OBJECTIVE STRUCTURED CLINICAL EXAMINATION

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OBJECTIVE STRUCTURED CLINICAL EXAMINATION OSCE

• Hassan Nasrat
• Professor of Obstetrics Gynecology
• King Abdulaziz University Hospital

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OSCE
O OBJECTIVE S STRUCTURED C
CLINICAL E EXAMINATION
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OSCE

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

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Why OSCE?
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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
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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
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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
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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
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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
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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
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This station is to test your ability to take
relevant history

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

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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 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)
11. Menstrual History (regularity)
12. LMP
13.Past medical history
14. Past surgical history
15.Family history

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This station is to test your skill in doing
abdominal examination and building differential
diagnosis

• 38 years old, P1 0 was referred to Gynecology
  clinic because of recurrent lower abdominal pain
  
• Do systematic abdominal examination
• What is the differential diagnosis

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Grade Failure Border line Pass
1. Introduce him/hers self ask patient name 0.5
2. Position patient properly for examination 0.5
3. Describe systemic general examination (not to do) 0.5
Inspection
4. Scars 0.5
5. Hernia 0.5
6.Hair distribution 0.5
7. Movement of Abdomen 0.5
Palpation
8. Ask about pain and start away from site of pain 0.5
9. Superficial palpation start away from pain 0.5
10. Deep palpation 0.5
11. Feel for renal angles 0.5
Describe Mass
12. Site 0.5
13. Size 0.5
14. Surface 0.5
15. Mobility 0.5
16. Tenderness 0.5
Differential Diagnosis
17. Ovarian mass 0.5
18. Fibroid 0.5
19. Pregnancy 0.5
20. Bladder 0.5

Failure Borderline Pass

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Grade Failure Border line Pass
1. Introduce him/hers self ask patient name 0.5
2. Position patient properly for examination 0.5
3. Describe systemic general examination (not to do) 0.5
Inspection
4. Scars 0.5
5. Hernia 0.5
6.Hair distribution 0.5
7. Movement of Abdomen 0.5
Palpation
8. Ask about pain and start away from site of pain 0.5
9. Superficial palpation start away from pain 0.5
10. Deep palpation 0.5
11. Feel for renal angles 0.5
Describe Mass
12. Site 0.5
13. Size 0.5
14. Surface 0.5
15. Mobility 0.5
16. Tenderness 0.5
Differential Diagnosis
17. Ovarian mass 0.5
18. Fibroid 0.5
19. Pregnancy 0.5
20. Bladder 0.5

Failure Borderline Pass

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Data interpretation

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

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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?

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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
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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
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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
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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

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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 micorcytic 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?
Thalassaemia 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 electorphoresis 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
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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?

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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
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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
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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