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Idea of OSCE in obstetrics in breif

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Undergraduate course lectures in obstetrics and gynecology prepared by DR Manal Behery,Faculty of Medicine,Zagazig University

Undergraduate course lectures in obstetrics and gynecology prepared by DR Manal Behery,Faculty of Medicine,Zagazig University


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  • 1. Idea of “OSCE” in obstetrics inbriefDr. Manal beheryAssistant professorZagazig university2013
  • 2. OSCEO : OBJECTIVES : STRUCTUREDC : CLINICALE : EXAMINATION
  • 3. Means fair and without bias. Most examination in the worldare not fair. Use of checklist ensures objectivity.Rather than subjective, which is where the examinersdecide whether or not the candidate fails based on theirsubjective assessment of their skills.Objective
  • 4. Refer to the organization of the examinationThe OSCE is carefully structured to include parts from allelements of the curriculum as well as a wide range of skills.Instructions are carefully written to ensure that thecandidate 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 arecompetent to handle patients.the candidate is only asked questions that are on themark sheet and if the candidate is asked any others thenthere will be no marks for them.Clinical exam
  • 6. Objective Structured Clinical ExaminationOROver Stimulation and Crying EventOROpportunity for Showing your Competenceand ExcellenceOSCE ?
  • 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 … littleagreement between examinersSome easy patients .. some hard onesSome co-operative patients … some notNot a test of communication skillsLong 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 testWith OSCE
  • 11. OSCEs – reliableLess dependent on examiner’s foibles (as there arelots of examiners)Less dependent on patient’s foibles (as there are lotsof patients)Structured markingMore stations … more reliableWider sampling – clinical, communication skills
  • 12. OSCEs – validContent validity – how well sampling of skillsmatches the learning outcomes of the courseConstruct validity – people who performed well onthis test have better skills than those who did notperform wellLength of station should be “authentic”
  • 13. 13OSCE performanceLucky?Nervous?Confident?Uncertain?Competent?Practised?Understood?
  • 14. OSCEperformance?
  • 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 – acceptabilityPerceived fairness – examiners andexamineesBecome widespread
  • 17. OSCE design - blueprintingMap assessment to curriculumAdequate samplingFeasibility – real patients, actors. manikins
  • 18. 1- Uniform scenarios for all candidates2. Availability3. Safety, no danger of injury to patients4. No risk of litigation5. Feedback from Actors (simulators)6. Allows for Recall7. Stations can be tailored to level of skills to beassessed8. Allows for teaching audit9. Allows for demonstration of emergency skillsAdvantage of OSCE
  • 19. 1- Organizational training2. The idealized ‘textbook’ scenarios may not mimicreal-life situations3. ExpensiveDisadvantage 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 guidesCore 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 stationswith short breaks between stationsThe exam is made up of 10 minute couplet stations and10 minute history or physical stationsCouplet stations consist of a 5 minute clinical encounterfollowed 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 historytaking or physical examination stations.There is usually a oral question asked bythe 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 ofheadacheThis station is to test your ability to take relevanthistory in the next 5 minutesAt the next station, you will be asked to answerquestions about this patient.
  • 24. Grade Failure BorderlinePassMarks 0 0.25 0.51. Age of patient2. Duration of symptoms3. Location of headache4. Respond to simple analgesics ( pain killers)5. Nausea or vomiting6. Blurred vision7. Swelling of hands, feet and face8. Pain in upper abdomen ( epigastric)9. Previous pregnancies (i.e. obstetric history)10. Relevant Past medical history
  • 25. Couplet History TakingExaminer 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 GynecologyHistory ObstetricH/RDiagnosis oflabourHistory ofGynecologyPhysical ObstetricManeuversProgress inlabourPost natalevaluation( normaland CS)DeliveryrelevantcomplicationsTests/investigations/proceduresBPPRoutine ANtestsCTGInstrumentsTests incomplicationsResuscitation ofNewbornInstrumentsSpecificinvestigationsDatainterpretationCTGGTTPETPartogram Postnataltests:Rubella. RHHSGSemen testHormoneprofileCommunication andeducationNutritionExerciseBreastfeedingContraception
  • 27. Antenatal Labor Postnatal Newborn GynecologyHistory ObstetricH/RDiagnosis oflabourHistory ofGynecologyPhysical ObstetricManeuversProgress inlabourPost natalevaluation( normaland CS)DeliveryrelevantcomplicationsTests/investigations/proceduresBPPRoutine ANtestsCTGInstrumentsTests incomplicationsResuscitation ofNewbornInstrumentsSpecificinvestigationsDatainterpretationCTGGTTPETPartogram Postnataltests:Rubella. RHHSGSemen testHormoneprofileCommunication andeducationNutritionExerciseBreastfeedingContraception
  • 28. Antenatal Labor Postnatal Newborn GynecologyHistory ObstetricH/RDiagnosis oflabourHistory ofGynecologyPhysical ObstetricManeuversProgress inlabourPost natalevaluation( normaland CS)DeliveryrelevantcomplicationsTests/investigations/proceduresBPPRoutine ANtestsCTGInstrumentsTests incomplicationsResuscitation ofNewbornInstrumentsSpecificinvestigationsDatainterpretationCTGGTTPETPartogram Postnataltests:Rubella. RHHSGSemen testHormoneprofileCommunication andeducationNutritionExerciseBreastfeedingContraception
  • 29. Antenatal Labor Postnatal Newborn GynecologyHistory ObstetricH/RDiagnosis oflabourHistory ofGynecologyPhysical ObstetricManeuversProgress inlabourPost natalevaluation( normaland CS)DeliveryrelevantcomplicationsTests/investigations/proceduresBPPRoutine ANtestsCTGInstrumentsTests incomplicationsResuscitation ofNewbornInstrumentsSpecificinvestigationsDatainterpretationCTGGTTPETPartogram Postnataltests:Rubella. RHHSGSemen testHormoneprofileCommunication andeducationNutritionExerciseBreastfeedingContraception
  • 30. Antenatal Labor Postnatal Newborn GynecologyHistory ObstetricH/RDiagnosis oflabourHistory ofGynecologyPhysical ObstetricManeuversProgress inlabourPost natalevaluation( normaland CS)DeliveryrelevantcomplicationsTests/investigations/proceduresBPPRoutine ANtestsCTGInstrumentsTests incomplicationsResuscitation ofNewbornInstrumentsSpecificinvestigationsDatainterpretationCTGGTTPETPartogram Postnataltests:Rubella. RHHSGSemen testHormoneprofileCommunication andeducationNutritionExerciseBreastfeedingContraception
  • 31. Couplet PhysicalExaminationWhat the candidate readsCandidate’s InstructionsTM, 31 years old, 33wks ,has been brought to youroffice with a history of PROMIn the next 5 minutes, conduct a focused and relevantphysical examination.As you proceed, explain to the examiner what youare doing and describe any findings.At the next station, you will be asked to answerquestions about this patient.
  • 32. Couplet PhysicalExaminationDid 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- ExcellentUnsatisfactory - Borderline- Poor- InferiorInadequate medical knowledge and/or provided misinformationCould not focus in on this patients problemDemonstrated poor communication and/or interpersonal skillsActions taken may harm this patientActions taken may be imminently dangerous to this patientOther
  • 33. Data interpretationA 38 years old patient, Gravida 8 para 6+1.Her previous delivery ended by cesareansection due to failure to progress.She is now around 28 weeksHer family doctor have ordered a GTT andshe brought the result for you for advise
  • 34. Instruction for the Simulated Patient(Examiner)Doctor can you tell me is my GTT resultnormal or not?Is there any danger (complications) for mefrom this condition?Is there any risk for my baby?
  • 35. Item MarkWell Average NDInterpretation of test (Positive for GDM) 2 1Risks to the patientIncreased risk of high BP (PET) 1 ½Increased rate of infection (urinary/vaginal) 1 ½Risks to the fetusPolyhydramnios 1 ½Macrosomia 1 ½Operative / Difficult delivery 1 ½RDS 1 ½Neonatal Jaundice 1 ½Other metabolic disorders 1 ½Total
  • 36. Item MarkWell Average NDInterpretation of test (Positive for GDM) 2 1Risks to the patientIncreased risk of high BP (PET) 1 ½Increased rate of infection (urinary/vaginal) 1 ½Risks to the fetusPolyhydramnios 1 ½Macrosomia 1 ½Operative / Difficult delivery 1 ½RDS 1 ½Neonatal Jaundice 1 ½Other metabolic disorders 1 ½Total
  • 37. Item MarkWell Average NDInterpretation of test (Positive for GDM) 2 1Risks to the patientIncreased risk of high BP (PET) 1 ½Increased rate of infection (urinary/vaginal) 1 ½Risks to the fetusPolyhydramnios 1 ½Macrosomia 1 ½Operative / Difficult delivery 1 ½RDS 1 ½Neonatal Jaundice 1 ½Other metabolic disorders 1 ½Total
  • 38. Data Interpretation28 years old Gravida 10 Para 9+0, at 13weeks of gestation came to the cliniccomplaining of: Palpitation and shortness ofbreath.A complete blood count (CBC) test wasperformed.You are require to interpret the result of theCBC
  • 39. Item MarkWell Average NDWhat does the result of this test shows?(Examiner to show CBC form)Low hemoglobin (anemia) 1 1/2What type of anemiaHypochromic microcytic 2 1Can it be confused with other type of anemia?Thalassanemia and 1 1/2Sickle cell anemia 1 1/2How would you confirm?Hemoglobin electrophoresis 1 ½Sickle cell test 1 ½What do you think of this result?(Examiner to show the result of the electrophoresis)Confirm Iron deficiency anemia 3 2Total
  • 40. Postnatal ExaminationYou are the house officer in the ward and inthe morning round you came across thispatient who had delivered 24 hours ago.How would you assess her?
  • 41. Item MarkWell Average NDInitial approach to the patient (introduce him/her self, explain whathe/she will be doing)1 ½Mode of delivery 1 ½Delivery outcome (the baby) 1 ½Lochia / Bleeding 1 ½Bladder function 1 ½Perineum/excessive pain (episiotomy) 1 ½Check vital signs 1 ½Breast feeding 1 ½What important investigations you would like to review before dischargeCBC 1/2 1/4Blood Group (RH factor) 1/2 1/4Rubella test 1/2 1/4Hepatitis test 1/2 1/4Total:
  • 42. Item MarkWell Average NDInitial approach to the patient (introduce him/her self, explain whathe/she will be doing)1 ½Mode of delivery 1 ½Delivery outcome (the baby) 1 ½Lochia / Bleeding 1 ½Bladder function 1 ½Perineum/excessive pain (episiotomy) 1 ½Check vital signs 1 ½Breast feeding 1 ½What important investigations you would like to review before dischargeCBC 1/2 1/4Blood Group (RH factor) 1/2 1/4Rubella test 1/2 1/4Hepatitis test 1/2 1/4Total:
  • 43. Item MarkWell Average NDInitial approach to the patient (introduce him/her self, explainwhat he/she will be doing)1 ½Mode of delivery 1 ½Delivery outcome (the baby) 1 ½Lochia / Bleeding 1 ½Bladder function 1 ½Perineum/excessive pain (episiotomy) 1 ½Check vital signs 1 ½Breast feeding 1 ½What important investigations you would like to review before dischargeCBC 1/2 1/4Blood Group (RH factor) 1/2 1/4Rubella test 1/2 1/4Hepatitis test 1/2 1/4Total:
  • 44. During the morning round you came across a28 years old who has delivered 24 hours ago.She was found to run a temperature of 390c.How would you approach herMode of Delivery: SpontaneousOutcome: 3 Kg baby BoyHow is the baby: Well in the nurseryDuration of labour: 12 hoursAny history of SRM: Loss of fluid for 3 daysSymptoms of upper or lower respiratory tract infectionSymptoms of UTI (upper or lower)Amount, and nature of Lochia
  • 45. You were urgently called to the labourroom by the obstetric nurse. A patient whojust had her episiotomy sutured by yourcolleague has suddenly became pale anddrowsy with rather heavy vaginal bleedingWhat is the differential diagnosis of post-partumhemorrhage (mention 4)?What are the immediate measures that should betaken in this case?What is the most likely cause of this patientcollapse?How would you confirm This diagnosis
  • 46. What is the differential diagnosis of post-partum hemorrhage (mention 4)Uterine AtonyLacerations of the Genital tractUterine InversionDIC
  • 47. What are the immediate measuresthat should be taken in this case?(A) Air Way(B) Breathing(C) Maintain Circulation IV infusion
  • 48.  What is the most likely cause ofthis patient collapse?How would you confirm Thisdiagnosis?Uterine AtonyAbdominal Palpation for Uterine fundalheight and consistency
  • 49. An 18 years old primigravida presentedto the emergency room in labourWhat important informations you wantto know about this case?How would you confirm the patientdiagnosis?
  • 50. What important informations you wantto know about this case?Is she booked or notHow many weeks is she now ( LMP)Is there any known medical problem?Yes38 weeksNo
  • 51. How would you confirm thepatient diagnosis?Symptoms:o Character of the pain: regular in pattern,increase in frequency and intensity.Signs:o Show.o Cervical Changes: effacement and dilatationo Loss of fluid per vaginum
  • 52. Common MistakesNot reading the question!Asking too many unfocused questions (shotgun)Not explaining what you are doing during physicalexamination stations Rectal, vaginal and inguinal exams not allowedBUT you will not be given credit unless youindicate that you would do them when appropriate.Talking too fast and too much – maintain professionalcourtesyTrying to guess what the station is about and notlistening to the patient
  • 53. THANKTHANKYOUTHANKYOU