How did OSCEhome.com created the Systematic Approach to the OSCEs and clinical patients encounters.

A Step By Step Guide To Mastering the OSCEs

and Patient Encounters

How did we create the Systematic Approach?

Dr Al Imari, MD

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OSCEhome Systematic Approach

Patients visit doctors complaining of a symptom, not a disease.

It is all about the differential diagnosis of symptoms and signs.

This is the main focus of physicians during patients’ interviews, right?

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OSCE stations, as well as real life patients’ interviews, have limited time.

Physicians have no choice but to be focused and to organize the interview in a time efficient manner.

On the other hand, physicians have to be vigilant not to miss anything!

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Obviously, there is a need for some sort of an approach that will fulfil both patients and physicians goals.

An approach that will explore all the patients’ presenting issues in a limited time frame.

An approach that will protect both the patients and physicians.

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How did we at OSCEhome formulated the

OSCEhome Systematic Approach ?

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We started by preparing a list of all signs and symptoms a physician faces.

We wrote one sign or symptom on a separate sheet of paper.

Then for each symptom or sign we wrote all the possible differentials.

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Then, we draw a table, assigned a column for each differential and wrote that symptom/sign presentation details, quality, duration, relation to other symptoms/signs, and red flags.. Etc..

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Symptom / sign

DDx 1 DDX 2 DDx 3 DDx 4

…..…..…..

…..…..…..

…..…..…..

…..…..…..


Then for every detail, we wrote questions to ask for or points to examine.

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Symptom / sign

DDx 1 DDX 2 DDx 3 DDx 4

….. Do you….. Is it

….. How is


….. How is


….. How is


….. How is


Obviously, there are now, many identical questions or points to examine concerning this symptom among all these differential diseases.

We started to merge the diseases’ columns into one set of questions. When the same question is required for several diseases, we placed these diseases’ names between brackets after the question to help us later with the clinical decision making process.

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Then we arranged these questions and points to examine in a logical easy flowing flowchart.

We have noticed that there are some details that are not required if you are just screening for a symptom and not thoroughly gathering details about it. So, we divided the to ask/do list into two files, we placed the must ask/do important ones up in the list for screening, and the rest at the bottom for detailed data gathering sub-file, and just in case we run out of time.

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OSCEhome Systematic ApproachOSCEhome Systematic Approach

What about communication skills? It a major issue to ensure an easy going interview professional organized interview and to achieve a mutual understanding and respect.

We rephrased the questions to meet communication skills guidelines. e.g. English language issues, open ended questions, non-leading questions, respective manner ..etc.

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Now, we have all the needed questions to ask and points to examine concerning that symptom on a separate sheet of paper.

We placed the sheet in a separate file, labelled it with the symptom/sign name.

Then, we repeated the same process for all other signs and symptoms.

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Again, there are now, many identical questions or points to examine among all these symptom/signs.

We started to gather identical questions or points to examine into a separate file box and crossed it out on that symptom/ sign sheet. e.g questions about medications, past illnesses, social, ..etc.

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Now, we have three sets of box files;

1. Chief complaint data gathering box file,

2. Specific symptom/sign box files, and

3. Standard questions box file.

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Remember, in real practice, as well as during OSCE stations, our time is limited.

So, we carefully went into each of these box files and rearranged the questions and points to examine for maximum time efficiency.

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So we came up with a tree of a step by step history taking and physical file boxes.

During the patient interview, you go through the file boxes one by one.

You only open the box files you need.

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Let us take an example. A patient presented with cough.

1. Introductions box: 5 sentences to say.

2. Chief Complaint: 10 question to ask.

3. HPI: 15 questions to ask.

4. Respiratory question box: 10 questions to ask.

5. Standard questions box: 14 questions to ask.

6. Wrap up box: Sentences for 8 points to explain.

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Most of the patients’ answers will be “NO”. How long then, will it take you to ask all these questions and wrap up the case?

FIVE minutes! And you have COVERED all the guidelines and checklists.

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We created similar flowcharts for the physical examination, counselling, and ER stations that, with practice, will take you just 5 minutes to perform.

ONE flow chart of 7 steps with 23 history taking and 24 physical examinations boxes to choose one depending on the case !

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Don’t you agree, it is much more easier to memorize than 488+ checklists!

Rest assured that all the guidelines and checks in ANY checklist are fulfilled, including communication skills.

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You won’t forget anything to ask, do, or explain. No need to anxious and nervous.

You will be on a relaxed autopilot mode! Letting you focusing on the clinical decision process and communication skills.

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The systematic approach took three of us a full year to finalize and eight years so far to tweak.

Don’t you agree, it is worth a try? It is yours in just few minutes.

Save your time and effort and get your copy now at www.OSCEhome.com ...

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A Step By Step Guide to The Mastering The OSCEs and Patient Encounters

www.OSCEhome.com

How did OSCEhome.com created the Systematic Approach to the OSCEs and clinical patients encounters.

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