OSCE Flashcards
Finals Osce
- Stations 1-8
Finals Osce
- Stations 1-8
- Community Care Planning (GP)
- Referral and discussion (Medicine)
- Post-Operative Patient on Ward Round (Surg, NO SIM)
- Using Investigations to prescribe safely (Medicine, NO SIM)
- Deteriorating Patient
- Multi-morbidity and Polypharmacy (GP)
- Complication in a surgical patient
- Ward Round Notes (Medicine/Surgery, NO SIM)
Final OSCE
- Stations 9-16
Final OSCE
- Stations 9-16
- Specialties in ED
- Pre-operative patient (surg)
- Managing uncertainty (GP)
- Difficult conversation
- Physical exam (Med or surg, REAL PT)
- Ethics and professionalism
- Handover and prioritisation (Med/surg)
Station 1: Community Care
- Possible topics
- Scenario
- Points
Station 1: Community Care
- Possible topics
- Advanced Care Planning
- Incl. End of Life
- Review of elderly
- Capacity - Scenario
- In GP
- See Patient/relative
- Brief history
- Discuss Care Planning - Points
- Identify need (recent admission/short-long term needs)
- Care planning (explain, discuss short, discuss long, discuss preferences)
- Patient-centered (establish wishes and reflect clearly)
- Holistic (health and social, services, family/voluntary)
Station 2: Referral and discussion
- Structure
- Marks
Station 2: Referral and discussion
- Structure
1. Interpret and summarise
2. Diagnose
3. Given specialist: decide request
eg. CT Scan, SPr Review, Transfer
4. SBAR
5. Answer questions based on referral
Marks:
1. EWS score/results
2. Logical
3. Justified
4. Unambiguous answers
Station 3: Post-Op Patient NO SIM
- Structure
- Expectations
- Marks
Station 3: Post-Op Patient
- Structure (no simulator)
5 minutes Review Obs/Drug chart
- Patient complaining of… currently NBM
- Explain approach to examiner and plan
5 minutes tasks
- eg calculate fluid balance+regime
- Marks
1. Interpret in context
2. Plan to determine cause
3. Identify likely cause and options
- Review charts and confirm options
- Clear communication and full explanation
Station 4: Safe prescribing NO SIM
- Structure
- Marks
Station 4: Safe prescribing
- Structure
- No simulator
- BNF app and calculator
5 Minutes
- Assimilate information
- Suggest investigations with justification
5 Minutes
- Interpret results
- Write clearly-documented prescription
- Prescribe safely (patient details)
- Marks
1. Accurate summary
2. Clear justification of requests
- Perfect prescribing
- Linked to results (adjust)
Station 5: Deteriorating Patient
- Structure
- Marks
Station 5: Deteriorating Patient
- Structure (NOT arrest)
6 minute A-E
4 minutes - clinical skill (no consent or comms)
- Interpret result of procedure
- Marks
1. Initial assessment
2. Interaction and team-working
3. Skills
4. Reasoning
Station 6: Multi-morbidity and polypharmacy
- Structure
- Marks
Station 6: Multi-morbidity and polypharmacy
- Structure
0. Discharge letter in reading time
1. History
2. Discuss medications and ADRs
3. Suggest changes
4. Negotiate plan with patient - Marks
1. Presenting complaint and symptoms
2. Active discussion of meds
3. Sensitively address challenges
4. Explain rationale for stopping
5. Agree plan
Station 7: Complications in surgical patient
- Structure
- Marks
Station 7: Complications in surgical patient
- Structure
- Reading time: scenario, Obs, Drugs
- 3 minutes: Hx + Describe key examination
- 2 minutes: Suggest Ix + interpret DDx
- 3 Minutes: Review Ix and Rx, give Dx
- 2 minutes: Discuss further management plan
- Marks
1. 4 mark history
2. 3 Mark exam
3. 3 mark reasoning
4. 5 marks investigation and drugs
5. 5 marks management - eg. sepsis 6, source of infection and CT
Station 8: Ward Round Notes NO SIM
- Structure
- Marks
Station 8: Ward Round Notes
- Structure
0. Drug and obs charts
1. 10 minute video - 2 minute warning
- EWS and Bloods included already
- Marks
0. Headed and signed
- Symptoms
- Exam findings
- Concise summary and clinical findings
- Highlight safety issues
- Succinct
- Accurate and logical
Station 9: ED Specialties
- Structure
- Marks
Station 9: ED Specialties
- Structure
0. Any Y4 ED presentation
1. History
2. Explain DDx, Ix, Mx
3. Answer qs - Marks
1. Skilled history no sig omissions
2. Excellent interaction
3. Confident and accurate
4. Assured answers
Station 10: Pre-Op Clinic
- Structure
- Marks
Station 10: Pre-Op Clinic
- Structure
0. History and symptoms
1. Indications, benefits, risks
2. Recovery time - LoStay/mobilisation/work/routine
3. Investigations required
4. Peri-op information giving - Nil By Mouth, Analgesia etc.
- Marks
1. Fluent history
2. Good risks/benefits
3. Skilled peri-op management
4. Good answers to qs
Station 11: Managing uncertainty
- Structure
- Marks
Station 11: Managing uncertainty
- Structure
5 minutes
1. History
2. Interpret exam findings
5 minutes
1. Explain DDx
2. Suggest management
- Marks
1. Depth of Hx and Red Flags
2. Clear DD with no jargon
3. Organised data gathering
Station 12: Difficult Conversation
- Structure
- Marks
Station 12: Difficult Conversation
- Structure
0. Palliative care conversation (ED, clinic, hospice) - Patient/relative/peer/carer
- Introduce and establish
1. PERCEPTION
2. Results
3. Next steps
4. Symptom relief advice
5. Guidance may be signposted
6. Questions - Marks
0. Communication
1. Content
2. Clarity
3. Next steps communications
Station 13: Physical Exam
- Structure
- Systems
- Marks
Station 13: Physical Exam
- Structure
8 minutes
- Pt has presented with ‘Sx’ please examine ‘…’ system
- ‘I would complete my exam with:…’
2 minutes
- Questions
1. DDx
2. Ix
3. Mx
Systems:
1.Abdo, CVS, resp,
2. Diabetic foot, thyroid, hands
3. Ortho: hip, knee, shoulder, spine
4. Vasc, neuro
- Marks
1. Structured with positive findings
2. Important negative findings
Station 14: Ethics and Professionalism
- Structure
- Topics
- Marks
Station 14: Ethics and Professionalism
- Structure
8 minute consultation with simulator
2 minutes questions from examiner - Topics
1. Raising and acting on concerns
2. Confidentiality
3. Consent and mental capacity
4. Duty of candour
5. Safeguarding
6. Conflict of interest - Marks
1. Skilled and fluent opening
2. Perception baseline
3. Empathy to concern and requests
4. Answer examiner with justification
5. Reflective
GP/Admin Stations
1 Community Care Planning (GP)
6 Multi-morbidity and Polypharmacy (GP)
11 Managing uncertainty (GP)
14 Ethics and professionalism
Surgical Stations
- Post-Operative Patient on Ward Round (Surg, NO SIM)
- Complication in a surgical patient
- Pre-operative patient (surg)
Ward Skills
- Referral and discussion (Medicine)
- Using Investigations to prescribe safely (Medicine, NO SIM)
- Ward Round Notes (Medicine/Surgery, NO SIM)
- Ethics and Professionalism
- Handover and prioritisation (Med/surg)
Acute Skills
- Deteriorating Patient
- Specialties in ED
- Physical exam (Med or surg, REAL PT)
Station 1. ACP
- Conversation points
- Diagnoses with palliative needs
- Life-prolonging treatments
Station 1. ACP
- Conversation points
1. Current clinical picture
2. Disease trajectory
3. Holistic approach
4. Short-term needs and wishes
5. Long-term needs and wishes
- ADRT
- LPA
- IMCA
6. Anticipation of future ‘events’
7. Management options
- Diagnoses with palliative needs
1. Advanced, progressive, incurable
2. Frailty and co-morbidity
3. Risk of sudden death
4. Sudden catastrophic condition
5. Extremely premature neonates
6. Withdrawing life support - Life-prolonging treatments
1. ABx
2. CPR
3. Dialysis
4. Nutrition/Fluids
5. Ventilation
EoL Help
- Appetite
- Breathing
- Sleep
- Restlessness
- Skin change
- Continence
EoL Help
- Appetite
1. Straw/spoon
2. Damp sponge
3. Ice chips
4. Lip balm - Breathing
1. Change position onto side
2. Secretions medications - Sleep
1. Speaking quietly
2. Holding hand
3. Playing music - Restlessness
1. Speak clearly
2. Repeated reassurance
3. Not correcting
4. Check bladder/bowels - Skin change
1. Gentle massage - Continence
1. Cleaning bedding
2. Pads/catheter
Station 10: Pre-Op
- Considerations
Station 10: Pre-Op
- Understanding of meeting
- Symptoms
- Indications, benefits, risks
- LoStay/mobilisation/work/drive - Investigations and why
- CVS: exercise tolerance
- Resp: lie flat, chronic cough
- GI: GORD, PO N&V
- Preg, gluc, bloods, ECG/ECHO
- G&S vs XMatch
- Lead up/day of
- Nil By Mouth/analgesia/ward
- Meds to stop & Allergies
Station 10: Pre-Op
- Hip Replacement
- Indications
- Prior mx
- Benefits
- Risks
- Preparation
A. Anaesthetic
B. LoStay
C. Mobilisation
D. Drive
E. Work
Station 10: Pre-Op
- Hip Replacement
- Indications
- OA
- RA
- NoF
- Septic
- Dysplasia
- Severe pain, swelling, stiff, LoF - Prior mx
- PT
- Steroid - Benefits
- Risks
- Dislocation/leg length
- Infection
- Neurovascular damage
- DVT
- Fracture - Preparation
- Activity eg. swim
- PT
A. Anaesthetic
- GA/Spinal
- Epidural
B. LoStay
3-5 days
C. Mobilisation
- Frame/crutches
- PT/OT
D. Drive
- 6 weeks
E. Work
- 6 weeks light duties/office
Station 10: Pre-Op
- Knee Replacement
- Indications
- Prior mx
- Benefits
- Risks
- Preparation
A. Anaesthetic
B. LoStay
C. Mobilisation
D. Drive
E. Work
Station 10: Pre-Op
- Knee Replacement
- Indications
- OA
- Gout
Sports injury - Prior mx
- Weight loss
- Swimming/walking/cycling
- Walking aids
- Pain relief/steroid
- Arthroscopy/osteotomy/microfracture - Benefits
- 20 years knee - Risks
- DVT
- Infection
- Neurovascular
- Pain/stiffness/LoF - Preparation
- Exercises
- Smoking cessation
- Weight management
- Stock food, easy to reach, transport, work arr.
A. Anaesthetic
- GA/Spinal
B. LoStay
- 1-3 days
- PT/OT
- 10 days stitches/clips
C. Mobilisation
- 6 weeks without aid (3 partial)
- 3 months heavy lifting
D. Drive
- 8 weeks
E. Work
- 6-23 weeks
Station 10: Pre-Op
- Colostomy/Ileostomy
- Indications
- Prior mx
- Benefits
- Risks
- Preparation
A. Anaesthetic
B. LoStay
C. Mobilisation
D. Drive
E. Work
Station 10: Pre-Op
- Colostomy/Ileostomy
- Indications
- Bowel/Anal/Gynae Ca
- Crohn’s/UC
- Diverticulitis
- Neurology/Hirschsprung’s
- Ischaemic bowel - Prior mx
- Disease dependent
- Medical
- Partial colectomy/J-pouch
- Stoma nurse
- Laxatives/bowel prep - Benefits
- Risks
- Infection
- Dehydration
- Blockage/obstruction
- Hernia/prolapse/retraction
- Skin damage - Preparation
A. Anaesthetic
- GA
B. LoStay
- Open/Lap
- 3-10 days
- Drip, catheter, oxygen, large output
C. Mobilisation
- 6-8 weeks usual activities
- 3 months heavy lifting
- low fibre diet
D. Drive
- At least 6 weeks
E. Work
- When ready
Station 10: Pre-Op
- Hernia repair
- Indications
- Prior mx
- Benefits
- Risks
- Preparation
A. Anaesthetic
B. LoStay
C. Mobilisation
D. Drive
E. Work
Station 10: Pre-Op
- Hernia repair
- Indications
- Inguinal/femoral/para-umbilical - Prior mx
- Benefits
- Risks
- Wound infection
- Recurrence
- Pain - Preparation
- Bath or shower
- Arrange to be collected
A. Anaesthetic
- Local/regional
- GA
B. LoStay
- Day case
- 1-2 hours
- E&D
C. Mobilisation
- 24hrs looked after, mild laxative
- 48hrs dressing
- 10 days dissolve stitches
- 1-2 weeks light activity
- 4-6 weeks lifting
D. Drive
- 1-2 weeks
E. Work
- 1-2 weeks
Station 10: Pre-Op
- Abortion
- Indications
- Prior mx
- Benefits
- Risks
- Preparation
A. Anaesthetic
B. LoStay
C. Mobilisation
D. Drive
E. Work
Station 10: Pre-Op
- Abortion
- Indications
- Prior to 24 weeks
- Post 24 weeks risk to mother’s life
- Grave permanent physical/mental injury
- Child serious disabilities - Prior mx
- Medical (12 weeks over phone)
- Medical 12-20 weeks longer process - Benefits
- Risks
- 1/1000 haemorrhage
- 10/1000 damage to cervix
- 4/1000 damage to uterus
- Uterus infection - Preparation
- USS, blood tests
A. Anaesthetic
- Local/sedation
- GA
B. LoStay
- Day case
C. Mobilisation
- Immediate
- 7-14 days bleeding
Stations to Prep:
1,3,8,10,14
Stations to Prep:
- Community Care Planning (GP)
- Post-Operative Patient on Ward Round (Surg, NO SIM)
- Complication in a surgical patient
- Pre-operative patient (surg)
14.
Ethics and professionalism
Station 10: Pre-Op
- Valve replacement
- Indications
- Prior mx
- Benefits
- Risks
- Preparation
A. Anaesthetic
B. LoStay
C. Mobilisation
D. Drive
E. Work
Station 10: Pre-Op
- Valve replacement
- Indications
- Narrowing/leaking - Prior mx
- TAVI
- Balloon valvuloplasty - Benefits
- Risks
- 1/50 death - Preparation
- Smoking/weight loss
- Dentistry
- Bloods/ECG, ECHO
A. Anaesthetic
- GA
- By-pass
B. LoStay
- 1 Day ICU
- 5-10 hospital
C. Mobilisation
- 15 days limited
- 2-6 weeks cardiac rehab
- 2-3 months
D. Drive
- At least 4 weeks
E. Work
- A few weeks -
- 3 months manual labour
Station 10: Pre-Op
- Cholecystectomy
- Indications
- Prior mx
- Benefits
- Risks
- Preparation
A. Anaesthetic
B. LoStay
C. Mobilisation
D. Drive
E. Work
Station 10: Pre-Op
- Cholecystectomy
- Indications
- Gallstone pain
- Pancreatitis - Prior mx
- Low fat diet
- Oral Dissolution (Bile acids)
- ESWL (extracorporeal shockwave lithotripsy) - Benefits
- Risks
- Non-resolution
- Post-op pain
- DVT
- Anaesthetic risks
- Wound infection/leak
- Bile acid leak (1/100)
- Bile duct damage (1/500)
- Organ damage (1/1000)
- Preparation
- Smoking/weight loss
- NBM
A. Anaesthetic
- GA
- + Local, meds
B. LoStay
- Lap: day case
- Open: 4-5 days
C. Mobilisation
- Lap 15 days normal (shower next day)
- Open 3 months normal (4-6 weeks light)
D. Drive
- Lap normal
- Open 6 weeks
E. Work
- Open 3 months manual labour
Station 10: Pre-Op
- Tonsillectomy
- Indications
- Prior mx
- Benefits
- Risks
- Preparation
A. Anaesthetic
B. LoStay
C. Mobilisation
D. Drive
E. Work
Station 10: Pre-Op
- Tonsillectomy
- Indications
- Recurrent infection
- Obstructive sleep apnoea - Prior mx
- ABx treatment/prophylaxis
- Observation - Benefits
- Risks
- Bleeding
- Re-operation for bleed
- Infection
- Anaesthetic risk - Preparation
- Pregnancy test
A. Anaesthetic
- GA
B. LoStay
- Day-case/Overnight
C. Mobilisation
- Minimum 6 hours
- 24 hours N&V
- peak pain day 3
D. Drive
- No public transport on day
E. Work
- 2 weeks off school
Station 1: CCP
- What to talk about
Station 1: CCP
- What to talk about
- Identify need
- recent admission
- short-term needs
- long-term needs - Care planning
- Explain
- Short term
- Long term
- Preferences - Patient-centered
- Establish wishes
- Reflect clearly - Holistic
- Health
- Social
- Available services
- Family
- Voluntary
Station 1: ACP
- When to use DOLS
- Principle for DOLS
- Oversight authority
- Length
Station 1: ACP
- When to use DOLS
1. Lack’s capacity for aspect of care
2. Continuous supervision in restricted space
3. State involvement in care - Principle for DOLS
1. Avoid DOLS
2. Proportionate response to likelihood of harm - Oversight authority
1. Local authority (supervisory body) - Mental disorder
- Mental capacity
- Best interests
- Hospital/care home (managing authority)
- Lack capacity
- Least restrictive, best interests
- Length
1. Urgent 7 days
Station 1:
CGA Components
Station 1:
CGA Components
- MDT Assessment
- Problem list
- Physical
- Cognitive
- Affective/spiritual
- Social/financial/environmental - Solution list
Multimorbidity
- Must hits
Multimorbidity
- Must hits
- Missing PMH, DH, Allergy, SH
- ICE
- Shared decision making
Care planning Vs ACP
Care planning Vs ACP
- ACP is legally binding when still has capacity
- ACP has three components
- Advanced statements (preferences)
- ADRT (Legal)
- LPA (Legal OPG)
Identifying palliative patients
- Three triggers
Identifying palliative patients
- Three triggers
- ‘Surprise’ question
- Patient choice
- Prognostic indicators
-phenotypes
- eg. GSF PIG (Gold standards framework: Proactive Identification Guidance)
Average GP deaths
- Pie pieces
Average GP deaths
- Pie pieces
- 8 frailty
- 5-6 organ failure
Eh. NYHA 3 or 4 - 5 Cancer
- Sudden expected deaths
Frailty assessments
- Two theories
Frailty
- Summary
- Cumulative deficits (EFI)
- Phenotype (CFS)
CFS 1-3 are not frail. 4 is pre-frail
5Is (6Is)
- Of frailty
6Is of frailty
- Instability
- Immobility
- Intellectual impairment
- Incontinence
- Inadequate oral intake
- Iatrogenisis (polypharmacy)
Dementia under delirium
- Proportion
Dementia under delirium
- Proportion
70% of delirium has a dementia
CAM4
- Delirium criteria
CAM4
- Delirium criteria
- Acute onset/disorganised
- Inattention
- Disorganised thinking
- Altered level of consciousness
Severe frailty
- Clear question
Severe frailty 7+
- Clear question
- Wipe your bum test
5 disability pathways to death
5 disability pathways to death
- No disability
- Progressive severe disability
- Disability
- Accelerated disability
- Catastrophic disability
ACP
- REDMAP Framework
ACP
- REDMAP Framework
- Ready
- Expect
- Diagnosis
- Matters
- Action
- Plan
