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Yourguidetoace yourOSCEs Saja Al BarmaniOutline • How toOSCE? • Things youneed to knowfor the OSCE+ resources • Grading • Commonstations • Toptips • Best resources Your Logo or NameHere2How to OSCE? 1 • YourOSCE willbe an 8stationOSCE • Willbe in twodays • Youwillbe dividedto circuits (potentialrest stations) • Each stationin 10minutes intotal • Youwillhave1minutes betweenthe stations • A horn is soundedat 8minutes andabell is sounded at10minutes Your Logo or NameHe3eHow to OSCE? 2 Your Logo or NameHere 4How to OSCE? 3 • Time management and pie charts • Look where most marks come from • Don’t spend too much time on history if you know you also have to examine. • If you have a mindblock you can alwaysmove on to the next task\question and go back to itat the end. • Don’t waste time on • Doing a comprehensive systematic enquiry. You still get the marks if you ask 2-3 questions • Summarising everything – ashort summary still gives you the marks • Stationsmay feel a bit rushed orunrealistic but it’s okaypeople knowthat youhave limited time Your Logo or NameHere 5Thingsyou needto know for OSCE Colonoscopy\endoscopy Smoking\alcohol Badnews GeekyQuiz GeekyQuiz OSCEcases book(goodbutextensive!) Your Logo or NameHere 6Resources • Geekyquiz: https://app.geekymedics.com/login/ - • OSCEstop: https://oscestop.education Detailedhistorytaking markingsheets Your Logo or NameHere 7Grading • Youeither pass or fail astation • Goodpass? • Haveto pass 6out of8 (75%of thestations) • Markingfor a8 stationOSCE– lastyear Your Logo or NameHe8eCommon stations • Medical: • STEMIHistorytaking+ ECGinterpretation+ management • Examinationofrespiratory system + CXR interpretation • Endocrine historyeg.DM,thyroid • Urosepsis • Loss ofconsciousness hx • Surgical • Peripheral vascularHxor examinationor both! • Abdominalexamination+ bloodresult interpretation+ management(appendixor cholecystitis) • Abdominalpainhistory+ AXR • Communication skills • Explainingcolonoscopy • Alcoholcounselling Your Logo or NameHe9eTop tips • Practice practice practice • Signup toOSCE sessions – put yourname on thewaitinglists OR havea studybuddy • Be confident.Even ifyou thinkyouransweris wrong • Wastenotime! • Don’tbe put offby examiners notgivingreactionto youranswers,. • Mostexaminationfindingsare normal! • Read the instructionscarefully(focused abdominalexamination) • Practice withpatientsonthe ward(getanFY to giveyou feedback) • ThirdyearOSCEs arestraightforward • Come to outmock osce Your Logo or NameHe10Resources • Geekyquiz: https://app.geekymedics.com/login/ - • OSCEstop: https://oscestop.education Detailedhistorytaking markingsheets Your Logo or NameHere 11Anyquestions? 2510452a@student.gla.ac.ukCommunication skillsstationsOutline • 1- explaining procedure • 2- breaking bad news • 3- alcohol cessation Your Logo or NameHereExplaining procedure • For Endoscopyand colonoscopy • take a short history to explorethe symptomsleadingto requiringthe procedure • Red flags may be appropriate • Take a medicationhistoryand allergies • Gatherthe patientunderstandingof the procedure • What do you know about this • Askingwhat the patientwouldlike to get out ofthe consultation+ICE • Patient might say “please doctor I want to know everything about this” Your Logo or NameHereExplaining procedure • For Endoscopyand colonoscopy • 1- before • Fasting 8-12 hours • Laxatives • Explain that it is a day procedure so they will be able to go our the same day • Explore whether they have someone to pick them up after • 2- during • sedation is used rather that general anaethetic • Ifthepatient is anxiousand demandsGA explain thatthis is something to bediscussedwiththe surgeonsontheday.Asthey generally doit undersedation and mostpeople toleratethat well • Mouth guard is used for endoscopy to protect teeth • Explain that a small tube “or telescope” with a camera will be inserted. Tube is 1 cm in diameter. This enables us to see inside the gut. • I like to sayit isthe sizeof thepicky finger • If required biopsies may be taken. Shouldn’t be painful • Thereis no pain receptorsinthe bowel Your Logo or NameHereExplaining procedure • For Endoscopyand colonoscopy • Colonoscopyspecific points • it is normal to pass wind just as the tube goes in • Lots of lubrication is used • Air is used to inflate the bowel to see better. May feel stretch. • 3- after • may not remember the full procedure so good to have someone with them so they can listen to what the doctors found. • Results of the biopsy takes up to two weeks to come back. • Can go home the. Same day • Have to have someone drive them back Your Logo or NameHereExplaining procedure • For Endoscopyand colonoscopy • Risksand safetynetting: • Smallrisk of: • Perforation • Bleeding especially if biopsy is taken • It is normalto: • feel bloated • Have a sore throat after the procedure (endoscopy) • If youexperience the followingplease visit A+E • fevers • Generally unwell • Coffee ground vomit • Large amount bleeding from the back passage (fresh blood or melena) Your Logo or NameHereExplaining procedure • For Endoscopyand colonoscopy • ALWAYS • deliver the information in small chunks • Check understanding throughout • Ask if the patient has any questions • Ask to summarise at the end • Your Logo or NameHereExplaining procedure Your Logo or NameHere 20Breaking bad news • Room set up: • in a ward ideally in a family room (if patient is ina bay) • Pull chairs closer if too far apart • A short historyexploringICE • patient might be expecting a bad news • Patient may want to know everything\nothing • Investigations the patient has had to date • Driving • did the patient come using public transport? • If driving\ anyone that can pick them up? Your Logo or NameHereBreaking bad news • A warningshot:I havethe resultsand just towarn you it isnot geed news I am afraid • do you want anyone to be with you while I tell you the results? • Break the badnews andgive them time to take it allin • Simulated patients will act that really well and turn to you once they are ready to hear more\continue conversation • Show empathy • Next steps • clarify if the patient wants to know first • List additional investigations\ available treatments • Mentioned the referral to specialist – you are not expected to know every detail about the prognosis of the disease Your Logo or NameHereBreaking bad news • Offer leafletsaboutthe diagnosis • Offer support • cancer support groups • Counselling • Another appointment to discuss diagnosis further • Invitequestions • ALWAYS: • deliver the information in small chunks • Check understanding • Pause Your Logo or NameHereBreaking bad news Your Logo or NameHereAlcohol cessation • History: • take a brief history from the patient • Get to know what they drink\how much\how often • Any problems at home regarding alcohol intake • What they work as? • Any problems financially relating to alcohol • If they drive • Any other issues because of their alcohol intake • Toolto screen for alcohol • CAGE • Usuallythinkstationwillhavea a bloodresult\IDL: • take the time to explain itand how it relates to their alcohol intake Your Logo or NameHere 25 Alcohol cessation • Encouragingchange: • haveyouever consideredcuttingdown? • They sometimes resist • You can remind them with your previous chat about alcohol and how it is affecting their health, relationship, money etc.. • Also detail the long term risks of alcohol consumption • It is ultimatelytheirdecisiontostop or not • Offer websites\leaflets\supportgroupsto help • Offer anotherappointmenttoreview andset targets Your Logo or NameHere 26Alcohol cessation Your Logo or NameHere 27Thank you!Please fill inthefeedback 2510452a@student.gla.ac.uk