OSCE Briefing notes for Students 2016

1. OSCE Briefing notes for Students 2016 Vinod Patel MD FRCP MRCGP DRCOG FHEA Principal Clinical Teaching Fellow Theme Lead for Clinical Skills

2. Assessment in the WMS MB ChB Course

3. Clinical Work Observed Miller’s Pyramid of Clinical Competency ACAT, CbD, CeX, Does OSLER Shows how OSCE Short Answer-Reasoning Knows how Written Exams Knows MCQ Miller GE (1990) Acad Med (Suppl)65 : S63

4. Objective Structured Clinical Examination Not: Organization for Security and Co-operation in Europe

5. General Characteristics of OSCE • Performance-based assessment • Samples a range of skills • All candidates perform the same tasks • Standardised marking scheme : checklists • Global Assessment by examiner

6. Full Clinical History OSCE: 10 mins

7. Full Clinical History OSCE: 10 mins

8. Introducing yourself • Checklist says: “Appropriate introduction to patient : greets the patient, states own name and role, checks patient’s name, states purpose of the interview, obtains consent. (Need all to score 1 mark.)” • Candidate : “Hi, I’m Jane, one of the medical students and I’ve been sent to talk to you.” • Do we award the mark?

9. Introducing yourself • “Hi” - Yes, it is a greeting but not effective or professional: hello, good morning, good afternoon. • “I’m Jane” – Friendly but full name probably more effective. • “One of the medical students” – Yes, has stated role. • “I’ve been sent to talk to you” – not effective as purpose of interview. “Talk to you” is non specific, could be about the weather, also gives an insight into motivation for being there, not out of interest but been told to do it. And: • No checking that the student is talking to the correct patient. • No attempt to gain consent. Do we award the mark?

10. Focussed Clinical History OSCE: 5 mins

11. Focussed Clinical History OSCE: 5 mins

12. Focussed Clinical History OSCE: 5 mins

13. Clinical History The 4 Frames If doing well consider a recap or summary

14. Clinical History The Warwick 4 Frames Consider recap or summary at end to patient to check information

15. Clinical History Process vs content

16. The 4 Point Presentation: History, Examination, signs, reports, ECGs, X-rays, General Findings O/E the patient was comfortable and well orientated Important Positive Findings My main findings were jaundice, anaemia and an enlarged liver that was hard and nodular Important “Negative” Findings However, there was no ascites or dilated veins on the abdomen Clinical Conclusion These findings would be consistent with cirrhosis of the liver or malignancy Helps with Clinical Decision Making

17. Examination Outline General Observations • End of Bed • Specific: BP, Pulse rate, Temp Introduction General Examination Hands, Pulse, Neck, tongue, lymph-nodes Systemic Examination CVS, RS, Abdo, CNS, other Clinical Conclusion

18. Handwashing

19. WMS Scoring Descriptors Adapted from the Leicester assessment Package: Fraser et al 2007 Stress on Patient Safety

20. Global Assessment: Do not add up the mark! This will depend on your professional judgement in relation to various aspects of competency such as timing, flow of examination, “feedback” from “patient” etc

21. Sequence of Examination

22. List of Potential Stations

23. The OSCE:Conclusions and Questions