Teaching/Advice

Question 1

What are the typical types of scenarios for OSCE teaching?

Answer 1

Guide the junior doctor (role player) through the correct interpretation of the patient’s (ECG/XR/blood test).

Teach an approach to (ECG/XR/blood test) interpretation in the specific clinical setting.

Explain to the junior doctor how they should assess the patient.

Outline an approach to ongoing management of the patient.

Demonstrate / teach a procedure (possibly using equipment provided).

Answer any questions asked by the junior doctor.

Teach the registrar how to resuscitate a …(e.g. newborn).

Question 2

What are some tips for teaching juniors in the OSCE?

Answer 2

• First establish the junior doctor’s baseline knowledge, use a mix of closed and open ended questions, check learning needs and adapt to this
• Outline a plan for the teaching session/topics to be covered
• Listen and check understanding throughout
• Be patience and tolerant with the learner
• Correct misconceptions, reinforce correct knowledge
• Specific and relevant depth and breadth of knowledge imparted
• Summarise important take home points at the end
• Answer questions throughout
• At the end of the OSCE, the candidate should recommend that the RMO reflect on the case and follow up with further reading (post experiential reflection and learning)

SETTUP
S- Set the scene
E- Establish prior experience
T- Talk through the procedure
T- Tips and tricks
U- Undertake procedure
P- Post procedure feedback

Question 3

What is a good way to explain the different causes of hyponatraemia to a junior?

Answer 3

• SIADH needs to be discussed (hypotonic, euvolaemic, urine Na+ >20 and urine mOsm >100, no other obvious cause)
• Reasonable differentials ie endocrine, psychogenic, central, drugs, cancer, pneumonia, hyperglycaemia/hyperlipidaemia etc

Tests: Urine Na+ and osmolarity, consider serum osmolarity, FBE/UEC/LFT’s, TFTs, cortisol level, CXR +/- CTB

Question 4

What should be considered when making a differential diagnosis list?

Answer 4

For each of the top 4-5 diagnoses come with discriminators

key symptoms
- ie intussuception is cyclical severe abdominal pain
- Aortic dissection is sudden onset severe ripping/tearing pain

Key risk factor
- Age, smoking, HTN, diabetes etc

Key exam finding
- Setting sun sign in infants with raised ICP

Key investigation
- VBG with hypokalaemic and hypochloraemic metabolic alkalosis for pyloric stenosis

Empiric treatment
- Ie appropriate antibiotics if sepsis or specific organism high up on differential list (20mg/kg IV aciclovir for HSV encepahlitis)