Class of 2015 Year 3 Objective Structured Clinical Exam (OSCE)

1. Class of 2015Year 3 Objective Structured Clinical Exam(OSCE)

2. Class of 2014 Year 3 OSCE • OSCE • Facts • Process • Grading • Tips

3. OSCE Facts An OSCE is: • a performance-based exam in which you are observed demonstrating various clinical skills as you rotate through a series of stations. • an exam to evaluate the process by which you interact with patients.

4. OSCE Facts An OSCE: • evaluates your basic clinical skills • measures your minimal competencies • provides feedback on your performance • gives you an idea of what the NBOME COMLEX-PE will be like

5. OSCE Facts Confidentiality • You must adhere to the Honor Code. • After the OSCE, sign into E*Value and complete OSCE honor code course work. • You must not share information with others.

6. OSCE Facts • Videotaping • Your OSCE will be videotaped for the purpose of evaluation

7. OSCE Process: • Wear your white lab coat and OU-HCOM ID badge (bring these with you) over professional clothing • Put on arm bands (provided at the time of the exam) • Keep a pen and a stethoscope with you • Empty your pockets of everything except your stethoscope • No pocket guides • No cells or beepers • No drug guides • No ChapStick, tissues, etc. • Everything you need for the exam will be in the room

8. OSCE Process: Hallway Sequence • Determine your designated start room. You will stay in the same color sequence (pink, green, gold or white) for the entire exam. • No talking in the hallway, please!

9. OSCE Process: Hallway Sequence • If you are scheduled to start at Green Station 1 for your first “patient”, your second “patient” will be at Green 2, your 3rd “patient” at Green 3, your 4th “patient” at Green 4. • If you are scheduled to start at Pink Station 2 for your first “patient”, your 2nd “patient” will be at Pink 3, your 3rd “patient” at Pink 4, your 4th at Pink 1. • If you are scheduled to start at Gold Station 4, your 2nd “patient” will be at Gold 1, your 3rd “patient” at Gold 2, and your 4th “patient” at Gold 3. • Etc.

10. OSCE Process: Cases • There will be 4 cases using standardized patients (SPs). • SPs are required to stay in character • If you recognize an SP from a previous lab, please do not acknowledge this • One of the 4 stations will be a “formal” OMM case where you are expected to assess, diagnose, treat with OMM and reassess. • This year this is the back pain case – you must provide OMM to this “patient” • No HVLA techniques are allowed on any patients • NBOME does not have a formal OMM case. OPP should be considered in all cases during the COMLEX PE.

11. OSCE Process: Schedule • The OSCE will take approximately 2- 2.5 hours • You will have a total of 23 minutes for each station: • 14 minutes to complete the appropriate tasks for each station, and • 9 minutes for SOAP note writing

12. OSCE Process: Debriefing • The last component of the OSCE is a debriefing. • We value your feedback!

13. OSCE Process: Patient Encounter • Wait outside each room until you are instructed to begin. • When instructed to begin, you may pick up and read the chart. The chart contains instructions, a worksheet (to take notes), approved abbreviations, and relevant diagnostic information. • The instructions in each chart include: • the setting: outpatient, primary care, or ER • patient demographic information • vital signs • You may enter the room when you are ready; take the chart with you into the room. • A sample chart will be provided for you to review prior to the exam.

14. OSCE Process: Patient Encounter • Use your 14 minutes to evaluate and treat each “patient” as you see fit. • Do not pretend there is someone else in the room or that the patient has taken medication you prescribed in the past – don’t make things up! • No pelvic, rectal, GU, or breast exams are allowed on standardized patients. (You may document your intention to do so in SOAP note.)

15. OSCE Process: OMT • Use OMT as appropriate. • Develop a treatment plan in response to presented symptoms – there may be no physical findings. • When using OMT, be sure to: • Gently position the patient • Explain what you are doing • Limit the amount of time for OMT to 3-5 minutes • Complete all steps of the process, including reassessment • Remember: Do not use HVLA, but you may document in the SOAP note that you would like to include it in your treatment.

16. OSCE Process: Patient Encounter Timing Completing an encounter in the time allotted is difficult for most students. We suggest you practice timing the process. • Twelve minutes after the encounter begins, you will receive a two-minute warning. • Fourteen minutes after the encounter begins, you will be instructed to leave the room. • You must take the chart and your worksheet out of the room with you. • You may leave the room before instructed. However, if you do leave, you will not be able to re-enter.

17. OSCE Process: SOAP Note Timing • During the 9 minutes allowed for SOAP note writing: • Type your note into the computer at the desk outside the room. • Also type patient name, date and time, your name, OMS III. • After 7 minutes, you will hear an announcement indicating that two minutes remain. • After 9 minutes of SOAP note typing, you will be instructed to stop typing. • Leave the chart and worksheet on the desk and move to stand in front of the next station.

18. OSCE Process: SOAP Notes For the SOAP Note: • Use the “Worksheet” for jotting down pertinent information while in the room. • Include three, ranked, differential diagnoses (for at least 3 possible etiologies). • Use only the abbreviations provided in the chart. • Be concise but thorough.

19. OSCE Process: SOAP Notes Please be aware that according to NBOME: • “…falsification of the medical record (written SOAP Notes) in COMLEX-USA Level 2-PE by documenting medical history that was not elicited, or physical examination maneuvers that were not performed, is considered irregular behavior and will be thoroughly investigated and dealt with as specified in NBOME’s Bulletin of Information.” • “Irregular conduct” will appear on the score report and transcript. • More than 16 students to date have received failing scores for this infraction. • NBOME checks/compares SOAP notes with videotapes.

20. OSCE Process: SOAP Notes • Sample SOAP notes are posted on OSCE web page. • Use abbreviations that are not on the list provided in each chart “at your own risk”.

21. OSCE Process This entire process is repeated three times.

22. OSCE Process If you need assistance at any time during the exam, proctors will be available in the hallways to help you.

23. OSCE Grading • Successful completion of the year 3 OSCE is a requirement for OU-HCOM graduation. • You will receive a pass/fail grade. • You must earn at least a 70% in each of the skill sets in order to receive a passing grade. • If your original grade is not passing, your CORE Assistant Dean will develop a plan for remediation. When your remediation plan is completed, you will have met the OSCE requirements for graduation. • Grade sheets are available for your review on the OSCE web page.

24. OSCE Grading Pass • Score of 70% or above on each skill set *Fail(Failure ratings are given based on any of the following): • Illogical sequencing • Deficient knowledge base • Lack of ability to focus • Interpersonal skills deficits • Unprofessional behavior

25. OSCE Grading • Checklists will be used by standardized patients (SP) to document student performance. • Checklists will be used by physicians to evaluate both OMM performance and SOAP note quality.

26. OSCE Grading SP documentation checklists include: • History-taking skills • Did you ask the appropriate questions? • Physical exam skills • Did you perform the appropriate exams? • Professionalism • Did you interact with the patient appropriately?

27. OSCE Grading: Standardized Patients Documentation of professionalism includes: • organization • courtesy • compassion • empathy • listening skills • eye contact • respect • the language you use • demeanor • dress • hand washing • drape appropriately • whether or not the standardized patient would select the examinee as their personal physician.

28. OSCE Grading: Physicians SOAP notes and OMM techniques will be evaluated by: • Dr. Batchelor • Dr. Kuttner-Sands • Dr. Cech • Dr. L. Tomc • Dr. Broecker • Dr. Bertuna • Dr. Rutter • Dr. Soroka • Dr. Walkowski • Dr. Regan • Dr. Ramey

29. OSCE Grading: OMM Physicians will be checking the videotape of your OMM encounter for: • Assessment Skills • Demonstration of OMM technique • Explanation of OMM technique • Communication with patient • Reassessment Skills • Professional behavior

30. OSCE Grading: SOAP Notes Physicians will be checking your SOAP notes for: • Subjective findings • Objective findings • Assessment (3 differential diagnoses) • Plan • Organization • Verification with videotaped content

31. OSCE Grading • Results will be available in approximately one month • Your CORE Assistant Dean will review the results with you.

32. OSCE Tips • Wash your hands as soon as you enter the room, before you touch or shake hands with the patient.

33. OSCE Tips When auscultating, listen on the patient’s skin.

34. OSCE Tips • Pace yourself. • Read the doorway instructions and take them at face value to be correct. • There is no need to repeat vital signs. • Introduce yourself as “Student Doctor + Your Last Name”. • Treat each patient with respect. • Communicate in clear lay terminology.

35. OSCE Tips • Ask one question at a time and let the patient answer that question before you ask the next one. • Elicit appropriate history. • psychosocial • occupational • medical/surgical • Elicit current medications and allergies.

36. OSCE Tips • Use the patient’s history to guide the scope of your focused examination. A complete exam is not required. • Do not turn off the lights if you examine a patient’s eyes (if you turn off the lights, we cannot see the videotape!). • Explain to the patient what you are going to do before you do it; ask the patient’s permission to perform examination.

37. OSCE Tips • Drape the patient appropriately. • Be sure you have considered osteopathic principles in all cases. • You may want to go to the restroom before the OSCE starts.

38. Thank you for your cooperation and good luck!