Candidate

Instructions
Your next patient is Martina, a 19 year old female who woke up this morning with a lopsided face, and is now unable to smile or eat properly. You have been given this patient's past medical history. You are not expected to ask any further history from this patient. You have eight (8) minutes to perform a focussed examination with respect to the presenting complaint. Do not make any inferences based on the appearance of the role player. You are expected to explain to the examiner the specific findings that you are looking for during your examination. Tasks Focussed examination including reasoning to each part of the examination to the examiner 8 minutes
Year 2 OSCE Practice 2011 Set 4, Examination Station

Past Medical History Chicken pox- age 8

Meds combined OCP Allergies/ADRs Nil

Past Surgical History Nil Immunizations Up to date Lifestyle Smoking Never Alcohol A lot on the weekends, nil during the week Diet Varied
Year 2 OSCE Practice 2011 Set 4, Examination Station

Family History Brother- Tourettes syndrome

Demographics Occupation University student Living arrangements Lives in college

Instructions to Standardised Patient

You are playing Martina, a 19 year old female, who woke up this morning with a lopsided face and difficulty smiling or eating. The students are NOT expected to take any further history from you regarding you presenting complaint. However they are expected to interact appropriately with you as a patient. The students should commence with introducing themselves and obtaining verbal consent to examine you. They should also ensure you are comfortable on the examination couch. If they fail to introduce themselves- please ask Who are you exactly? If they fail to ask for your consent- please ask What exactly are you going to be doing? The students should start with a general inspection of your face, before moving on to check your cranial nerves 7-12. You will be required to expose your upper torso. This examination will take eight (8) minutes. During this time the students are expected to explain to the EXAMINER the specific findings that they are looking for. They will be talking to the examiner, as requested and you are not expected to respond to their comments.

Year 2 OSCE Practice 2011 Set 4, Examination Station

Instructions to Examiners
The task for the candidate To perform an examination of cranial nerves 7-12 to try to determine the cause of this patient's lopsided face & difficulty eating/smiling. The candidate should make an attempt at visualising the tympanic membrane to check for herpetic vesicles/ Ramsey Hunt syndrome. Conduct of the Station Ensure that the candidate understands the task that he/she has to do. The candidate is expected to interact appropriately with the patient- including introducing themselves, and obtaining consent for the examination. The candidate has been told to explain to the examiner the specific findings they are looking for during their examination. They are not to make any inferences based on the appearance of the role player. Please prompt the candidates if they are performing the examination in silence - or talking to the patient instead using the phrases below. Please indicate the signs you are specifically looking for Please talk me through your examination, as you are performing it. During the course of the interview the candidate may refer to any notes they have made during the perusal time. This is an eight (8) minute station.
Year 2 OSCE Practice 2011 Set 4, Examination Station

MARKING
Examiners are asked to grade students performance on a scale of 0 - 4 in the areas on the mark sheet in capitals. The standards for awarding these grades are; 0 = Unequivocal fail: Student was unable to demonstrate history or examination skills without significant prompting, OR displayed unethical or unprofessional behaviour. Student lacked a comprehensive approach, and/or needed considerable prompting to complete the task.

1 = Marginal fail: 2 = Borderline pass:

Student performed a systematic examination or history but did not complete some components in a number of areas of the marking guide. Student had a systematic approach, required little or no prompting, was confident and completed most components of the marking guide.

3 = Clear pass:

4 = High pass: Examiners are required to make an overall judgement about the students performance in each area on the marking sheet. The specific items listed are there to remind examiners about issues which might be considered. It is not intended that these items should rigidly translate into a score. It would be helpful, particularly when feedback is being given to poorly performing students, if there is some notation in the comments column. Also examiners may find it helpful, when considering what grade to award, to have indicated in the comments column when items were omitted or when prompting was required. Global Score. This mark does not form part of the students overall mark. The score should reflect the students empathy and overall performance, and is from the examiners perspective only.
Year 2 OSCE Practice 2011 Set 4, Examination Station

Student had a high level of proficiency, well above what would be expected of a student in Year 2.

Feature Introduction/General Who/role Permission Wash hands Appropriate Pt interaction Positioning (patient sitting) General Inspection: Facial asymmetry CN 7 Temporalis (forehead movement) Other muscles of facial expression (squeeze eyes shut, smile + puff out cheeks) Asks about change in taste Corneal reflex CN 8 Asks about change in hearing/ pain around ear (important for Bells palsy) Whisper test Webers test Rinnes test Otoscope (important for Bells palsy) CN 9 & 10 Inspection of palate + movement Inspection of uvula Gag reflex Voice for hoarness Cough CN 11 Inspect for torticolis Trapezius strength Sternocleidomastoid strength CN 12 Wasting of tongue Deviation of tongue

Comment

Score (please circle) 0 1 2 3 4

0 1 2 3 4 0 1 2 3 4

0 1 2 3 4

0 1 2 3 4

0 1 2 3 4

0 1 2 3 4

Pass Mark = 15/20 Pass/ Fail (Circle as appropriate) Comments (essential if the candidate has failed the station) Global Impression- from examiners only- score 0-4

Year 2 OSCE Practice 2011 Set 4, Examination Station