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OSCEExpress Session7– Community CarePlanning SaraSabur(FY1) Meet the Team Nidhi Agarwal Sumedh Sridhar SaraSabur NikitaChoudhary Shaili Kadambande OSCE Express Co-Founder5OSCE Express and FY1 Doctor FY1 Doctor FY1 Doctor OsceAce Co-founder LNRTrust LON Trust LNRTrust Holly Garcia BethanyTurner Nevash Maraj VanessaDatta FatimaAhmedi FY1 Doctor FY1 Doctor FY1 Doctor FY1 Doctor FY1 Doctor LNRTrust SY Trust NWTrust LNRTrust LNRTrustCourseOverview 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 AgarwalFY1 Sumedh SridharYr5 MedicalStudent OSCEExpressco-creators InToday’sSession… 01 02 03 Possible scenariosin Caseexamples+ Q&A+ communitycare paperwork Recap planningstation 01 Possiblescenarios incommunitycare planningstation Layoutofthestation - Simulated patient and observed 01 by (ideally) a GP examiner - More complex consultation skills Community focusing on more than one area 02 care - Will include some sort of planning individualised care planning required in the community 03 - 10 minutes to speak to the patient, warning bell at 8- minute mark.TopTips–markingcriteriaTopTips–readingtimePossiblescenarios Advanced care planning • Patient may have been diagnosed with a long term condition that needs an advanced care plan • This means you may have to talk to the patient about future wishes such as further treatments, hospital visits and ceiling of care • May include talking through a RESPECT form (know how to fill this out) • Relative may or may not be present – make sure to keep them involved during the consultation however the patient comes first • End of life discussions – preferred place of death etcPossiblescenarioscont. Review of frequent hospital admissions • Frail elderly patients have a high rate of hospitalisation and a GP consultation may be required to review if these visits are necessary • Take into consideration the reason for admission and whether we can manage this in the community before we send the patient to hospital • Focus on patient wishes as well – some patients are very sensible in deciding when they're best managed in the community rather than risking a hospital admission where they are more likely to be deconditioned and pick up bugsPossiblescenarioscont. Assessment of capacity • You may have to assess capacity of a patient to see if they can make certain decisions • Remember capacity is time and decision specific i.e. a patient may have capacity to decide how many sugars they want in their tea but may not have capacity to decide if they need an emergency surgery • Need to be aware how to assess capacity and explain to the patient/relative why this is important 02 Caseexamples andpaperworkExamplecase1 Advanced care planning • You are working as a FY1 doctor in a GP surgery Mrs Bell has presented with her husband as she was told to discuss a care plan with her GP after her recent hospital admission • Take a brief history and discuss care planning with the patient • You have 10 minutesExamplecase1 Advanced care planning • Please remember to treat it like any other consultation – easy to forget during finals, 3 point patient identification, clarify who they have brought with them, introduce yourself and your role • Brief history – about her hospital admission, why was she admitted, what did they do at the hospital, frequent hospital admissions, how she feels about going into hospital, smoking history, vaccinations • Remember she is with her husband – should be asked if it's okay for him to be in the room due to confidentiality, make sure to keep him involved in the consultation but also remember to keep the patient your first priorityExamplecase1 Advanced care planning • What would you ask in the brief history (2-3 mins) • What aspects of advanced care planning would you cover in this case?Examplecase1 Advanced care planning • She tells you she has once again been in hospital due to an infective exacerbation of COPD • She was given IV antibiotics and discharged on an oral course • She doesn't particularly like going into hospital and would only go if it's absolutely necessary • Her husband is supportive of this and agrees with the planExamplecase1 Advanced care planning – Gold standard framework ‘Advance care planning is a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care. The goal of advance care planning is to help ensure that people receive medical care that is consistent with their values, goals and preferences during serious and chronic illness.’ International Consensus Definition of Advance Care Planning (Sudore et al 2017)Examplecase1 Advanced care planning – Gold standard frameworkExamplecase1 Advanced care planning – Gold standard frameworkExamplecase1 Advanced care planning – Gold standard framework summary • Includes lasting power of attorney, advance decisions, advance statement, life sustaining treatment • Take into account social circumstances, wishes of patient (and family), beliefs including religious and cultural factors • What they would like to happen, what they hope doesn't happen • Signpost towards DNAR – if they don’t wish to discuss at this point don’t pressurise them • Safety of the patient now – do they need any extra help now to ensure we can follow their future wishes as plannedExamplecase2 End of life planning • Some patients however may require a consultation solely based on end of life planning • This is slightly different to advanced care planning as it purely focuses on one thing • You may be asked to fill out a RESPECT form – know the different components to it • RESPECT form is NOT a DNACPR (this is just one part of it) • Does need co-signing by a consultant for it to be validExamplecase2 • What are the components of a RESPECT form? • When would you fill out a RESPECT form? • Is the RESPECT form a medical decision or not? • If you haven't already, please do try and fill out a respect form or at least see it being filled out – common F1 job too!Example case2 End of life planning – RESPECT FORM 03 Q&Aand recapTopTips 1. Practise practise practise!! (with friends/clinical groups) 2. Aim for concise history taking and keep to time 3. Geeky medics/med school checklists 4. Ask for supervision of history taking and care planning during GP rotation – focus on empathy, communication skills and triadic consultation skillsTOPTIPSFORANYCCPSTATION • EMPATHY EMPATHY EMPATHY • Listen to the patient – they will tell you everything! • Don’t pressurise the patient • Acknowledge all present in the consultation • CUES will be everywhere in this station– they may want to talk about something uncomfortable etc • Be familiar with all the legal jargon– be ready to be asked about it by the patient • This station is all about getting the patient to think about things– major decisions DO NOT have to be made for you to pass the station • Summarise if you blank out :)Questions?NextSession…Feedback Thanks ! Follow us for updates @osce.express Cases: osceace.com/osceexpress Pleasedon't hesitateto contact me at sara.sabur@uhl-tr.nhs.ukforany questionsregardingfinals