OSCE : Observed StationsDr Sandeep Kavade

Consultant, Vatsalya Children’s Hospital Bhosari

PG CME, August 2012

REST STATIONOBSERVED STATION

OBSERVED STATION

OBSERVED STATION

OBSERVED STATION

OBSERVED STATION

REST STATION

REST STATION

STATION 1

Blank OSCE SheetsClinical PhotoX RayClinical ScenarioECGABGKaryotypeBiostatistics

Stay calm Focused Don’t spend time mugging things on the last

day OSCE is an skill assessment of your entire

post graduation

A professional outfit A good apron A stethoscope Roll No card 2 pens Last but not the least A cool, calm mind

Things to carry for OSCE

Spots designed with around a 3 – 4 minute time frame

Writing never takes more than 2 minutes Certain stations like statistics may be time-

consuming

5 minutes are more than enough (usually)

Life comes in a circle Some students get 3 simple OSCEs, some 3

impossible ones Some will start on a rest station Don’t decide your fate on the first OSCE OSCE goes in a circle too

First few OSCEs

See what the question says Example: ECG of SVT followed by question, name the

drug treatment of above condition, please see DRUG.

Do not mention vagal maneuvers / DC conversion over here

Read the question CORRECTLY

We had a OSCE question where we had to take the height of a child and plot it in the growth chart.

Simple isn't it There were 4 children of different age groups Examiner randomly sent any one to each

student

Trick We had to remember to ask the name of the

child and write on space provided on growth chart

Also had to attach growth chart to answer sheet and then give it back

NRP question about 18 hrs old baby found apneic in ward

It is 18 hrs old…do not ask the 4 standard questions

At a station for taking child’s length with infantometer a nursing assistant was standing in corner

Most students tried to do it on their own Assistance was provided to only those who

asked.

Getting the diagnosis or identification of a spot right is very crucial

Even if you get other answers correct, no marks are awarded.

Go with your gut instinct Do not diagnose or identify slides with the

questions Many questions have false hints

History taking

Clinical examination

Counseling

Indices calculation or some procedure or Development examination

NALS/PALS/Spirometry/ Rotahaler/Spacer use etc……

Observed stations are fixed (more or less)

Introduction and ask about the language When diagnosed, is it confirmed Remove the guilt of parents (no one to blame) Treatment (If available or not for cure)

If not supportive therapy Treatment of disease complications and their

Complications

Counseling

Compliance with Treatment Antenatal counseling Recurrence Risk Support Group Thanks! All the best, do you want to ask any

question

Counseling

Always ask language No medical jargon Give options Never force a decision

24 yr old lady diagnosed as HIV + at 36 weeks of gestation. Counsel regarding perinatal transmission and follow up.

COUNSELING

1. Ensures the presence of husband 0.5 2. Introduces self/ puts the couple at ease. 0.53. Explains the disease in simple words 0.54. Explains the incidence and modes of perinatal

transmission 20-30% 0.5

Prenatal 0.5Intranatal 0.5Breast feeding 0.5

5. Explains modalities of reducing rate of transmissionART to mother and child

1.0LSCS Vs Vaginal delivery

1.0Breast feeding Vs top feeding

1.06. Explains effect of measures – reduction by 50%

1.07. Explains screening of the infant

0.58. Explains safety of cuddling, petting and kissing

1.09. Asks for queries if any.

0.510. Advises to report back if any problems.

0.5

(Total marks 10.0)

COUNSEL THE MOTHER OF A DOWN’S SYNDROME

Introduction Asking for what she knows about the child’s

condition. Telling common problems of downs to watch for Education and vaccination of present affected child. Inheritance & Possibility in next child Antenatal testing in next pregnancy Ask for and clarifying doubts Thank the mother.

Advise the mother of a child with simple febrile seizures

Greeting the mother Introduce yourself Asking the mother what she knows about her

child’s illness. Explaining what is simple febrile seizure Management plan and side effects of drugs used Prognosis Avoiding technical jargon Asking for any more doubts and clarifying them.

Introduction Remove the stress Main symptoms Onset, progression, severity ? Similar problem in past Negative history for D/d Sibling/Family history Drug history Perinatal history, if imp Social /Environmental history if imp Thanks

History taking

A 2 yr old child presents to emergency department with severe pallor. Take the history of the child from mother.

Introduces himself and tries to make the mother comfortable 0.5 marks

Asks onset sudden or gradual 1 mark history of bleeding or bluish spots 1 mark History of associated symptoms : fever, failure to thrive 1

mark Recurrent blood transfusions 1 mark history of associated jaundice 1 mark history of worm infestation 0.5 mark birth history 0.5 mark community and religion and history of consanguinity 1 mark dietary history 1 mark family history 0.5 mark drug history 1 mark

Take history of a 8 year old child with past history of repeated cough, breathlessness, not associated with fever?

Identify patient Introduce yourself Ask Duration & frequency of symptoms With expectoration? Allergic history?-rhinitis, urticaria Association with exertion Diurnal variation?

Seasonal variation? H/o growth, weight gain H/o asthma, cough, allergies in family. H/ TB contact Investigation history Treatment History

Always remember to wash hands Informed consent Check instruments provided Show the exact technique Collection of specimen Advise regarding post procedure observation Disposal of waste Thanks

Procedures

ELICITING KNEE JERK

Greeting the patient and self introduction Taking consent and explaining the procedure. Adequate exposure Proper position of the patient (supine) and the doctor Proper technique (Keeping the hand under the knee

and striking the patellar tendon midway between its origin and insertion).

Looking for quadriceps contraction. Grading the reflex Thanking the patient.

EXAMINATION OF B.P IN A 10 YEAR OLD

Rapport with patient and Bystander Choice of cuff size Positioning of the patient Site of tubing in relation to artery is correct? Initial palpation, then auscultation method Rate of deflation is correct To say if reading is normal or otherwise Thanking patient and bystander

Examination of Head Circumference

Introducing oneself and establishing rapport To explain the procedure Positioning on right hand side of the patient. Inspection for skull abnormalities. Head circumference to be measured with fibre glass tape. Tape should encircle over the most prominent point on the

occiput and supra orbital frontal ridge. Ends of the tape should overlap and intersecting value to

be taken. Accurate reading and plotting on the growth chart, if

available.

Examination of Height of a 7yr old child by Stadiometer

Introducing oneself and take consent Explaining the procedure Examining from right hand side of the patient Make the child stand against scale bare feet. Feet together parallel with heel, buttocks, shoulders and

occiput touching the rod. Ask to look straight head erect with chin up. Frankfurt

plane and biauricular plane being horizontal Scale brought to touch the vertex, pressing the hair. Accurate reading and plotting on the growth chart, if

available.

Do Motor system examination of the child

Introduces. ½

Explain to parents & consent ½

Warms hand before examination ½

Posture / tone ½

Nutrition ( wasting etc.) ½

Power : fingers / wrist / elbow / shoulder in all move. ( 0.5*4=2)

2

Power : hip / knee / ankle / 1 ½

Deep reflexes : AJ /KJ /BJ /TJ / BR.JERK ( 0.5 *5) 2 ½

PERSISTENT NEONATAL REFLEX (if infant) ½

Abnormal reflex ( jaw jerk) ½

Gait ½

Thanks the Mother ½

TOTAL 10

Administer HIB Vaccine to this 4 month old child who is otherwise normal.

Introduces. ½

Explain to parents about vaccine / cost / side effect 1

Wash Hands ½

Take 2 ml syringe and needle to withdraw diluent and Mix it with the lyophilised Powder

½

Changes the needle ½

Identify the site. Anterolat Thigh middle 1/3 ½

Correct needle ½ inch ( IM) ½

Clean the site ½

Correct direction ( vertical) .. ½

Withdraw and press at the Inj Site ½

Post procedure advise to mother ½

Instructions to wait 20 min and inform on case of problem ½

When to come for the next dose ½

BIOWASTE DISPOSAL 1

Thanks the Mother ½

TOTAL 10

Examine the Abdomen of this child.

Introduces. ½

Explains to child what exactly has to be done 1

Warms hand before examination ½

Inspection: shape ½

Scar / sinus veins /umbilicus ½

GENITALS / Hernia ½

Palpation: Liver / spleen…superficial and deep ½

Bimanual Palpation ½

Percussion: all quadrant ½

Shifting dullness / coin test ½

Auscultation for 1 min : for peristalsis and Bruit ½

TOTAL 6

Except the NRP station

Do not ask examiner any question

Rest at the rest station

Thanks http://groups.yahoo.com/group/PediatricsDNB/

Theory: http://dnbpediatricstheory.blogspot.in/

OSCE: http://oscepediatrics.blogspot.in/

Clinical: http://clinicalpediatrics.blogspot.in/

Practicals: http://practicalpediatrics.blogspot.in/

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