2019 OSCE stations PDF

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2019 OSCE stations...

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Final Year OSCEs – Tuesday 19th February 2019 Station 1: ENT - Otalgia Examination, diagnosis and management General examiner feedback to students Generally good approach to patients but in examination of the mouth some students omitted to mention tonsils. Also examination of nose sometimes poor when students did not ask the patient to breathe through their mouth. Generally good exam of neck. Main learning points 1) A patient with otalgia and pain on swallowing at the level of the oropharynx is indicative of significant pathology (probably neoplastic) at the level of the oropharynx. Needs competent examination of mouth, throat, ears, nose and neck. 2) This situation requires urgent referral for ENT examination and imaging by CT scan. OGD is not a good assessment of swallowing problems at this level.

17.9% of students did not achieve the cut score (pass mark) in this station

Station 2: Psychosis Communication with a relative regarding diagnosis and management General examiner feedback to students A wide range of performances. Several students omitted hallucinations and delusions as part of the definition and manifestation of psychosis. Generally good knowledge of side effects of olanzapine. Main learning points 1) Emphasis on explanation of psychosis as a mental illness with loss of reality and manifestations of delusions and hallucinations. 2) A brain metabolic imbalance that can be treated by medication such as olanzapine.

8.7% of students did not achieve the cut score (pass mark) in this station

Station 3: Medical emergency and SBAR handover Urgent assessment of an acutely unwell patient and handover to senior medical staff General examiner feedback to students Good assessment of management of an acutely unwell patient. Many students did not take an adequate history of the new symptoms. Main learning points 1. Keep calm, take a focused history, ABCDE assessment, check clinical observations and Medicine prescription chart systematically. Communicate to senior team member using SBAR. 2. Remember to reassure patient. 7.1% of students did not achieve the cut score (pass mark) in this station

Station 5: Neurology – first presentation of witnessed seizure History (including collaborative), diagnosis and management General examiner feedback to students Generally well done but a lot of students did not recognise the significance of Tramadol and knowledge of how to deal with driving was often poor. Main learning points 1. Awareness of tramadol as a trigger for seizure. 2. Awareness of the need to advise no driving for at least 6 months and need to inform DVLA. 9.9% of students did not achieve the cut score (pass mark) in this station

Station 6: Stroke History, examination and completion of documentation General examiner feedback to students Generally poor familiarity with NIHSS scoring system. Main learning points 1) When carrying out sensory examination ask patient about any differences in sensation between sides, test right and left sides simultaneously. The patient had sensory inattention i.e. sensation intact when affected side tested alone but when both sides tested simultaneously could not feel affected side. 2) In the period shortly after an ischaemic stroke there may be no changes on CT but a history indicative of the condition. The importance of CT is to rule out haemorrhagic stroke which would be a contra-indication to thrombolysis. 14.2% of students did not achieve the cut score (pass mark) in this station

Final Year OSCEs – Wednesday 20th February 2019 Station 1: Child Health – Growth chart History-taking, management and communication, documentation and data interpretation General examiner feedback to students Most students have a good rapport and manner with the carer. Some students appeared to be unfamiliar with growth charts. Many students clarified regarding family relationship and consent and showed an awareness of safeguarding. Main learning points/concerns 1) Don’t forget to confirm patient’s details on growth chart. 2) Remember to ask about the specific details of the weight loss. 3) Take care that you are using the correct part of the growth chart appropriate to age. Plot height on height curves and weight on weight curves – some mixed this up. 11.5% students did not achieve the cut score (pass mark) in this station

Station 2: Nephrology - AKI Data interpretation and management General examiner feedback to students Overall high standard. Most students able to read the NEWS chart but some had difficult with the practical interpretation. Many students did not mention the metabolic acidosis. Main learning points/concerns 1. Many students failed to stop the antihypertensive drug Amlodipine even though the patient was hypotensive. 2. Many students did not mention the Sepsis 6 protocol. 3. Remember to check the patient’s identity on EVERY chart. 13.8% of students did not achieve the cut score (pass mark) in this station

Station 3: O&G Postmenopausal bleeding Examination and communication General examiner feedback to students Most students were patient-focused. Main learning points/concerns 1) Don’t forget to mention everything about the uterus on palpation – consistency, size, anteverted, mobile, regular. 2) Remember to use the light source. 3) Ensure you answer the patient’s question fully. 4) Avoid wiping gel from anus to vulva.

9.9% of students did not achieve the cut score (pass mark) in this station

Station 5: VTE assessment Communication, documentation and prescribing General examiner feedback to students Very few students remembered to prescribe or recommend TED stockings as per the protocol. Wide variation in how familiar students were with the prescription chart. Main learning points/concerns 1. 2. 3. 4.

Remember to review the renal function and platelet count. Labelling the chart with the correct patient details is vital. It is also vital to ask about allergy status and document appropriately. Some students prescribed an incorrectly high dose of enoxaparin. The dose should have been reduced in the light of the renal function as per the protocol. 5. Some students asked the 72 year old patient if she was pregnant. 11.1% of students did not achieve the cut score (pass mark) in this station

Station 6: Surgery – Abdominal pain emergency Urgent assessment – history, examination and management General examiner feedback to students History –taking generally too scanty even in an urgent situation. Past medical history, smoking, alcohol, drug history and allergy status all relevant here. Associated symptoms also very important. ECG interpretation was also variable. Main learning points/concerns 1) IV access vital here but fluid given should be minimal (...