Transcript Tips to help you prepare for the Family Medicine OSCE

Tips to help you prepare for the
Family Medicine OSCE
The Format
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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
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In order to standardize physical exam findings, you will be provided with the
full physical exam during the post encounter portion of the exam.
Use the physical exam results you are given after the encounter to create a
differential and plan.
If a sensitive exam is 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 max per station. This includes time in the room
with the patient and time for follow up writing assignments. You will have
only 17 minutes per patient education station because there is NO write-up
for these stations
– Bring a watch to help you better keep track of time
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You will be provided blank paper to take notes on. No other study aides
allowed in room
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Bring your stethoscope and wear your white coat.
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Other diagnostic equipment will be provided but you can bring your own if you wish
The Patients with Acute Complaints
Overview
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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.
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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.
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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.
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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.
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All students will be required to leave the patient room when there are 5 minutes
left in the exam.
The Patients with Acute Complaints
Suggested Time Management
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Review the patient's chart (Approximately 5 minutes)
When you are ready, click “start encounter” on the computer screen and enter the room
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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.”
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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)
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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
The Patients with Acute Complaints
Details on Written Task
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These will be the exact questions you will be asked on the OSCE
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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 note should
be brief. You do not need to use complete sentences.
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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 those things that are common but also those that are less common but serious. Do
not include the rare and unlikely.
The Patients with Acute Complaints
Details on Written Task
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These will be the exact questions you will be asked on the OSCE
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Written Task 3 - Evaluation
What labs or studies do you want to order to help clarify what is going on with this patient?
Be judicious about what further evaluation you order as such studies will not only add to the
cost of care but can also lead to false positives. There are times when no further studies are
needed. There are other times when further studies are essential.
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 further test and studies you want to order,
how you will treat the patient (medications and/or non pharmaceutical interventions) and
when and where you want the patient to follow up. If you ordered a test that would change
the management plan, write the variations of the treatment plan based on the different
results you might get back.
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The Patients with Acute Complaints
Details on Written Task
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These will be the exact questions you will be asked on the OSCE
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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 made above under management. The
areas of prevention do not need to relate to the current complaint.
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
The Patients with Chronic Illness
Overview
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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.
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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.
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All Students will be required to leave the patient room when there are 5
minutes left in the exam.
The Patients with Chronic Illness
Suggested Time Management
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Review the patient's chart (Approximately 5 minutes)
When you are ready, click “start encounter” on the computer screen and enter the room
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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.”
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Written tasks following the patient encounter (Approximately 10 minutes)
Follow the instructions on the screen. You will document
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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
The Patients with Chronic Illness
Details on Written Task
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These will be the exact questions you will be asked on the OSCE
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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 note should be brief. You do not need to use complete sentences.
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Written Task 2 – Problem List
Create a problem list based on this patient’s prior medical history and current information.
The Patients with Chronic Illness
Details on Written Task
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These will be the exact questions you will be asked on the OSCE
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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 further test and studies you want to order,
how you will treat the patient (medications and/or non pharmaceutical interventions) and
when and where you want the patient to follow up. If you ordered a test that would change
the management plan, write the variations of the treatment plan based on the different
results you might get 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 not repeat recommendations made above under management. The
areas of prevention do not need to relate to the current complaint.
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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.
The Patient Education Cases
Overview
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Summary of task: This station focuses on your ability to communicate medical
information to a patient.
• You DO NOT need to do perform a full history OR physical
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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”
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All Students will be required to leave the patient room after 17 minutes
(this gives the patient time to complete their checklist)
The Patient Education Cases
Suggested Time Management
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Review the patient's chart (Approximately 1 minute)
When you are ready, click “start encounter” on the computer screen and enter the room
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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.”
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There is NO write up for these cases
….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 tape 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
– Try to attend OSCE feedback session on Friday afternoon after Shelf
Questions?
• Contact your campus clerkship director
or
• Email clerkship director, Kelly Bossenbroek
Fedoriw at [email protected]