Types of OSCE stations - Observed OSCE in Pediatrics


This is a detailed discussion on various types of OSCE stations in the DNB practical exam. The focus is on the observed stations. This hopefully will orient on how the actual OSCE station feels like.

Before we start with the various type of OSCE stations, lets us briefly get an idea about the marks distribution in the exam.

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


So as the name suggests, Observed OSCE stations, as are OBSERVED by the examiner. 

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

The time allotted is exactly 8 minutes, but marks may vary as per individual OSCE but generally sum total of all observed OSCE stations is around 50 marks.

5-6 observed OSCEs or even more are asked in each exam. The topics for this type of OSCE are based on day to day ward /OPD cases and procedures we perform. So if u have worked well during residency, it is not very difficult to perform a given task. However, u definitely need the practice to speak out what you doing.

Here is the list of topics generally asked in observed OSCE stations.

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 OSCE:

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 your clinical work experience.
Lets, elaborate on individual categories.


1. CLINICAL EXAMINATION

Generally, the Task in question is given in form of a clinical scenario, or some equipment are also kept. REMEMBER, WHATEVER OBJECTS KEPT ON TABLE ARE THERE TO BE USED. you can lose marks if you don’t use them. After reading the task just have a look at equipments. 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/percussing on both symmetrically opposite sides.
 

You should be thorough with all systemic clinical examination proformas. Its always useful to have a nice revision of clinical methods from the standard clinical examination textbook Before starting the task don’t forget the initial steps of consent, explaining to parents what you doing, hand hygiene, maintaining the comfort of the patient, and warming your hands.

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

The examination kit is provided to you if you find any unexpected object then you should be smart enough to think of the utility of that object in a 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 the umbilicus, and umbilicus to pubic symphysis distance. Span of the liver, spleen.

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

Fundoscopy:

CVS: Roths spot for IE.

GIT: Cherry red spots for storage disorders.

CNS: Pappiloedema.

Whether you get findings or not doesn't matter, the 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 a recently introduced subtype of observed OSCE. Here is a detailed explanation regarding the topic.


3.COUNSELLING

Another really tricky task. Generally, it is in the form of a 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 textbook.

In these types of OSCE stations, your body language, EYE CONTACT, attitude, confidence, patience, and content of knowledge is checked. So mind your behavior and eye contact.

Start with the introduction, ask for the 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 a patient listener and solve their doubt. Don't show them dominating or bossy attitude. Don't ask them unnecessary questions, this is a counseling station, not a history taking.

The practice is the only way out o these types of  OSCEs. There is a high chance of having unexpected points in the Answer Key which are way more specific than we think off.

Example

Counseling for a child born with ambiguous genitalia (nov-2015)

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

Common scenarios asked for counseling are.

Neonatal situations ( jaundice, breastfeeding, hypothyroidism, prematurity, ambiguous genitalia, etc. Every exam there is a minimum, one scenario about neonates).

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


4. HISTORY TAKING

A clinical scenario or symptom is given. Before starting the task take 30 sec and think of 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. Don't forget to ask for relevant negative history and go up to socioeconomic /family history.

YOUR RELEVANCE OF QUESTIONS/SEQUENCE AND FLOW OF VERBAL OUTPUT makes the examiner understand that you deserve/ do not deserves a degree!

It is nice to practice with all clinical symptoms from all systems.


5.PROCEDURES

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

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


6.NRP/PALS

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 that 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. It is also important for a case as it is allotted 5 marks in each case, be it CNS or be it CVS. In these OSCE stations,  age may be given or may be asked to guess.

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

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

For example, 4 yr old child is given, he can climb down steps 1 foot per step but then also ask him to jump backward (5 yr milestone) which he won't be able to, thus ruling out that he is not 5 years 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 a child how to make a 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 a child or not doesn't matter, the examiner wants to OBSERVE whether you know what to look for and method of performance.

Don't forget to thanks the child at the end. Describe your assessments to examiners with clear words. If the question wanted you to find out the motor and fine motor age then say “by the assessment gross motor age is **** and fine motor age is ***”

These are again one of the most scoring observed OSCE stations.


Ok, so that is all for now, Please add suggestions and correction in the comment box below. 

Watch the space for more  OSCEs.

Other articles by Kishor

  1. Observed OSCE stations - OSCE Guide
  2. Body language in Practical exam
  3. Previous year OSCE questions
auhtor

About Author

Kishor L Giri | DNB Pediatric

Kishor completed his DNB Pediatric residency at Jehangir Hospital, Pune and currently working as a Pediatrician in Navi Mumbai. His articles focus on clinical aspects of the exams including tips for preparing practical and OSCE exams.