Idea of OSCE in obstetrics in breif
- 1. Idea of “OSCE” in obstetrics in brief Dr. Manal behery Assistant professor Zagazig university 2013
- 2. OSCE O : OBJECTIVE S : STRUCTURED C : CLINICAL E : EXAMINATION
- 3. Means fair and without bias. Most examination in the world are not fair. Use of checklist ensures objectivity. Rather than subjective, which is where the examiners decide whether or not the candidate fails based on their subjective assessment of their skills. Objective
- 4. Refer to the organization of the examination The OSCE is carefully structured to include parts from all elements of the curriculum as well as a wide range of skills. Instructions are carefully written to ensure that the candidate is given a very specific task to complete. Structured
- 5. the station are clinical in nature. . It is an examination with usually declares those who are competent to handle patients. the candidate is only asked questions that are on the mark sheet and if the candidate is asked any others then there will be no marks for them. Clinical exam
- 6. Objective Structured Clinical Examination OR Over Stimulation and Crying Event OR Opportunity for Showing your Competence and Excellence OSCE ?
- 7. Why OSCE? WHAT DOES IT TEST ? HOW TO RUN IT? OSCE
- 8. Increase validity and reliability More certain mapping to curriculum Better standard setting (pass score) More fair? More fun? WHY OSCE ?
- 9. One hour with the patient Full history and exam not observed Examiner bias .... unstructured questioning … little agreement between examiners Some easy patients .. some hard ones Some co-operative patients … some not Not a test of communication skills Long case
- 10. Clinical skill – history, exam, procedure Marking structured and determined in advance Time limit Checklist/global rating scale Real patient/actor Every candidate has the same test With OSCE
- 11. OSCEs – reliable Less dependent on examiner’s foibles (as there are lots of examiners) Less dependent on patient’s foibles (as there are lots of patients) Structured marking More stations … more reliable Wider sampling – clinical, communication skills
- 12. OSCEs – valid Content validity – how well sampling of skills matches the learning outcomes of the course Construct validity – people who performed well on this test have better skills than those who did not perform well Length of station should be “authentic”
- 15. What does it test ? 1. History taking. 2. Factual knowledge. 3. Interpretation of laboratory results and clinical data. 4. Ability to formulate dd. 5. Counseling skills. 6. Clinical problem solving.
- 16. OSCEs – acceptability Perceived fairness – examiners and examinees Become widespread
- 17. OSCE design - blueprinting Map assessment to curriculum Adequate sampling Feasibility – real patients, actors. manikins
- 18. 1- Uniform scenarios for all candidates 2. Availability 3. Safety, no danger of injury to patients 4. No risk of litigation 5. Feedback from Actors (simulators) 6. Allows for Recall 7. Stations can be tailored to level of skills to be assessed 8. Allows for teaching audit 9. Allows for demonstration of emergency skills Advantage of OSCE
- 19. 1- Organizational training 2. The idealized ‘textbook’ scenarios may not mimic real-life situations 3. Expensive Disadvantage of OSCE
- 20. OSCE Preparations See one, do one, teach one → see many, write some, learn some (learn how examiners think) Get a template Pick a topic from your block guides Core clinical presentations? Core clinical condition? Physical examination skill? Procedural or practical skill? Medical imaging?
- 21. OSCE Stations The OSCE is made up of a series of 10 minute stations with short breaks between stations The exam is made up of 10 minute couplet stations and 10 minute history or physical stations Couplet stations consist of a 5 minute clinical encounter followed by a 5 minute post-encounter probe (PEP) The PEP is a written station; DDx, interpret test results, write orders or prescriptons, etc.
- 22. OSCE Stations 10 minute stations are usually history taking or physical examination stations. There is usually a oral question asked by the examiner at the 9 minute mark.
- 23. Couplet History Taking This is a 5 minute station with 5 minute PEP What the candidate reads Candidate’s Instructions; Mrs. Fatma is 38 weeks pregnant lady complaining of headache This station is to test your ability to take relevant history in the next 5 minutes At the next station, you will be asked to answer questions about this patient.
- 24. 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 simple analgesics ( 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) 10. Relevant Past medical history
- 25. Couplet History Taking Examiner asked to judge performance as Satisfactory (borderline/good/excellent) or Unsatisfactory (borderline/poor/inferior) This is a global rating If unsatisfactory there are several reasons Inadequate medical knowledge Could not focus Poor communication/interpersonal skills Potential harm to patient Dangerous act
- 26. 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 complicatio ns Tests/investi gations/proc edures BPP Routine AN tests CTG Instruments Tests in complicatio ns Resuscitatio n of Newborn Instruments Specific investigatio ns Data interpretati on CTG GTT PET Partogram Postnatal tests: Rubella. RH HSG Semen test Hormone profile Communica tion and education Nutrition Exercise Breast feeding Contracepti on
- 27. 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 complicatio ns Tests/investi gations/proc edures BPP Routine AN tests CTG Instruments Tests in complicatio ns Resuscitatio n of Newborn Instruments Specific investigatio ns Data interpretati on CTG GTT PET Partogram Postnatal tests: Rubella. RH HSG Semen test Hormone profile Communica tion and education Nutrition Exercise Breast feeding Contracepti on
- 28. 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 complicatio ns Tests/investi gations/proc edures BPP Routine AN tests CTG Instruments Tests in complicatio ns Resuscitatio n of Newborn Instruments Specific investigatio ns Data interpretati on CTG GTT PET Partogram Postnatal tests: Rubella. RH HSG Semen test Hormone profile Communica tion and education Nutrition Exercise Breast feeding Contracepti on
- 29. 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 complicatio ns Tests/investi gations/proc edures BPP Routine AN tests CTG Instruments Tests in complicatio ns Resuscitatio n of Newborn Instruments Specific investigatio ns Data interpretati on CTG GTT PET Partogram Postnatal tests: Rubella. RH HSG Semen test Hormone profile Communica tion and education Nutrition Exercise Breast feeding Contracepti on
- 30. 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 complicatio ns Tests/investi gations/proc edures BPP Routine AN tests CTG Instruments Tests in complicatio ns Resuscitatio n of Newborn Instruments Specific investigatio ns Data interpretati on CTG GTT PET Partogram Postnatal tests: Rubella. RH HSG Semen test Hormone profile Communica tion and education Nutrition Exercise Breast feeding Contracepti on
- 31. Couplet Physical Examination What the candidate reads Candidate’s Instructions TM, 31 years old, 33wks ,has been brought to your office with a history of PROM In the next 5 minutes, conduct a focused and relevant physical examination. As you proceed, explain to the examiner what you are doing and describe any findings. At the next station, you will be asked to answer questions about this patient.
- 32. Couplet Physical Examination Did the candidate respond satisfactorily to the needs/problem(s) presented by this patient? If unsatisfactory, please specify why: (For items 4-6, please explain below) Satisfactory - Borderline - Good - Excellent Unsatisfactory - Borderline - Poor - Inferior Inadequate medical knowledge and/or provided misinformation Could not focus in on this patient's problem Demonstrated poor communication and/or interpersonal skills Actions taken may harm this patient Actions taken may be imminently dangerous to this patient Other
- 33. Data interpretation A 38 years old patient, Gravida 8 para 6+1. Her previous delivery ended by cesarean section due to failure to progress. She is now around 28 weeks Her family doctor have ordered a GTT and she brought the result for you for advise
- 34. 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?
- 35. Item Mark Well Average ND Interpretation of test (Positive for GDM) 2 1 Risks to the patient Increased risk of high BP (PET) 1 ½ Increased rate of infection (urinary/vaginal) 1 ½ Risks to the fetus Polyhydramnios 1 ½ Macrosomia 1 ½ Operative / Difficult delivery 1 ½ RDS 1 ½ Neonatal Jaundice 1 ½ Other metabolic disorders 1 ½ Total
- 36. Item Mark Well Average ND Interpretation of test (Positive for GDM) 2 1 Risks to the patient Increased risk of high BP (PET) 1 ½ Increased rate of infection (urinary/vaginal) 1 ½ Risks to the fetus Polyhydramnios 1 ½ Macrosomia 1 ½ Operative / Difficult delivery 1 ½ RDS 1 ½ Neonatal Jaundice 1 ½ Other metabolic disorders 1 ½ Total
- 37. Item Mark Well Average ND Interpretation of test (Positive for GDM) 2 1 Risks to the patient Increased risk of high BP (PET) 1 ½ Increased rate of infection (urinary/vaginal) 1 ½ Risks to the fetus Polyhydramnios 1 ½ Macrosomia 1 ½ Operative / Difficult delivery 1 ½ RDS 1 ½ Neonatal Jaundice 1 ½ Other metabolic disorders 1 ½ Total
- 38. Data Interpretation 28 years old Gravida 10 Para 9+0, 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
- 39. Item Mark Well Average ND What does the result of this test shows? (Examiner to show CBC form) Low hemoglobin (anemia) 1 1/2 What type of anemia Hypochromic microcytic 2 1 Can it be confused with other type of anemia? Thalassanemia and 1 1/2 Sickle cell anemia 1 1/2 How would you confirm? Hemoglobin electrophoresis 1 ½ Sickle cell test 1 ½ What do you think of this result? (Examiner to show the result of the electrophoresis) Confirm Iron deficiency anemia 3 2 Total
- 40. 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?
- 41. Item 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 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:
- 42. Item 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 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:
- 43. Item 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 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:
- 44. During the morning round you came across a 28 years old who has delivered 24 hours ago. She was found to run a temperature of 390 c. How would you approach her Mode of Delivery: Spontaneous Outcome: 3 Kg baby Boy How is the baby: Well in the nursery Duration of labour: 12 hours Any history of SRM: Loss of fluid for 3 days Symptoms of upper or lower respiratory tract infection Symptoms of UTI (upper or lower) Amount, and nature of Lochia
- 45. You were urgently called to the labour room by the obstetric nurse. A patient who just had her episiotomy sutured by your colleague has suddenly became pale and drowsy with rather heavy vaginal bleeding What is the differential diagnosis of post-partum hemorrhage (mention 4)? What are the immediate measures that should be taken in this case? What is the most likely cause of this patient collapse? How would you confirm This diagnosis
- 46. What is the differential diagnosis of post- partum hemorrhage (mention 4) Uterine Atony Lacerations of the Genital tract Uterine Inversion DIC
- 47. What are the immediate measures that should be taken in this case? (A) Air Way (B) Breathing (C) Maintain Circulation IV infusion
- 48. What is the most likely cause of this patient collapse? How would you confirm This diagnosis? Uterine Atony Abdominal Palpation for Uterine fundal height and consistency
- 49. An 18 years old primigravida presented to the emergency room in labour What important informations you want to know about this case? How would you confirm the patient diagnosis?
- 50. What important informations you want to know about this case? Is she booked or not How many weeks is she now ( LMP) Is there any known medical problem? Yes 38 weeks No
- 51. How would you confirm the patient diagnosis? Symptoms: o Character of the pain: regular in pattern, increase in frequency and intensity. Signs: o Show. o Cervical Changes: effacement and dilatation o Loss of fluid per vaginum
- 52. Common Mistakes Not reading the question! Asking too many unfocused questions (shotgun) Not explaining what you are doing during physical examination stations Rectal, vaginal and inguinal exams not allowed BUT you will not be given credit unless you indicate that you would do them when appropriate. Talking too fast and too much – maintain professional courtesy Trying to guess what the station is about and not listening to the patient