OBJECTIVE STRUCTURED CLINICAL EXAMINATION

1
OBJECTIVE STRUCTURED CLINICAL EXAMINATION OSCE

• Dr. Nawal Al Sinani
• Consultant Obs Gyne
• King Abdulaziz University Hospital

2
OSCE
O OBJECTIVE S STRUCTURED C
CLINICAL E EXAMINATION
3
WHAT DOES IT TEST ?

• 1. HISTORY TAKING.
• FACTUAL KNOWLEDGE.
• 3. INTERPRETATION OF LABORATORY RESULTS AND
• CLINICAL DATA.
• ABILITY TO FORMULATE DD.
• 5. COUNSELING SKILLS.
• 6. CLINICAL PROBLEM SOLVING.

4
Why OSCE?
5
OSCE

• Why OSCE?
• WHAT DOES IT TEST ?
• HOW TO RUN IT?

6
Antenatal Labor Postnatal Newborn Gynecology
History Obstetric H/R Diagnosis of labour History of Gynecology
Physical Obstetric Maneuvers Progress in labour Post natal evaluation ( normal and CS) Delivery relevant complications
Tests/investigations/procedures BPP Routine AN tests CTG Instruments Tests in complications Resuscitation of Newborn Instruments Specific investigations
Data interpretation CTG GTT PET Partogram Postnatal tests Rubella. RH HSG Semen test Hormone profile
Communication and education Nutrition Exercise Breast feeding Contraception
7
This station is to test your ability to take
relevant history

• Mrs. Fatma is 38 weeks pregnant lady complaining
  of headache

8
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 simple analgesics ( 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)
10. Relevant Past medical history





9
Data interpretation

• A 38 years old patient, Gravida 8 para 61. Her
  previous delivery ended by cesarean section due
  to failure to progress.
• She is now around 28 weeks
• Her family doctor have ordered a GTT and she
  brought the result for you for advise

10
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?

11
Item Mark Mark Mark Mark Mark
Well Average Average Average ND
Interpretation of test (Positive for GDM) 2 1 1 1
Risks to the patient Risks to the patient Risks to the patient Risks to the patient Risks to the patient Risks to the patient
Increased risk of high BP (PET) 1 1 ½
Increased rate of infection (urinary/vaginal) 1 1 ½
Risks to the fetus Risks to the fetus Risks to the fetus Risks to the fetus Risks to the fetus Risks to the fetus
Polyhydramnios 1 1 ½
Macrosomia 1 1 ½
Operative / Difficult delivery 1 1 ½
RDS 1 1 ½
Neonatal Jaundice 1 1 ½
Other metabolic disorders 1 1 ½
Total
12
Item Mark Mark Mark Mark Mark
Well Average Average Average ND
Interpretation of test (Positive for GDM) 2 1 1 1
Risks to the patient Risks to the patient Risks to the patient Risks to the patient Risks to the patient Risks to the patient
Increased risk of high BP (PET) 1 1 ½
Increased rate of infection (urinary/vaginal) 1 1 ½
Risks to the fetus Risks to the fetus Risks to the fetus Risks to the fetus Risks to the fetus Risks to the fetus
Polyhydramnios 1 1 ½
Macrosomia 1 1 ½
Operative / Difficult delivery 1 1 ½
RDS 1 1 ½
Neonatal Jaundice 1 1 ½
Other metabolic disorders 1 1 ½
Total
13
Item Mark Mark Mark Mark Mark
Well Average Average Average ND
Interpretation of test (Positive for GDM) 2 1 1 1
Risks to the patient Risks to the patient Risks to the patient Risks to the patient Risks to the patient Risks to the patient
Increased risk of high BP (PET) 1 1 ½
Increased rate of infection (urinary/vaginal) 1 1 ½
Risks to the fetus Risks to the fetus Risks to the fetus Risks to the fetus Risks to the fetus Risks to the fetus
Polyhydramnios 1 1 ½
Macrosomia 1 1 ½
Operative / Difficult delivery 1 1 ½
RDS 1 1 ½
Neonatal Jaundice 1 1 ½
Other metabolic disorders 1 1 ½
Total
14
Data Interpretation

• 28 years old Gravida 10 Para 90, 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

15
Item Mark Mark Mark Mark Mark
Well Average Average Average ND
What does the result of this test shows? (Examiner to show CBC form) What does the result of this test shows? (Examiner to show CBC form) What does the result of this test shows? (Examiner to show CBC form) What does the result of this test shows? (Examiner to show CBC form) What does the result of this test shows? (Examiner to show CBC form) What does the result of this test shows? (Examiner to show CBC form)
Low hemoglobin (anemia) 1 1 1/2
What type of anemia What type of anemia What type of anemia What type of anemia What type of anemia What type of anemia
Hypochromic microcytic 2 2 1
Can it be confused with other type of anemia? Can it be confused with other type of anemia? Can it be confused with other type of anemia? Can it be confused with other type of anemia? Can it be confused with other type of anemia? Can it be confused with other type of anemia?
Thalassanemia and 1 1 1/2
Sickle cell anemia 1 1 1/2
How would you confirm? How would you confirm? How would you confirm? How would you confirm? How would you confirm? How would you confirm?
Hemoglobin electrophoresis 1 1 ½
Sickle cell test 1 1 ½
What do you think of this result? (Examiner to show the result of the electrophoresis) What do you think of this result? (Examiner to show the result of the electrophoresis) What do you think of this result? (Examiner to show the result of the electrophoresis) What do you think of this result? (Examiner to show the result of the electrophoresis) What do you think of this result? (Examiner to show the result of the electrophoresis) What do you think of this result? (Examiner to show the result of the electrophoresis)
Confirm Iron deficiency anemia 3 3 2
Total
16
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?

17
Item Mark Mark Mark
Well Average ND
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 What important investigations you would like to review before discharge What important investigations you would like to review before discharge 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
18
Item Mark Mark Mark
Well Average ND
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 What important investigations you would like to review before discharge What important investigations you would like to review before discharge 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
19
During the morning round you came across a 28
years old who has delivered 24 hours ago.She was
found to run a temperature of 390 c.How would
you approach her

• Mode of Labour Spontaneous
• Mode of Delivery Spontaneous
• Outcome 3 Kg baby Boy
• How is the baby Well in the nursery
• Duration of labour 12 hours
• Any history of SRM Loss of fluid for 3 days
• Symptoms of upper or lower respiratory tract
  infection
• Symptoms of UTI (upper or lower)
• Amount, and nature of Lochia

20
You were urgently called to the labour room by
the obstetric nurse.A patient who just had her
episiotomy sutured by your colleague has suddenly
became pale and drowsy with rather heavy vaginal
bleeding

• What is the differential diagnosis of post-partum
  hemorrhage (mention 4)?
• What are the immediate measures that should be
  taken in this case?
• What is the most likely cause of this patient
  collapse?
• How would you confirm This diagnosis

21
What is the differential diagnosis of post-partum
hemorrhage (mention 4)

• Uterine Atony
• Lacerations of the Genital tract
• Uterine Inversion
• DIC

22
What are the immediate measures that should
be taken in this case?

• (A) Air Way
• (B) Breathing
• (C) Maintain Circulation IV infusion

23
What is the most likely cause of this patient
collapse?
Uterine Atony

• How would you confirm This diagnosis?

Abdominal Palpation for Uterine fundal height and
consistency
24
An 18 years old primigravida presented to the
emergency room in labour

• What important informations you want to know
  about this case?
• How would you confirm the patient diagnosis?

25
What important informations you want to know
about this case?
Yes

• Is she booked or not
• How many weeks is she now ( LMP)
• Is there any known medical problem?

38 weeks
No
26
How would you confirm the patient diagnosis?

• Symptoms
• Character of the pain regular in pattern,
  increase in frequency and intensity.
• Signs
• Show.
• Cervical Changes effacement and dilatation
• Loss of fluid per vaginum

27
Other Areas can be testes

• Fetal Monitoring
• Routine tests in ANC booking clinic
• GCT and GTT
• PET profile
• Anemia
• Postpartum complications e.g. DVT, Fever,
  Hemorrhage