidentally detected innocent murmur General examiner feedback to students In general good rapport and communication skills Main learning points/concerns 1. Iman  eablih ih aen ha he ndeand b he em mm and inncen  this applies to any situation where an individual (patient or relative is seeking further information. It is the basis from which to start. 2. No need for specialist follow up 12.6% of students did not achieve the pass mark

Station 3 Overdose Psychiatric history taking and dealing with a patient who needed to be detained Main learning points/concerns 1. Recognition of patient who is potentially suicidal 2. Knowledge f he cec cede f legal deenin in he aien be inee 9.2% of students did not achieve the pass mark

Station 4 Eye Casualty Hi aking, eaminain f il and ecgniin f e macla degeneain fm photograph Main learning points/concerns 1. Appropriate history taking of visual loss 2. Competent examination of pupils 3. Recgniin f e macla degeneain fm hgah and knledge ab this condition. 11.8% failed to reach pass mark

Station 6 CVS exam-AF Main learning points/concerns 1. Correct examination of the CVS and accurate identification of signs (AF) 12.6% students did not reach pass mark

Station 7 Adjustment of insulin for post-operative inpatient Main learning points/concerns 1. Recognition from chart of pattern of poor control of blood sugars. 2. History from patient of disrupted food intake and activity whilst being given usual insulin 3. Need to adjust insulin appropriately and accurate prescription 25.6% of students failed to reach pass mark

Station 8 Abdominal examination Main learning points/concerns 1. Accurate examination of the abdomen 2. Knowledge of stomas 7.6% students did not reach pass mark

MED5008 – Year 5 OSCE – Thursday 26th February 2015 Station 1:

Neurology

General examiner feedback to students Overall poorly done

- all done on observation

¾ Tone ¾ Power ¾ Reflexes Most did not get diagnosis 10.1% students did not reach pass mark

Station 2:

Patient Safety Resuscitation

General examiner feedback to students x x x x

Mostly well done A few missed ABC Some did not ask about medication / allergies Many did not take focused history

8% students did not reach pass mark

Station 3:

Patient Safety Human Factors

General examiner feedback to students x x x

Some students found station confusing Did n check if aien elaie had emiin  be gien infmain Many students did not understand background to patient transfer

9.2% students did not reach pass mark

Station 5:

Non-Draining Catheter

General examiner feedback to students x x x x

Mostly well done Some did not focus on all the information given Some missed the clues in the history Inexperience with catheters clear with many students

11.3% students did not reach pass mark

Station 6:

Sepsis Station

General examiner feedback to students x x x

Many students wished to treat this elevation of potassium Many students did well. Most know sepsis bundle Some forgot to check allergies

10.5% students did not reach pass mark...