Pediatric OSCE : dealing with Observed stations

Hi, friends, I am back with another subset of OSCE, sharing some ideas about Observed OSCE in pediatric practical exams.


Lets go through marks distribution of practical exam.

Observed osce’s generally accounts for 50 marks out of 150 marks. So this subset is very crucial for passing or you can say difficult to get through if u couldn’t do well here.

Now some words about ideology of Natboard behind Observed osces. Observed osces are as name suggest are OBSERVED . 

You are given a task and you have to perform it and examiners will OBSERVE you and will 
give you marks as per key provided to them by NBE.

The time allotted is exactly 8 minutes, but marks may very as per individual osce’s but generally sum total of all observed osces is constant around 50 marks.

5-6 observed osce’s are asked in every session. The topics for this type of osce are based on day to day ward /OPD work.so if u have worked well during residency, it is very easy to pass in these osce’s but u definitely need practice to speak out what you know.

Here is list of topics generally asked in in observed Osces.

1. Clinical examination.
2. Focused clinical examination.
3. Counselling
4. History taking
5. Procedures
6. NRP/PALS
7. Developmental assessment.

About marking system of above osces:

Even if you go unprepared for these (with good clinical work experience in past), you will be able to score 50% of these marks. But DNB keys are prepared in such a way that there is always a point in key worth 20% marks, which makes them understand about your clinical work experience.
Lets, elaborate individual categories.


1. CLINICAL EXAMINATION

Generally Task in question is given in form of clinical scenario or some equipment's are also kept. REMEMBER, WHATEVER OBJECTS KEPT ON TABLE ARE THERE TO BE USED. you can loose marks if you don’t use them. After reading task just have a look at equipment's. Take 30 sec to plan your action before you start.

This could save you from probable loss of silly mistakes like,
“ Not standing on Rt. Side of pt. in Abdominal system examination,
Not checking/purcussing on both symmetrically opposite sides.

This could save you from probable loss of silly mistakes like,
“ Not standing on Rt. Side of pt. in Abdominal system examination,
Not checking/purcussing on both symmetrically opposite sides.”

You should be thorough with all systemic clinical examination proformas. Its always useful to have nice revision of clinical methods from standard clinical examination text book Before starting the task don’t forget initial steps of consent, explanation, hand hygiene, maintaining dignity of patient and warming hands.

You are expected to give running commentary of what you are doing and for what you are looking.

In examination kit provided to you if you find any unexpected objet then you should be smart enough to think of utility of that object in given task beyond the proformas you mugged up.

For example.


Measuring tape:

RS: measure chest circumference and also check after full inspiration.

GIT: Abdominal girth, xiphisternum to umbilicus and umbilicus to pubic symphysis distance. Span of liver, spleen.

CNS: Head circumference, limb circumference to check nutrition of muscles.

Fundoscope:

CVS: Roths spot for IE.

GIT: Cherry red spots for storage disorders.

CNS: Pappiloedema.

Whether you get findings or not doesn't matter, examiner wants to OBSERVE whether you know what to look for and method.

Remember, this is one of the most scoring observed osce station.


2. FOCUSED CLINICAL EXAMINATION

This is recently introduced subtype of observed osces. Here is the detailed explanation regarding the topic.

Focused Clinical Examination.


3.COUNSELLING

Another task, which is really tricky. Generally its in the form of clinical scenario where-in you have to counsel the parents.

After reading the task please take 30 sec in mind to think and PLAN YOUR APPROACH IN 10 STEPS OF COUNSELLING GIVEN IN NELSONs text book.

In this osce your body language, EYE CONTACT, attitude, confidence, patience and content of knowledge is checked. So mind your behavior and eye contact.

Start with introduction, ask for preferred language of communication. Then discuss the problem. Give prompt and brief knowledge. Instigate and encourage the parent to ask any query. And IF THEY ASK, be patient listener and solve their doubt. Dont show them dominating or bossing attitude. Dont ask them unnessesary questions, this is counselling station not a history taking.

Practice is the only way out to these types of osce. In this type of osce there is high chance of having unexpected points in the answer Key which are way more specific than we think off.

Example

Counselling for child born with ambiguous genitalia (nov-2015)

All points given in standard text book was allotted 0.25- 0.5 marks each. But a sample advice to delay registration of birth certificate and official documents till final lab results are available, would score  1 mark ! (Just a common sense)

Common scenarios asked for counselling are.

Neonatal situations ( jaundice, breast feeding, hypothyroidism, prematurity, ambiguous genitalia etc. Every session there is min. 1 scenario about neonate).

Diet advice (FTT, Renal diet, celiac diet, hepatic diet etc.)
Counselling for child with syndromes
Consent for clinical procedure.
Counselling for child with habit/conduct /behaviour/learning disorders.
Situational counselling like shifting to ICU, Bad news etc.


4. HISTORY TAKING

Clinical scenario or symptom is given. Before starting the task take 30 sec and think all possible DDs and preferably covering all systems for that given symptoms. Ask for Name/age /sex... as if you are talking real life case. Dont forget to ask for relevant negative history and go upto socioecnomical /family history.

YOUR RELEVENCE OF QUESTIONS/SEQUENCE AND FLOW OF VERBAL OUTPUT makes examiner understand that you deserves/ do not deserves degree!

Its nice to practice with all clinical symptoms from all systems.


5.PROCEDURES

All clinical and ICU procedures are covered under this. Read up task. You should be thorough with procedure methods. Before starting the task don’t forget initial steps of consent, explanation, hand hygine, maintaining dignity of patient and warming hands.

You are expected to give running commentary of what you are doing. After demonstrating procedure don’t forget to speak about biomedical waste management and post procedure monitoring.


6.NRP/PALS

These are life saving procedures to know in life of pediatrician, after and before exam also! These stations are lethal as they have got negative markings, and also scoring because you have to learn to perform them as it is. NALS, PALS and PGALS are the only stations which can fetch you 100% marks. so revise them as many times as possible.


7.DEVELOPMENTAL ASSESSMENT

Again an indispensable part of pediatrics. You should be thorough with developmental assessment till 5 yrs of age. Its also important for case as it is allotted 5 marks in each case , be it CNS or be it CVS. In this osce age may be given or may be asked to guess.

Start with gentle attitude, make child friendly and do relevant tasks. Cover all domains if not specified. start with higher age which you expect and if child is unable to do the task then then bring down to lower age.

For motor assessment like asking 5 year old child to jump backward, better to show him personally. it saves time. If you are asked to guess the age of child then don’t forget to demonstrate inability of child to perform higher age task.

For example 4 yr old child is given, he is able to climb down steps 1 foot per step but then also ask him to jump backwards (5 yr milestone) which he wont be able to, thus ruling out that he is not 5 year old. If age is provided in question then no need to go for this.

For assessment of fine motor skills if you are using cubes then first show child how to make bridge/gate/train.

Again remember ALL OBJECTS KEPT ON TABLE ARE THERE TO USE.

It is also better to know age groups for tests and tasks to be used like form board for 1.5 yrs-2.5 years. Draw a man test for > 3 years. Scissors for > 3 yr etc. This saves time.

Whether you get findings from child or not doesn't matter, examiner wants to OBSERVE whether you know what to look for and method of performance.

Dont forget to thanks child at end. Don't forget to tell your assessments result to examiners with clear word. If question has asked you to find out motor and fine motor age then say “by assessment gross motor age is **** and fine motor age is ***”

This is one of the most scoring observed osce station.


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