Family medicine OSCE preparation

1. TIPS TO HELP YOU
PREPARE FOR THE
FAMILY MEDICINE
OSCE

2. THE FORMAT
There will be 5 stations total
 2 patients with undifferentiated acute complaints from the list of 16 on the clerkship website
under OSCE Preparation
 1 patient with a chronic illness from the list of 8 on the clerkship website under OSCE
Preparation
 2 patients with a need for patient education only
Do a focused physical examforthe chronic case and the 2 acute cases.
Patient education cases do not need a physical exam.
In orderto standardize physical examfindings, you will be provided with the
full physical examduring the post encounterportion of the exam.
Use the physical exam results you are given afterthe encounterto create a
differential and plan.
If a sensitive examis indicated (breast exam, rectal exam) please let the
patient know you would like to do that exam and then the results will be
outside the room.
You will have 40 minutes forthe chronic case and the 2 acute cases. This
includes time in the roomwith the patient and time forfollow up writing
assignments. You will have only 17 minutes perpatient education station
because there is NOwrite-up forthese stations
 Bring a watch to help you better keep track of time
You will be provided blankpaperto take notes on. No otherstudy aides
allowed in room
Bring yourstethoscope and wearyourwhite coat.
 Other diagnostic equipment will be provided but you can bring your own if you wish

3. THE PATIENTS WITH ACUTE COMPLAINTS
OVERVIEW
Summary of task: This station focuses on your ability to develop a
differential and management plan for an undifferentiated complaint
based on your history and physical exam.
Obtain a focused history and physical exam relevant to the patient’s
acute complaint. Note that you are not expected to share your
differential & management plan with patient. Leave sufficient time to do
this during your written task.
You have 40 minutes to complete the case. Suggested times given
below are only a guide but leave enough time for the written portion
after seeing patient.
Student enters the room at signal. The following announcements will
guide your time management: “15 minutes remaining, 10 minutes
remaining, 5 minutes remaining, you must now leave the room.
All students will be required to leave the patient roomwhen there are
5 minutes left in the exam.

4. THE PATIENTS WITH ACUTE COMPLAINTS
SUGGESTED TIME MANAGEMENT
Review the patient's chart (Approximately 5 minutes)
When you are ready, click “start encounter” on the computer screen and enter the room
Time with patient (Approximately 20 minutes)
Take a problem focused history on the patient’s presenting problem.
Perform a problem-focused physical exam relevant to the patient’s presenting problem.
Exit the patient's room. On the computer screen, click “stop encounter.”
Written tasks following the patient encounter (Approximately 15 minutes)
Follow the instructions on the screen. You will document
 A problem focused HPI, including pertinent PMH/SH/FH/ROS (no need to include PE findings)
 A relevant differential for the patient’s presenting problem
 Your plan for any further workup of patient.
 A plan for treatment over the next few days
 Instructions as to when the patient should follow up
 Any relevant prevention issues that should be discussed with this patient

5. THE PATIENTS WITH ACUTE COMPLAINTS
DETAILS ON WRITTEN TASK
These will be the exact questions you will be asked on the OSCE
Written Task 1 - History
Document the subjective portion of a SOAP note (a problem focused HPI,
including pertinent PMH/SH/FH/ROS). The note should contain relevant
positives and negatives. The no te sho uld be brie f. Yo u do no t ne e d to use
co m ple te se nte nce s.
Written Task 2 - Differential
Based on history obtained from patient and physical exam findings given to you
by the patient, list the five most important diagnoses that should be considered
in this patient. Include tho se thing s that are co m m o n but also tho se that are
le ss co m m o n but se rio us. Do no t include the rare and unlike ly.

6. THE PATIENTS WITH ACUTE COMPLAINTS
DETAILS ON WRITTEN TASK
These will be the exact questions you will be asked on the OSCE
Written Task 3 - Evaluation
What labs or studies do you want to order to help clarify what is going
on with this patient? Be judicio us abo ut what furthe r e valuatio n yo u
o rde r as such studie s willno t o nly add to the co st o f care but can also
le ad to false po sitive s. The re are tim e s whe n no furthe r studie s are
ne e de d. The re are o the r tim e s whe n furthe r studie s are e sse ntial.
Written Task 4- Management
What management plan would you suggest for this patient at this time?
You do not yet know the results of any tests you ordered. Include what
furthe r te st and studie s yo u want to o rde r, ho w yo u willtre at the patie nt
(m e dicatio ns and/o r no n pharm ace uticalinte rve ntio ns) and whe n and
whe re yo u want the patie nt to fo llo w up. If yo u o rde re d a te st that wo uld
chang e the m anag e m e nt plan, write the variatio ns o f the tre atm e nt plan
base d o n the diffe re nt re sults yo u m ig ht g e t back.

7. THE PATIENTS WITH ACUTE COMPLAINTS
DETAILS ON WRITTEN TASK
These will be the exact questions you will be asked on the OSCE
Written Task 5- Prevention
Based on this patient's age, gender and history list TWO areas of
prevention that should be recommended to this patient at THIS VISIT.
List recommendations that have Grade A Evidence from the U.S.
Preventative Services Task Force. Do not list areas that are not due.
For example, this patient already had their blood pressure checked
today so do not list blood pressure screening. Do not repeat
recommendations madeaboveundermanagement. The are as o f
pre ve ntio n do no t ne e d to re late to the curre nt co m plaint.

8. THE PATIENTS WITH ACUTE COMPLAINTS
SAMPLE WRITE UP
Written Task 1 - History
Patient is a healthy 54 yr old woman with no chronic illnesses who presents with
generalized fatigue for 1 month. Felt well until that time. Fatigue has gradually worsened
over the last 4 weeks to the point that she has missed 2 days of work this week. Pt
describes fatigue as ‘feeling so tired I can’t get out of bed in the morning’. She is
sleeping well, at least 10-12 hours per night but doesn’t feel rested. Also notes that she
has been somewhat constipated on and off for the last few weeks. No blood in stools, no
chest pain, no shortness of breath, no lightheadedness. Both parents have passed away
in the past 6 months and was given clonazepam 2mg BID for anxiety by another
physician. Endorses decreased interest in activities, appetite is the same, no weight
changes. No SI/HI. No h/o depression
Written Task 2 - Differential
Medication side effect, Hypothyroidism, Anemia, Chronic Fatigue, Depression
Written Task 3 - Evaluation
PHQ -9, CBC, TSH
Written Task 4- Management
Would decrease clonazepam by half and monitor symptoms while we wait for the labs to
come back. Would teach stress relaxation techniques. Offer referral to counseling
services for grief counseling. Call patient with lab results and she will return for follow up
in 4 weeks or sooner if any worsening or new symptoms.
Written Task 5- Prevention
Pap smear (none on record x 5 yrs), Colon cancer screening

9. THE PATIENTS WITH CHRONIC ILLNESS
OVERVIEW
Summary of task: This station focuses on your ability to share
results with a patient and develop a management plan together
with the patient.
Obtain a focused history and physical exam assessing the
patient’s control and management of chronic illness. Develop a
management plan for patient and briefly discuss with patient.
This may include focused counseling, suggestions re medication
changes, and or recommended follow up. Leave sufficient time
to complete written task.
You have 40 minutes to complete the case. Suggested times
given below are only a guide
Student enters the room at signal. The following announcements
will guide your time management: “15 minutes remaining,10
minutes remaining, 5 minutes remaining, you must now leave
the room.
All Students will be required to leave the patient roomwhen
there are 5 minutes left in the exam.

10. THE PATIENTS WITH CHRONIC ILLNESS
SUGGESTED TIME MANAGEMENT
Review the patient's chart (Approximately 5 minutes)
When you are ready, click “start encounter” on the computer screen and enter the room
Time with patient (Approximately 25 minutes)
Share with patient recent test results what they mean for management of chronic condition.
Take a history of the patient’s symptoms (control and management)
Perform an focused exam for the patients chronic condition
Stay in the room and discuss with patient how to manage his condition and counsel on
behavior changes.
Apply the evidence based guidelines relevant to his particular situation
Exit the patient's room. On the computer screen, click “stop encounter.”
Written tasks following the patient encounter (Approximately 10 minutes)
Follow the instructions on the screen. You will document
 Focused note of patient chronic history (no need to include physical exam)
 A problem list
 A management plan for each of the patients problems on the problem list
 Any relevant prevention issues that should be discussed with this patient

11. THE PATIENTS WITH CHRONIC ILLNESS
DETAILS ON WRITTEN TASK
These will be the exact questions you will be asked on the OSCE
Written Task 1 - History
Document the subjective portion of a SOAP note. The note should document
relevant parts of chronic illness care, contain relevant positives and negatives
and describe relevant aspects of social context. The no te sho uld be brie f. Yo u
do no t ne e d to use co m ple te se nte nce s.
Written Task 2 – Problem List
Create a problem list based on this patient’s prior medical history and current
information.

12. THE PATIENTS WITH CHRONIC ILLNESS
DETAILS ON WRITTEN TASK
These will be the exact questions you will be asked on the OSCE
Written Task 3- Management
What management plan would you suggest for this patient at this time? You do
not yet know the results of any tests you ordered. Include what furthe r te st and
studie s yo u want to o rde r, ho w yo u willtre at the patie nt (m e dicatio ns and/o r
no n pharm ace uticalinte rve ntio ns) and whe n and whe re yo u want the patie nt to
fo llo w up. If yo u o rde re d a te st that wo uld chang e the m anag e m e nt plan, write
the variatio ns o f the tre atm e nt plan base d o n the diffe re nt re sults yo u m ig ht g e t
back.
Written Task 4- Prevention
Based on this patient's age, gender and history list TWO areas of prevention
that should be recommended to this patient at THIS VISIT. List
recommendations that have Grade A Evidence from the U.S. Preventative
Services Task Force. Do not list areas that are not due. For example, this
patient already had their blood pressure checked today so do not list blood
pressure screening. Do no t re pe at re co m m e ndatio ns m ade abo ve unde r
m anag e m e nt. The are as o f pre ve ntio n do no t ne e d to re late to the curre nt
co m plaint.

13. THE PATIENTS WITH CHRONIC ILLNESS
SAMPLE WRITE UP
Written Task 1 - History
Patient returns today for routine follow up of diabetes. He feels generally well and has no specific
questions or complaints today. He does not report any episodes of hypoglycemia. He has had no
chest pain, shortness of breath, vision complaints, pain/ numbness in his feet, or problems with sex.
He has been taking his Metformin as prescribed and not reporting any side effects. He does not
have problems with missed doses as he leaves his medication beside his toothbrush. He has been
able to avoid sweets but still snacks a lot. He has not increased the amount he exercises. He checks
his sugars once a day with values between 140-160 fasting. Still smoking but wants to quit.
Written Task 2 – Problem List
Diabetes. Tobacco Abuse, Health Literacy
Written Task 3- Management
DM- Patient with control slightly above goal. Long discussion about use of insulin. Patient would like to
focus further on diet and exercise modifications before making this step. Discussed better choices for
snacks. Will call friend and recruit as daily walking partner. No labs today as up to date. Continue
Metformin and recheck in one month. A1c at that time.
Tobacco Abuse – discussed strategies for cessation, trial patch, 1-800-QUIT-NOW # given
Health Literacy – literacy appropriate review of visit and education material provided to patient
Written Task 4- Prevention
Colonscopy (none on chart), Lipids.

14. THE PATIENT EDUCATION CASES
OVERVIEW
•Summary of task: This station focuses on your ability to communicate
medical information to a patient.
•You DO NOT need to perform a full history OR physical
•You have 17 minutes to complete the case. Suggested times given
below are only a guide
•Student enters the room at signal. The following
announcements will guide your time management: “5
minutes remaining, you must now leave the room”
• All Students will be required to leave the patient roomafter17
minutes
(this gives the patient time to complete their checklist)

15. THE PATIENT EDUCATION CASES
SUGGESTED TIME MANAGEMENT
Review the patient's chart (Approximately 1 minute)
When you are ready, click “start encounter” on the computer screen and enter
the room
Time with patient (Approximately 17 minutes)
Take a very focused history to identify the patient’s learning need
Stay in the room and provide patient education using written notes for the
patient as necessary
Exit the patient's room. On the computer screen, click “stop encounter.”
There is NO write up for these cases

16. ….AND FINALLY A WORD
ON GRADING
Simulated Patient evaluates whether you ask key questions
during interview
Simulated Patient evaluates whether you perform key
components of PE. Video recording of encounter allows
review of case if you disagree with grading
Clerkship director evaluates written portion of OSCE (if you
don’t write it down, I cannot give you credit!)
Reassurance and Suggestions:
 Remember there are many items so missing one or two will not
significantly affect your grade
 See next page for sample grade form. Mean of OSCE is generally in
mid 80s so there is no expectation that you will get every item correct

18. QUESTIONS?
Contact your campus clerkship director
or
Email clerkship director, Kelly
Bossenbroek Fedoriw at
kelly_fedoriw@med.unc.edu