OSCE Pediatrics Observed Stations Dr.D.Y.Patil Medical College CME

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OSCE Pediatrics CME, Observed Stations. August 2012, Dr.D.Y.Patil Medical College.

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OSCE Pediatrics Observed Stations Dr.D.Y.Patil Medical College CME

  1. 1. OSCE : Observed Stations Dr Sandeep Kavade Consultant, Vatsalya Children’s Hospital Bhosari
  2. 2. OBSERVED STATION OBSERVED STATION OBSERVED STATION OBSERVED REST STATION STATION REST STATIONSTATION 1 OBSERVED REST STATION STATION
  3. 3. Clinical Photo Blank OSCE SheetsX RayClinical ScenarioECGABGKaryotypeBiostatistics
  4. 4. Stay calmFocusedDon’t spend time mugging things on the last dayOSCE is an skill assessment of your entire postgraduation
  5. 5. Things to carry for OSCEA professional outfitA good apronA stethoscopeRoll No card2 pensLast but not the leastA cool, calm mind
  6. 6. 5 minutes are more than enough (usually)Spots designed with around a 3 – 4 minute time frameWriting never takes more than 2 minutesCertain stations like statistics may be time-consuming
  7. 7. First few OSCEsLife comes in a circleSome students get 3 simple OSCEs, some 3 impossibleonesSome will start on a rest stationDon’t decide your fate on the first OSCEOSCE goes in a circle too
  8. 8. Read the question CORRECTLY See what the question says Example: ECG of SVT followed by question, name the drug treatment of above condition, please see DRUG. Do not mention vagal maneuvers / DC conversion over here
  9. 9. We had a OSCE question where we had to take theheight of a child and plot it in the growth chart.Simple isnt itThere were 4 children of different age groupsExaminer randomly sent any one to each student
  10. 10. TrickWe had to remember to ask the name of the child andwrite on space provided on growth chartAlso had to attach growth chart to answer sheet andthen give it back
  11. 11. NRP question about 18 hrs old baby found apneic inwardIt is 18 hrs old…do not ask the 4 standard questions
  12. 12. At a station for taking child’s length withinfantometer a nursing assistant was standing incornerMost students tried to do it on their ownAssistance was provided to only those who asked.
  13. 13. Getting the diagnosis or identification of a spot rightis very crucialEven if you get other answers correct, no marks areawarded.
  14. 14. Go with your gut instinctDo not diagnose or identify slides with the questionsMany questions have false hints
  15. 15. Observed stations are fixed (more or less) History taking Clinical examination Counseling Indices calculation or some procedure or Development examination NALS/PALS/Spirometry/ Rotahaler/Spacer use etc……
  16. 16. CounselingIntroduction and ask about the languageWhen diagnosed, is it confirmedRemove the guilt of parents (no one to blame)Treatment (If available or not for cure) If not supportive therapyTreatment of disease complications and theirComplications
  17. 17. CounselingCompliance with TreatmentAntenatal counselingRecurrence RiskSupport GroupThanks! All the best, do you want to ask any question
  18. 18. Always ask languageNo medical jargonGive optionsNever force a decision
  19. 19. COUNSELING24 yr old lady diagnosed as HIV + at 36 weeks of gestation.Counsel regarding perinatal transmission and follow up.
  20. 20. 1. Ensures the presence of husband 0.52. Introduces self/ puts the couple at ease. 0.53. Explains the disease in simple words 0.54. Explains the incidence and modes of perinatal transmission 20-30% 0.5 Prenatal 0.5 Intranatal 0.5 Breast feeding 0.5
  21. 21. 5. Explains modalities of reducing rate of transmission ART to mother and child 1.0 LSCS Vs Vaginal delivery 1.0 Breast feeding Vs top feeding 1.06. Explains effect of measures – reduction by 50% 1.07. Explains screening of the infant 0.58. Explains safety of cuddling, petting and kissing 1.09. Asks for queries if any. 0.510. Advises to report back if any problems. 0.5 (Total marks 10.0)
  22. 22. COUNSEL THE MOTHER OF A DOWN’S SYNDROME
  23. 23. IntroductionAsking for what she knows about the child’s condition.Telling common problems of downs to watch forEducation and vaccination of present affected child.Inheritance & Possibility in next childAntenatal testing in next pregnancyAsk for and clarifying doubtsThank the mother.
  24. 24. Advise the mother of a child with simple febrileseizures
  25. 25. Greeting the motherIntroduce yourselfAsking the mother what she knows about her child’sillness.Explaining what is simple febrile seizureManagement plan and side effects of drugs usedPrognosisAvoiding technical jargonAsking for any more doubts and clarifying them.
  26. 26. History takingIntroductionRemove the stressMain symptomsOnset, progression, severity? Similar problem in pastNegative history for D/dSibling/Family historyDrug historyPerinatal history, if impSocial /Environmental history if impThanks
  27. 27. A 2 yr old child presents to emergency departmentwith severe pallor. Take the history of the child frommother.
  28. 28. Introduces himself and tries to make the mother comfortable0.5 marks Asks onset sudden or gradual 1 markhistory of bleeding or bluish spots 1 markHistory of associated symptoms : fever, failure to thrive 1 markRecurrent blood transfusions 1 markhistory of associated jaundice 1 markhistory of worm infestation 0.5 markbirth history 0.5 markcommunity and religion and history of consanguinity 1 markdietary history 1 markfamily history 0.5 markdrug history 1 mark
  29. 29. Take history of a 8 year old child with past history ofrepeated cough, breathlessness, not associated withfever?
  30. 30. Identify patientIntroduce yourselfAsk Duration & frequency of symptomsWith expectoration?Allergic history?-rhinitis, urticaria Association with exertionDiurnal variation?
  31. 31. Seasonal variation?H/o growth, weight gainH/o asthma, cough, allergies in family.H/ TB contactInvestigation historyTreatment History
  32. 32. ProceduresAlways remember to wash handsInformed consentCheck instruments providedShow the exact techniqueCollection of specimenAdvise regarding post procedure observationDisposal of wasteThanks
  33. 33. ELICITING KNEE JERK
  34. 34. Greeting the patient and self introductionTaking consent and explaining the procedure.Adequate exposureProper position of the patient (supine) and the doctorProper technique (Keeping the hand under the knee andstriking the patellar tendon midway between its origin andinsertion).Looking for quadriceps contraction.Grading the reflexThanking the patient.
  35. 35. EXAMINATION OF B.P IN A 10 YEAR OLD
  36. 36. Rapport with patient and BystanderChoice of cuff sizePositioning of the patientSite of tubing in relation to artery is correct?Initial palpation, then auscultation methodRate of deflation is correctTo say if reading is normal or otherwiseThanking patient and bystander
  37. 37. Examination of Head Circumference
  38. 38. Introducing oneself and establishing rapportTo explain the procedurePositioning on right hand side of the patient.Inspection for skull abnormalities.Head circumference to be measured with fibre glass tape.Tape should encircle over the most prominent point on theocciput and supra orbital frontal ridge.Ends of the tape should overlap and intersecting value to betaken.Accurate reading and plotting on the growth chart, if available.
  39. 39. Examination of Height of a 7yr old child byStadiometer
  40. 40. Introducing oneself and take consentExplaining the procedureExamining from right hand side of the patientMake the child stand against scale bare feet.Feet together parallel with heel, buttocks, shoulders and occiputtouching the rod.Ask to look straight head erect with chin up. Frankfurt plane andbiauricular plane being horizontalScale brought to touch the vertex, pressing the hair.Accurate reading and plotting on the growth chart, if available.
  41. 41. Do Motor system examination of the child
  42. 42. Introduces. ½Explain to parents & consent ½Warms hand before examination ½Posture / tone ½Nutrition ( wasting etc.) ½Power : fingers / wrist / elbow / shoulder in all move. ( 0.5*4=2) 2Power : hip / knee / ankle / 1½Deep reflexes : AJ /KJ /BJ /TJ / BR.JERK ( 0.5 *5) 2½PERSISTENT NEONATAL REFLEX (if infant) ½Abnormal reflex ( jaw jerk) ½Gait ½Thanks the Mother ½ TOTAL 10
  43. 43. Administer HIB Vaccine to this 4 month old child whois otherwise normal.
  44. 44. Introduces. ½Explain to parents about vaccine / cost / side effect 1Wash Hands ½Take 2 ml syringe and needle to withdraw diluent and Mix it with the ½lyophilised PowderChanges the needle ½Identify the site. Anterolat Thigh middle 1/3 ½Correct needle ½ inch ( IM) ½Clean the site ½Correct direction ( vertical) .. ½Withdraw and press at the Inj Site ½Post procedure advise to mother ½Instructions to wait 20 min and inform on case of problem ½When to come for the next dose ½BIOWASTE DISPOSAL 1Thanks the Mother ½ TOTAL 10
  45. 45. Examine the Abdomen of this child.
  46. 46. Introduces. ½Explains to child what exactly has to be done 1Warms hand before examination ½Inspection: shape ½Scar / sinus veins /umbilicus ½GENITALS / Hernia ½Palpation: Liver / spleen…superficial and deep ½Bimanual Palpation ½Percussion: all quadrant ½Shifting dullness / coin test ½Auscultation for 1 min : for peristalsis and Bruit ½ TOTAL 6
  47. 47. Do not ask examiner any question Except the NRP station
  48. 48. Rest at the rest station
  49. 49. http://groups.yahoo.com/group/PediatricsDNB/Theory: http://dnbpediatricstheory.blogspot.in/OSCE: http://oscepediatrics.blogspot.in/Clinical: http://clinicalpediatrics.blogspot.in/Practicals: http://practicalpediatrics.blogspot.in/Download at: http://www.4shared.com/folder/t8E_yjDv/_online.html

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