The Unofficial Guide to Passing OSCEs

• Publisher: Unofficial Guide to Medicine
• Year: 2012
• ISBN:
  9781910399040
• Edition: 3
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

OSCE examinations are used worldwide as a critical part of medical student assessment, yet there is often little preparation for them provided by medical schools. The Unofficial Guide to Passing OSCEs is intended to fill this gap. It includes over 100 scenarios, covering medical history taking, clinical examination, practical skills, communication skills, plus specialties, meaning that everything is covered in one place. To bring the cases to life, over 300 full color clinical photos are included, including patients with features of important diseases. It also includes clear outlines of how to relay the assessment of a patient to an examiner or to other doctors on a ward round, and model answers to common questions put to students/junior doctors in OSCEs. This book has relevance beyond examinations, for post graduate further education and as a day-to-day reference for professionals.

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1 History Taking

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Some topics are more likely to surface than others are, and many history taking scenarios have not been mentioned here. After completing a year of attachments, the hope is that you will have accumulated enough neuronal connections to cope with any situation thrown at you! When in doubt or under stress, go back to the basics. The simple history taking format and SOCRATES should never be forgotten, and always remember the importance of communication. Maintain good eye contact, ask a mixture of open and closed questions, and you are already halfway there.

For every OSCE station in the finals, remember the following tips:

• Introduce yourself and wash your hands
• Ensure that patient dignity is preserved in the context of the task
• Explain what you are going to do and offer information leaflets, particularly when counselling a patient
• Gain consent
• If you don’t know the answer to any question, then admit this, and say you will speak to a colleague and find out the answer
• Thank the patient at the end of the consult

Study Action Plan

Practice history taking in small groups Take turns to be the patient, doctor and assessor: ask your colleagues to take the time to get into a character, and to think of a specific disease and how it might present: this is good clinical revision as well Ask your assessor to provide constructive feedback and reflect on this feedback Work towards being observed by more experienced clinicians whether in role play scenarios or on the wards with real patients If possible, go to acute medical admission wards, and after liaising with staff, clerk in patients ‘fresh’, discuss them with senior staff, and present them on the ward round. This simulates both a real life role, and the role you might expect an actor to take on in an OSCE

This chapter contains notes on the following histories:

1.1 Cardiovascular History: Chest Pain

1.2 Respiratory History: Productive Cough

1.3 Gastrointestinal (GI) History: Abdominal Pain

1.4 Gastrointestinal (GI) History: Diarrhoea

1.5 Neurological History: Headache

1.6 Vascular History: Intermittent Claudication

1.7 Orthopaedic History: Back Pain

1.8 Haematology History

1.9 Breast History

1.10 Genitourinary Medicine: Sexual History

1.11 Genitourinary Medicine: Vaginal Discharge

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Station 1: CARDIOVASCULAR HISTORY: CHEST PAIN

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Mrs Jones is a 60 year-old lady who presented with a two-hour history of shortness of breath, central chest pain and sweating. Please take a history from Mrs Jones and then present your findings.

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Pain History (‘SOCRATES’ mnemonic)

• Site: Central/left/right sided chest pain?

• Onset: Sudden or gradual? What was the patient doing when it came on?

• Character: Gripping? Crushing? Tearing? Burning? Cramping? Heavy? Tight?

• Radiation: Up into the jaw and/or down the left arm? Into the right arm? Through to the back?

• Associated Symptoms:

• Shortness ...