Transcript What is the OSCE?

Class of 2015
Year 3
Objective Structured Clinical Exam
(OSCE)
Class of 2014 Year 3 OSCE
 OSCE




Facts
Process
Grading
Tips
OSCE Facts
An OSCE is:
 a performance-based exam in which you are observed
demonstrating various clinical skills as you rotate through a
series of stations.
 an exam to evaluate the process by which you interact with
patients.
OSCE Facts
An OSCE:
 evaluates your basic clinical skills
 measures your minimal competencies
 provides feedback on your performance
 gives you an idea of what the NBOME COMLEX-PE will be
like
OSCE Facts
Confidentiality
 You must adhere to the Honor Code.
 After the OSCE, sign into E*Value and complete OSCE
honor code course work.
 You must not share information with others.
OSCE Facts
Videotaping
•Your OSCE will be
videotaped for the
purpose of evaluation
OSCE Process:
 Wear your white lab coat and OU-HCOM ID badge (bring
these with you) over professional clothing
 Put on arm bands (provided at the time of the exam)
 Keep a pen and a stethoscope with you
 Empty your pockets of everything except your stethoscope
 No pocket guides
 No cells or beepers
 No drug guides
 No ChapStick, tissues, etc.
 Everything you need
for the exam will be in the room
OSCE Process: Hallway Sequence
 Determine your designated
start room. You will stay in
the same color sequence
(pink, green, gold or white)
for the entire exam.
 No talking in the hallway,
please!
OSCE Process: Hallway Sequence
 If you are scheduled to start at Green Station 1 for your first
“patient”, your second “patient” will be at Green 2, your 3rd
“patient” at Green 3, your 4th “patient” at Green 4.
 If you are scheduled to start at Pink Station 2 for your first
“patient”, your 2nd “patient” will be at Pink 3, your 3rd
“patient” at Pink 4, your 4th at Pink 1.
 If you are scheduled to start at Gold Station 4, your 2nd
“patient” will be at Gold 1, your 3rd “patient” at Gold 2, and
your 4th “patient” at Gold 3.
 Etc.
OSCE Process: Cases
 There will be 4 cases using standardized patients (SPs).
 SPs are required to stay in character
 If you recognize an SP from a previous lab, please do not
acknowledge this
 One of the 4 stations will be a “formal” OMM case where
you are expected to assess, diagnose, treat with OMM and
reassess.
 This year this is the back pain case – you must provide OMM to this
“patient”
 No HVLA techniques are allowed on any patients
 NBOME does not have a formal OMM case. OPP should be
considered in all cases during the COMLEX PE.
OSCE Process: Schedule
 The OSCE will take approximately 2- 2.5 hours
 You will have a total of 23 minutes for each station:
 14 minutes to complete the appropriate
tasks for each station, and
 9 minutes for SOAP note writing
OSCE Process: Debriefing
 The last component of the OSCE is a debriefing.
 We value your feedback!
OSCE Process: Patient Encounter
 Wait outside each room until you are instructed to begin.
 When instructed to begin, you may pick up and read the chart.
The chart contains instructions, a worksheet (to take notes),
approved abbreviations, and relevant diagnostic information.
 The instructions in each chart include:
 the setting: outpatient, primary care, or ER
 patient demographic information
 vital signs
 You may enter the room when you are ready; take the chart with
you into the room.
 A sample chart will be provided for you to review prior to the
exam.
OSCE Process: Patient Encounter
• Use your 14 minutes to evaluate and treat each “patient”
as you see fit.
• Do not pretend there is someone else in the room or that
the patient has taken medication you prescribed in the
past – don’t make things up!
• No pelvic, rectal, GU, or breast exams are allowed on
standardized patients. (You may document your
intention to do so in SOAP note.)
OSCE Process: OMT
 Use OMT as appropriate.
 Develop a treatment plan in response to presented symptoms –
there may be no physical findings.
 When using OMT, be sure to:




Gently position the patient
Explain what you are doing
Limit the amount of time for OMT to 3-5 minutes
Complete all steps of the process, including reassessment
 Remember: Do not use HVLA, but you may document in the
SOAP note that you would like to include it in your
treatment.
OSCE Process: Patient Encounter Timing
Completing an encounter in the time allotted is difficult for
most students. We suggest you practice timing the process.
 Twelve minutes after the encounter begins, you will receive
a two-minute warning.
 Fourteen minutes after the encounter begins, you will be
instructed to leave the room.
 You must take the chart and your worksheet out of the
room with you.
 You may leave the room before instructed. However, if you
do leave, you will not be able to re-enter.
OSCE Process: SOAP Note Timing
 During the 9 minutes allowed for SOAP note writing:
 Type your note into the computer at the desk outside the room.
 Also type patient name, date and time, your name, OMS III.
 After 7 minutes, you will hear an announcement indicating that two
minutes remain.
 After 9 minutes of SOAP note typing, you will be instructed to stop
typing.
 Leave the chart and worksheet on the desk and move to stand in
front of the next station.
OSCE Process: SOAP Notes
For the SOAP Note:
 Use the “Worksheet” for jotting down pertinent
information while in the room.
 Include three, ranked, differential diagnoses (for at least 3
possible etiologies).
 Use only the abbreviations provided in the chart.
 Be concise but thorough.
OSCE Process: SOAP Notes
Please be aware that according to NBOME:
 “…falsification of the medical record (written SOAP Notes)
in COMLEX-USA Level 2-PE by documenting medical
history that was not elicited, or physical examination
maneuvers that were not performed, is considered irregular
behavior and will be thoroughly investigated and dealt with
as specified in NBOME’s Bulletin of Information.”
 “Irregular conduct” will appear on the score report and
transcript.
 More than 16 students to date have received failing scores
for this infraction.
 NBOME checks/compares SOAP notes with videotapes.
OSCE Process: SOAP Notes
 Sample SOAP notes are posted on OSCE web page.
 Use abbreviations that are not on the list provided in
each chart “at your own risk”.
OSCE Process
This entire process
is repeated
three times.
OSCE Process
If you need assistance at any
time during the exam,
proctors will be available in
the hallways to help you.
OSCE Grading
 Successful completion of the year 3 OSCE is a requirement for
OU-HCOM graduation.
 You will receive a pass/fail grade.
 You must earn at least a 70% in each of the skill sets in order to
receive a passing grade.
 If your original grade is not passing, your CORE Assistant Dean
will develop a plan for remediation. When your remediation plan
is completed, you will have met the OSCE requirements for
graduation.
 Grade sheets are available for your review on the OSCE web page.
OSCE Grading
Pass
 Score of 70% or above
on each skill set
*Fail (Failure ratings are
given based on any of the
following):
• Illogical sequencing
• Deficient knowledge
base
• Lack of ability to focus
• Interpersonal skills
deficits
• Unprofessional
behavior
OSCE Grading
 Checklists will be used by standardized patients (SP) to
document student performance.
 Checklists will be used by physicians to evaluate both
OMM performance and SOAP note quality.
OSCE Grading
SP documentation checklists include:
 History-taking skills
 Did you ask the appropriate questions?
 Physical exam skills
 Did you perform the appropriate exams?
 Professionalism
 Did you interact with the patient appropriately?
OSCE Grading: Standardized Patients
Documentation of professionalism includes:
 organization
 demeanor
 courtesy
 dress
 compassion
 hand washing
 empathy
 drape appropriately
 listening skills
 whether or not the
 eye contact
 respect
 the language you use
standardized patient would
select the examinee as their
personal physician.
OSCE Grading: Physicians
SOAP notes and OMM techniques will be evaluated by:
 Dr. Cech
 Dr. Law
 Dr. Zidron
 Dr. Balbo
 Dr. Clark
 Dr. Kuttner-Sands
 Dr. Coon
 Dr. Rutter
 Dr. Healy
 Dr. Soroka
 Dr. Schwartz
 Dr. Walkowski
 Dr. Shubrook
 Dr. Regan
 Dr. Guo
 Dr. Eland
OSCE Grading: OMM
Physicians will be checking the videotape of your
OMM encounter for:






Assessment Skills
Demonstration of OMM technique
Explanation of OMM technique
Communication with patient
Reassessment Skills
Professional behavior
OSCE Grading: SOAP Notes
Physicians will be checking your SOAP notes for:
 Subjective findings
 Objective findings
 Assessment (3 differential diagnoses)
 Plan
 Organization
 Verification with videotaped content
OSCE Grading
 Results will be available in approximately one month
 Your CORE Assistant Dean will review the results with you.
OSCE Tips
 Wash your
hands as
soon as you
enter the
room, before
you touch or
shake hands
with the
patient.
OSCE Tips
When
auscultating,
listen on the
patient’s skin.
OSCE Tips
 Pace yourself.
 Read the doorway instructions and take them at face
value to be correct.
 There is no need to repeat vital signs.
 Introduce yourself as “Student Doctor + Your Last
Name”.
 Treat each patient with respect.
 Communicate in clear lay terminology.
OSCE Tips
 Ask one question at a time and let the patient
answer that question before you ask the next one.
 Elicit appropriate history.
 psychosocial
 occupational
 medical/surgical
 Elicit current medications and allergies.
OSCE Tips
 Use the patient’s history to guide the scope of your focused
examination. A complete exam is not required.
 Do not turn off the lights if you examine a patient’s eyes (if
you turn off the lights, we cannot see the videotape!).
 Explain to the patient what you are going to do before you
do it; ask the patient’s permission to perform examination.
OSCE Tips
 Drape the patient appropriately.
 Be sure you have considered osteopathic principles in all
cases.
 You may want to go to the restroom before the OSCE starts.
Thank you
for your cooperation
and good luck!