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Idea of OSCE in obstetrics in brief

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Undergraduate course lectures in obstetrics &Gynecology .Faculty of medicine,Zagazig University .Prepared by DR Manal Behery – PowerPoint PPT presentation

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Title: Idea of OSCE in obstetrics in brief


1

Idea of OSCE in obstetrics in brief
Dr. Manal behery Assistant professor
Zagazig university 2013
2
OSCE
O OBJECTIVE S STRUCTURED C
CLINICAL E EXAMINATION
3
  • Means fair and without bias. Most examination in
    the world are not fair. Use of checklist ensures
    objectivity.
  • Rather than subjective, which is where the
    examiners decide whether or not the candidate
    fails based on their subjective assessment of
    their skills.

Objective
4
  • Refer to the organization of the examination
  • The OSCE is carefully structured to include parts
    from all elements of the curriculum as well as a
    wide range of skills.
  • Instructions are carefully written to ensure that
    the candidate 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 are competent to handle patients.
  • the candidate is only asked questions that are on
    the mark sheet and if the candidate is asked any
    others then there will be no marks for them.

Clinical exam
6
OSCE ?
  • Objective Structured Clinical Examination
  • OR
  • Over Stimulation and Crying Event
  • OR
  • Opportunity for Showing your Competence and
    Excellence

7
OSCE
  • Why OSCE?
  • WHAT DOES IT TEST ?
  • HOW TO RUN IT?

8
WHY OSCE ?
  • Increase validity and reliability
  • More certain mapping to curriculum
  • Better standard setting (pass score)
  • More fair?
  • More fun?

9
Long case
  • One hour with the patient
  • Full history and exam not observed
  • Examiner bias .... unstructured questioning
    little agreement between examiners
  • Some easy patients .. some hard ones
  • Some co-operative patients some not
  • Not a test of communication skills

10
With OSCE
  • 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 test

11
OSCEs reliable
  • Less dependent on examiners foibles (as there
    are lots of examiners)
  • Less dependent on patients foibles (as there are
    lots of patients)
  • Structured marking
  • More stations more reliable
  • Wider sampling clinical, communication skills

12
OSCEs valid
  • Content validity how well sampling of skills
    matches the learning outcomes of the course
  • Construct validity people who performed well on
    this test have better skills than those who did
    not perform well
  • Length of station should be authentic

13
OSCE performance
  • Lucky?
  • Nervous?
  • Confident?
  • Uncertain?
  • Competent?
  • Practised?
  • Understood?

14
OSCE performance?
15
What does it test ?
  • 1. History taking.
  • Factual knowledge.
  • 3. Interpretation of laboratory results and
    clinical data.
  • Ability to formulate dd.
  • 5. Counseling skills.
  • 6. Clinical problem solving.

16
OSCEs acceptability
  • Perceived fairness examiners and examinees
  • Become widespread

17
OSCE design - blueprinting
  • Map assessment to curriculum
  • Adequate sampling
  • Feasibility real patients, actors. manikins

18
1- Uniform scenarios for all candidates 2.
Availability 3. Safety, no danger of injury to
patients 4. No risk of litigation 5. Feedback
from Actors (simulators) 6. Allows for Recall 7.
Stations can be tailored to level of skills to be
assessed 8. Allows for teaching audit 9. Allows
for demonstration of emergency skills
Advantage of OSCE
19
Disadvantage of OSCE
1- Organizational training 2. The idealized
textbook scenarios may not mimic real-life
situations 3. Expensive
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 guides
  • Core 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
    stations with short breaks between stations
  • The exam is made up of 10 minute couplet stations
    and 10 minute history or physical stations
  • Couplet stations consist of a 5 minute clinical
    encounter followed 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 history taking or
    physical examination stations.
  • There is usually a oral question asked by the
    examiner at the 9 minute mark.

23
Couplet History Taking
  • This is a 5 minute station with 5 minute PEP
  • What the candidate reads
  • Candidates Instructions
  • Mrs. Fatma is 38 weeks pregnant lady complaining
    of headache
  • This station is to test your ability to take
    relevant history in the next 5 minutes
  • At the next station, you will be asked to answer
    questions about this patient.

24
Grade Failure Border line Pass
Marks 0 0.25 0.5
1. Age of patient
2. Duration of symptoms
3. Location of headache
4. Respond to simple analgesics ( pain killers)
5. Nausea or vomiting
6. Blurred vision
7. Swelling of hands, feet and face
8. Pain in upper abdomen ( epigastric)
9. Previous pregnancies (i.e. obstetric history)
10. Relevant Past medical history





25
Couplet History Taking
  • Examiner 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 Gynecology
History Obstetric H/R Diagnosis of labour History of Gynecology
Physical Obstetric Maneuvers Progress in labour Post natal evaluation ( normal and CS) Delivery relevant complications
Tests/investigations/procedures BPP Routine AN tests CTG Instruments Tests in complications Resuscitation of Newborn Instruments Specific investigations
Data interpretation CTG GTT PET Partogram Postnatal tests Rubella. RH HSG Semen test Hormone profile
Communication and education Nutrition Exercise Breast feeding Contraception
27
Antenatal Labor Postnatal Newborn Gynecology
History Obstetric H/R Diagnosis of labour History of Gynecology
Physical Obstetric Maneuvers Progress in labour Post natal evaluation ( normal and CS) Delivery relevant complications
Tests/investigations/procedures BPP Routine AN tests CTG Instruments Tests in complications Resuscitation of Newborn Instruments Specific investigations
Data interpretation CTG GTT PET Partogram Postnatal tests Rubella. RH HSG Semen test Hormone profile
Communication and education Nutrition Exercise Breast feeding Contraception
28
Antenatal Labor Postnatal Newborn Gynecology
History Obstetric H/R Diagnosis of labour History of Gynecology
Physical Obstetric Maneuvers Progress in labour Post natal evaluation ( normal and CS) Delivery relevant complications
Tests/investigations/procedures BPP Routine AN tests CTG Instruments Tests in complications Resuscitation of Newborn Instruments Specific investigations
Data interpretation CTG GTT PET Partogram Postnatal tests Rubella. RH HSG Semen test Hormone profile
Communication and education Nutrition Exercise Breast feeding Contraception
29
Antenatal Labor Postnatal Newborn Gynecology
History Obstetric H/R Diagnosis of labour History of Gynecology
Physical Obstetric Maneuvers Progress in labour Post natal evaluation ( normal and CS) Delivery relevant complications
Tests/investigations/procedures BPP Routine AN tests CTG Instruments Tests in complications Resuscitation of Newborn Instruments Specific investigations
Data interpretation CTG GTT PET Partogram Postnatal tests Rubella. RH HSG Semen test Hormone profile
Communication and education Nutrition Exercise Breast feeding Contraception
30
Antenatal Labor Postnatal Newborn Gynecology
History Obstetric H/R Diagnosis of labour History of Gynecology
Physical Obstetric Maneuvers Progress in labour Post natal evaluation ( normal and CS) Delivery relevant complications
Tests/investigations/procedures BPP Routine AN tests CTG Instruments Tests in complications Resuscitation of Newborn Instruments Specific investigations
Data interpretation CTG GTT PET Partogram Postnatal tests Rubella. RH HSG Semen test Hormone profile
Communication and education Nutrition Exercise Breast feeding Contraception
31
Couplet Physical Examination
  • What the candidate reads
  • Candidates Instructions TM, 31 years old, 33wks
    ,has been brought to your office with a history
    of PROM
  • In the next 5 minutes, conduct a focused and
    relevant physical examination.
  • As you proceed, explain to the examiner what you
    are doing and describe any findings. At the next
    station, you will be asked to answer questions
    about this patient.

32
Couplet Physical Examination
  • Did 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
  • - Excellent
  • Unsatisfactory - Borderline
  • - Poor
  • - Inferior
  • Inadequate medical knowledge and/or provided
    misinformation
  • Could not focus in on this patient's problem
  • Demonstrated poor communication and/or
    interpersonal skills
  • Actions taken may harm this patient
  • Actions taken may be imminently dangerous to this
    patient
  • Other

33
Data interpretation
  • A 38 years old patient, Gravida 8 para 61. Her
    previous delivery ended by cesarean section due
    to failure to progress.
  • She is now around 28 weeks
  • Her family doctor have ordered a GTT and she
    brought the result for you for advise

34
Instruction for the Simulated Patient (Examiner)
  • Doctor can you tell me is my GTT result normal or
    not?
  • Is there any danger (complications) for me from
    this condition?
  • Is there any risk for my baby?

35
Item Mark Mark Mark Mark Mark
Well Average Average Average ND
Interpretation of test (Positive for GDM) 2 1 1 1
Risks to the patient Risks to the patient Risks to the patient Risks to the patient Risks to the patient Risks to the patient
Increased risk of high BP (PET) 1 1 ½
Increased rate of infection (urinary/vaginal) 1 1 ½
Risks to the fetus Risks to the fetus Risks to the fetus Risks to the fetus Risks to the fetus Risks to the fetus
Polyhydramnios 1 1 ½
Macrosomia 1 1 ½
Operative / Difficult delivery 1 1 ½
RDS 1 1 ½
Neonatal Jaundice 1 1 ½
Other metabolic disorders 1 1 ½
Total
36
Item Mark Mark Mark Mark Mark
Well Average Average Average ND
Interpretation of test (Positive for GDM) 2 1 1 1
Risks to the patient Risks to the patient Risks to the patient Risks to the patient Risks to the patient Risks to the patient
Increased risk of high BP (PET) 1 1 ½
Increased rate of infection (urinary/vaginal) 1 1 ½
Risks to the fetus Risks to the fetus Risks to the fetus Risks to the fetus Risks to the fetus Risks to the fetus
Polyhydramnios 1 1 ½
Macrosomia 1 1 ½
Operative / Difficult delivery 1 1 ½
RDS 1 1 ½
Neonatal Jaundice 1 1 ½
Other metabolic disorders 1 1 ½
Total
37
Item Mark Mark Mark Mark Mark
Well Average Average Average ND
Interpretation of test (Positive for GDM) 2 1 1 1
Risks to the patient Risks to the patient Risks to the patient Risks to the patient Risks to the patient Risks to the patient
Increased risk of high BP (PET) 1 1 ½
Increased rate of infection (urinary/vaginal) 1 1 ½
Risks to the fetus Risks to the fetus Risks to the fetus Risks to the fetus Risks to the fetus Risks to the fetus
Polyhydramnios 1 1 ½
Macrosomia 1 1 ½
Operative / Difficult delivery 1 1 ½
RDS 1 1 ½
Neonatal Jaundice 1 1 ½
Other metabolic disorders 1 1 ½
Total
38
Data Interpretation
  • 28 years old Gravida 10 Para 90, at 13 weeks of
    gestation came to the clinic complaining of
    Palpitation and shortness of breath.
  • A complete blood count (CBC) test was performed.
  • You are require to interpret the result of the CBC

39
Item Mark Mark Mark Mark Mark
Well Average Average Average ND
What does the result of this test shows? (Examiner to show CBC form) What does the result of this test shows? (Examiner to show CBC form) What does the result of this test shows? (Examiner to show CBC form) What does the result of this test shows? (Examiner to show CBC form) What does the result of this test shows? (Examiner to show CBC form) What does the result of this test shows? (Examiner to show CBC form)
Low hemoglobin (anemia) 1 1 1/2
What type of anemia What type of anemia What type of anemia What type of anemia What type of anemia What type of anemia
Hypochromic microcytic 2 2 1
Can it be confused with other type of anemia? Can it be confused with other type of anemia? Can it be confused with other type of anemia? Can it be confused with other type of anemia? Can it be confused with other type of anemia? Can it be confused with other type of anemia?
Thalassanemia and 1 1 1/2
Sickle cell anemia 1 1 1/2
How would you confirm? How would you confirm? How would you confirm? How would you confirm? How would you confirm? How would you confirm?
Hemoglobin electrophoresis 1 1 ½
Sickle cell test 1 1 ½
What do you think of this result? (Examiner to show the result of the electrophoresis) What do you think of this result? (Examiner to show the result of the electrophoresis) What do you think of this result? (Examiner to show the result of the electrophoresis) What do you think of this result? (Examiner to show the result of the electrophoresis) What do you think of this result? (Examiner to show the result of the electrophoresis) What do you think of this result? (Examiner to show the result of the electrophoresis)
Confirm Iron deficiency anemia 3 3 2
Total
40
Postnatal Examination
  • You are the house officer in the ward and in the
    morning round you came across this patient who
    had delivered 24 hours ago.
  • How would you assess her?

41
Item Mark Mark Mark
Well Average ND
Initial approach to the patient (introduce him/her self, explain what he/she will be doing) 1 ½
Mode of delivery 1 ½
Delivery outcome (the baby) 1 ½
Lochia / Bleeding 1 ½
Bladder function 1 ½
Perineum/excessive pain (episiotomy) 1 ½
Check vital signs 1 ½
Breast feeding 1 ½
What important investigations you would like to review before discharge What important investigations you would like to review before discharge What important investigations you would like to review before discharge What important investigations you would like to review before discharge
CBC 1/2 1/4
Blood Group (RH factor) 1/2 1/4
Rubella test 1/2 1/4
Hepatitis test 1/2 1/4
Total
42
Item Mark Mark Mark
Well Average ND
Initial approach to the patient (introduce him/her self, explain what he/she will be doing) 1 ½
Mode of delivery 1 ½
Delivery outcome (the baby) 1 ½
Lochia / Bleeding 1 ½
Bladder function 1 ½
Perineum/excessive pain (episiotomy) 1 ½
Check vital signs 1 ½
Breast feeding 1 ½
What important investigations you would like to review before discharge What important investigations you would like to review before discharge What important investigations you would like to review before discharge What important investigations you would like to review before discharge
CBC 1/2 1/4
Blood Group (RH factor) 1/2 1/4
Rubella test 1/2 1/4
Hepatitis test 1/2 1/4
Total
43
Item Mark Mark Mark
Well Average ND
Initial approach to the patient (introduce him/her self, explain what he/she will be doing) 1 ½
Mode of delivery 1 ½
Delivery outcome (the baby) 1 ½
Lochia / Bleeding 1 ½
Bladder function 1 ½
Perineum/excessive pain (episiotomy) 1 ½
Check vital signs 1 ½
Breast feeding 1 ½
What important investigations you would like to review before discharge What important investigations you would like to review before discharge What important investigations you would like to review before discharge What important investigations you would like to review before discharge
CBC 1/2 1/4
Blood Group (RH factor) 1/2 1/4
Rubella test 1/2 1/4
Hepatitis test 1/2 1/4
Total
44
During the morning round you came across a 28
years old who has delivered 24 hours ago. She was
found to run a temperature of 390 c. How would
you approach her
  • Mode of Delivery Spontaneous
  • Outcome 3 Kg baby Boy
  • How is the baby Well in the nursery
  • Duration of labour 12 hours
  • Any history of SRM Loss of fluid for 3 days
  • Symptoms of upper or lower respiratory tract
    infection
  • Symptoms of UTI (upper or lower)
  • Amount, and nature of Lochia

45
You were urgently called to the labour room by
the obstetric nurse. A patient who just had her
episiotomy sutured by your colleague has suddenly
became pale and drowsy with rather heavy vaginal
bleeding
  • What is the differential diagnosis of post-partum
    hemorrhage (mention 4)?
  • What are the immediate measures that should be
    taken in this case?
  • What is the most likely cause of this patient
    collapse?
  • How would you confirm This diagnosis

46
What is the differential diagnosis of
post-partum hemorrhage (mention 4)
  • Uterine Atony
  • Lacerations of the Genital tract
  • Uterine Inversion
  • DIC

47
What are the immediate measures that should
be taken in this case?
  • (A) Air Way
  • (B) Breathing
  • (C) Maintain Circulation IV infusion

48
What is the most likely cause of this patient
collapse?
Uterine Atony
  • How would you confirm This diagnosis?

Abdominal Palpation for Uterine fundal height and
consistency
49
An 18 years old primigravida presented to the
emergency room in labour
  • What important informations you want to know
    about this case?
  • How would you confirm the patient diagnosis?

50
What important informations you want to know
about this case?
Yes
  • Is she booked or not
  • How many weeks is she now ( LMP)
  • Is there any known medical problem?

38 weeks
No
51
How would you confirm the patient diagnosis?
  • Symptoms
  • Character of the pain regular in pattern,
    increase in frequency and intensity.
  • Signs
  • Show.
  • Cervical Changes effacement and dilatation
  • Loss of fluid per vaginum

52
Common Mistakes
  • Not reading the question!
  • Asking too many unfocused questions (shotgun)
  • Not explaining what you are doing during physical
    examination stations
  • Rectal, vaginal and inguinal exams not allowed
    BUT you will not be given credit unless you
    indicate that you would do them when appropriate.
  • Talking too fast and too much maintain
    professional courtesy
  • Trying to guess what the station is about and not
    listening to the patient

53
THANK
THANK YOU
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