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OsceExpress Session5 Dr Fatima Ahmedi (FY1) Meet the Team Nidhi Agarwal SumedhSridhar Sara Sabur NikitaChoudhary ShailiKadambande FY1Doctor(NW) Yr5 Med Student FY1Doctor FY1Doctor FY1Doctor Osce Express Co-Founder Osce Express and LNR Trust LONTrust LNR Trust OsceAce Co-founder BethanyTurner HollyGarcia NevashMaraj Vanessa Datta FatimaAhmedi FY1Doctor FY1Doctor FY1Doctor FY1Doctor FY1Doctor(LNR) LNR Trust SY Trust NW Trust LNR Trust OSCE ExpressCore TeamCourseOverview Osce Express 1. 11 session guide to common OSCE finals stations 2. Delivered by Foundation Year 1 Doctors 3. Peer-Reviewed Cases + Video Guides provided to all participants (published on MedAll, osceace.com) 4. Preparation for OSCEs… 5. …And also preparation to be a safe FY1Disclaimer This course has been designed to help final year students with practical OSCE exams and is an unofficial resource that covers themes present in the University of Leicester Final OSCEs. We have nonetheless made this course as applicable to other final year OSCEs as possible, but there may be discrepancies in your University’s expectations. OSCE Express sessions are peer-reviewed by junior doctors, but we take no responsibility in the accuracy of the content, and additionally our sessions do not represent medical advice. Please use our sessions as a learning aid, and if you note any errors, do not hesitate to message us at osce.express@gmail.com Kind regards, Dr Nidhi Agarwal FY1 Sumedh Sridhar Yr5 Medical Student OSCE Express co-creators InToday’sSession… 01 02 03 Difficult Ethics& Q&A ConversationsProfessionalism 01 Difficult Conversations Layout 0-4 mins: - Establish what the patient already 01 knows about their diagnosis. - Explore the sequence of events leading to admission today. Difficult 4-10 mins: Conversation - Explain the blood test results and A 10-minute palliative other investigations. conversation in ward/ clinic/ - Explore patient concerns regarding ED with patient/ relative/ 02 their current symptom and discuss another healthcare how to best manage this. employee. - Answer any questions the patient has.STATIONTIME!JillianSmith,72,S206012 You are the FY1 on an HPB ward. You have been asked to speak to a patient called Jillian Smith regarding her pain management. She presented to the triage area with increasing abdominal pain and jaundice a few days ago. She has a background of hepatocellular carcinoma for which she underwent a hemi- hepatectomy operation 4 months ago. A PET scan was performed during this admission which showed disease activity in the liver and bile ducts. A biopsy confirmed disease spread. Patient is aware of this. Palliative nurses have been to see her - their documentation is available for you to view. Her case was discussed in the HPB MDT amongst the surgeons and another resection is not possible. This decision has not been communicated to her.Scanthislinkforfurtherdocumentation. HowtomanageSymptoms:Pain Cause: Effects of tumour itself, treatment side effect, unrelated to cancer, only on movement, Conservatively: Reassurance, Getting seen by someone from chaplaincy/ mosque, non-religious visitor. Medically: WHO pain ladder - Medication: Paracetamol, Codeine, Morphine + adjuvants etc (depends on the type of pain) - Route: PO vs IV vs S/C vs patch (unable to swallow, personal preference ) - Frequency: Regular and PRN Other: Acute pain team review in hospital, community pain team reviewHowtomanagesymptoms: Breathlessness Cause - Anxiety, direct cause (lung mets), SVCS, anaemia, PE, HF, COPD Conservatively: Sit upright, hand held fan, oxygen (if maintaining stats no need for this), chest physio, Medically: Low dose opiate or Midazolam, treat other medical causes, nebulisers. Other: Palliative care review - if needed palliative care nurses can facilitate home oxygen.Howtomanagesymptoms: constipation Cause - Opiates, dehydrating lack of privacy, suboptimal food intake, direct effect of tumour causing obstruction, hypercalcaemia. Conservatively: Encourage oral fluids, commode easily available to them, side room, mobilise. Medically: PR exam, Laxatives, Enema, Top Tip: For all patients you are starting on opiates prescribe laxatives even if a simple admission.Howtomanagesymptoms:N&V Cause: opiates, cytotoxic drugs, gastric stasis, gastric outlet obstruction, delayed gastric emptying, anxiety, Conservatively: Encourage oral fluids, food in small amounts, puréed food, Medically: Anti-emetics, either single one or often for palliative patients a combination, evaluate cause of N&V, consider NG feed, TPNHowtomanagesymptoms: Secretions Cause: salivary secretions, chest infection, aspiration, gastric reflux elevating chest to allow for drainage.nd Medically: Glycopyrronium Bromide, ABX (if due to an infection)Howtomanagesymptoms: Agitation Cause: Anxiety over impending end of life, living alone, dying alone without family Conservatively: Reassurance, Chaplaincy Visits (religious or non- religious), CNS nurses, palliative nurses, hospital volunteers Medically: MidazolamAnticipatoryMedications Pain/ Breathlessness - Morphine Anxiety/ Agitation/ Seizures - Midazolam Nausea, Vomiting, Hallucinations - Levomepromazine Respiratory Secretions - Glycopyrronium Bromide TopTips 1) This is not a medical station - you are allowed to say you do not know exact management, doses etc 2)Pick up on verbal cues/ be empathetic - simulator marks!! 3)PRACTICE 4)Lots of reading material - systematically scan and summarise. 02 Ethicsand Professionalism Part1:(patient-focused) ExampleStations ● Confidentiality (The Caldicott Principles, Gillick Competence and Frazer guidelines) ● Consent and mental Capacity (4 principles of capacity) ● Duty of candour (medical error whilst prescribing, equipment left inside patient during surgery) ● Sadult, DoLS)(child abuse, domestic violence, vulnerable ● Conflict of interest (financial, providing care to people you know) ● Raising and Acting on Concerns (Datix, colleague not contributing enough at work / late, freedom to speak up guardians) Layout 01 0- 8 minutes ⮚Consultation with simulator. Complications ⮚- A conversation testing any of the Ethical issues inSurgical Patients according to GMC GMP. ⮚ 8-10 minutes 02 ⮚Questions from the examiner.STATIONTIME! First 8 minutes DutyofCandour You are the FY1 working in HPB triage on Monday morning. It has been a very busy morning and your registrar just got called to theatre half an hour ago. A nurse comes up to you and says the family member of a patient would like to talk to a doctor. The patient is a 55 year old woman who has come in with abdominal pain and a high temperature. US scan showed gall bladder wall oedema, sludge in the gallbladder and gallstones. She was diagnosed with acute cholecystitis. As part of the treatment the registrar administered Co-Amoxiclav 1.2 g IV. A few minutes later the patient broke out in a rash over her entire body, was itchy and hypotensive. Adrenaline and chlorphenamine were delivered promptly. Patient is now doing well. Their daughter has asked the nurse if they can speak to the doctor responsible. You know the registrar will take a few hours to return from the surgery so you decide to speak to the daughter.Questionsfromtheexaminer? 1)What is duty of candour? 2)What systems are in place to ensure an error such as this does not happen again? 3)What is a DATIX?MarkScheme Dutyofcandour - To be open and honest with people in your care if something has gone wrong with their treatment or care. 1) Tell the patient when something has gone wrong. 2)Apologise 3)Remedy it / support to put matters right. 4)Explain the short and long term effects. Datix - A risk management information system designed to collect and manage data on adverse events. - Incident reporting (a way to identify incidents/ near misses to learn from them - not blaming anyone) - Any staff member can do it. - Some examples: : injury to patient, failure of equipment, failure to follow trust procedure (steroid step down), delay (tasks not being done by day team), abuse towards staff - Gets reviewed and actioned by managers, / risk governance team. - Outcome = incident closed or further investigation (serious incident). - Action/ learning/ outstanding actions in Quality and governance report. TopTips 1. Good Medical Practice in action scenarios 2. Practice - very similar template to tackle most of these cases. 3. Gather your information before hand - prep for station. 4. You are allowed to say sorry, say that you do not know, you will speak to a senior etc. NextSession… Detailscomingsoon,potentialsession cancellationnextweek. Feedback https://app.medall.org/feedback/feedback-flow?keyword=1dc28740cfc2cd196f72ad2a&organisation=osceexpress Thanks ! Follow us for updates @osce.express Cases: osceace.com/osceexpress