Idea of OSCE in obstetrics in breif

Idea of “OSCE” in obstetrics in
brief
Dr. Manal behery
Assistant professor
Zagazig university
2013

OSCE
O : OBJECTIVE
S : STRUCTURED
C : CLINICAL
E : EXAMINATION

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

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

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

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

 Why OSCE?
WHAT DOES IT TEST ?
HOW TO RUN IT?
OSCE

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

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
Long case

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
With OSCE

OSCEs – reliable
Less dependent on examiner’s foibles (as there are
lots of examiners)
Less dependent on patient’s foibles (as there are lots
of patients)
Structured marking
More stations … more reliable
Wider sampling – clinical, communication skills

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?

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.

OSCEs – acceptability
Perceived fairness – examiners and
examinees
Become widespread

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

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

1- Organizational training
2. The idealized ‘textbook’ scenarios may not mimic
real-life situations
3. Expensive
Disadvantage of OSCE

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?

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.

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.

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 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.

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

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

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
complicatio
ns
Tests/investi
gations/proc
edures
BPP
Routine AN
tests
CTG
Instruments
Tests in
complicatio
ns
Resuscitatio
n of
Newborn
Instruments
Specific
investigatio
ns
Data
interpretati
on
CTG
GTT
PET
Partogram Postnatal
tests:
Rubella. RH
HSG
Semen test
Hormone
profile
Communica
tion and
education
Nutrition
Exercise
Breast
feeding
Contracepti
on

Couplet Physical
Examination
What the candidate reads
Candidate’s 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.

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

Data interpretation
A 38 years old patient, Gravida 8 para 6+1.
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

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?

Item Mark
Well Average ND
Interpretation of test (Positive for GDM) 2 1
Risks to the patient
Increased risk of high BP (PET) 1 ½
Increased rate of infection (urinary/vaginal) 1 ½
Risks to the fetus
Polyhydramnios 1 ½
Macrosomia 1 ½
Operative / Difficult delivery 1 ½
RDS 1 ½
Neonatal Jaundice 1 ½
Other metabolic disorders 1 ½
Total

Data Interpretation
28 years old Gravida 10 Para 9+0, 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

Item Mark
Well Average ND
What does the result of this test shows?
(Examiner to show CBC form)
Low hemoglobin (anemia) 1 1/2
What type of anemia
Hypochromic microcytic 2 1
Can it be confused with other type of anemia?
Thalassanemia and 1 1/2
Sickle cell anemia 1 1/2
How would you confirm?
Hemoglobin electrophoresis 1 ½
Sickle cell test 1 ½
What do you think of this result?
(Examiner to show the result of the electrophoresis)
Confirm Iron deficiency anemia 3 2
Total

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?

Item 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
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:

Item 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
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:

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

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

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

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

 What is the most likely cause of
this patient collapse?
How would you confirm This
diagnosis?
Uterine Atony
Abdominal Palpation for Uterine fundal
height and consistency

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?

What important informations you want
to know about this case?
Is she booked or not
How many weeks is she now ( LMP)
Is there any known medical problem?
Yes
38 weeks
No

How would you confirm the
patient diagnosis?
Symptoms:
o Character of the pain: regular in pattern,
increase in frequency and intensity.
Signs:
o Show.
o Cervical Changes: effacement and dilatation
o Loss of fluid per vaginum

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

Idea of OSCE in obstetrics in breif

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