Professional Documents
Culture Documents
OSCE
Dr . Ziad . N . Arandi
D . P . L Psych - London
B . C . i, Psych - Lm.10.0.11
; . B . C Psych Amman
Chapter I
Multiple Choice
Questions
MCQs from part of the preliminary test and the Palestinian board certificate
exam .ln the MCQ there is no problem in presentation since the answer sheet
has a uniform format and are marked by computer recall is less of problem
The response to one part of a stem does not .influer.ce or exclude possible
responses to any of
the others {I.e , -there may be -five true or five false answers in any stem or
any other combination).
Two hours are available to answer the papers. Answers are recorded onto a
computer niarking sheet with the soft lead pencil.
Pe11cil ,is provided.
It is important that all sixty systems are. Answered either 'True' or 'False ' in
each of the 300 spaces.
A sample answer sheet is sent out to all candidates 1,id it is important to be
familiar with~ this and the order of questions cm lt.
The computer marks the sheet by giving on mark for each correct answer.
The wording of MCQs may be difficult for those unused to this form of
examination in that it can appear ambiguous.
There is a consensus that the following term has these implied meanings:
Occurs
-makes no statement on
symptoms) (T)
I some questions trap by virtue of names which sound
alike
e.g. catatonia, catalepsy , cataplexy .
others bring in names or terms from other Ares which sound right even
though they are wrong. e.g. the following are correctly paired with the
concepts they introduced :
Chapter II
Clinical
Examination
Build up:
1 . Where is it
2. What cases they can possibly present.
3.
3.
What to wear.
difficult)
-be hesitated
-take too long
-give too much detail
Do not say the patient is liying by saying he claimed , he denied , he is
promiscuous
Do not give the diagnosis alone say its differential Diagnosis ( I , II , Ill) If
they ask you what is your impression they mean The . formulation.
C . Questions:
-Look interested
-Answer to the point
- expect to be provoked
-stick to your opinion
-do not anger
minutes
the case
Q : What is the crutial points about the case, this means: History,
Chapter III
In Oral
DON'T
- be evasive
be too Cautious
- Put your foot in it
- Worry if interrupted
- Worry if they change the topic quickly
- Anger
** Admit if you don't Know in some points Be great full for Criticism
Remember examiners are humans
ID
Example Oral questions
statement then details of the problems, history, mental state, diff. diagnosis
and etiology)
Chapter IV
OSCE
)r . Ziad . N . Arandi
Assistant Professor ol I'sycchiatry An - Najaah Univrsity
D . P . L Psych - London B . C . L Psych - London J . B . C Psych Amman
The OSCE was introduced for the first time in Spring 2003 and it replaced
the individual patient assessment (i.e. the long case). The OSCE consists of
12 stations that test the range of psychiatric knowledge and skills acquired
within first 12 months of basic specialist training (i.e. at the SHO level). The
examination may include one or two additional pilot stations, the results of
which do not count towards the overall result of the OSCE. The patient's role
is played by a role player (actor/actress).
There is ONE examiner at each station, who observes the candidate as they
perform their task. The examiner does not get involved except in exceptional
circumstances. Candidates have ONE minute before entering each station to
read the instructions. These include the purpose of the station and basic
information
OSCE ADVICE
THE EXAM STRUCTURE
There are 12 7-minute stations.
There may be a rest station, but tbis depends on the examination centre. You
have l minute to read the scenario and tasks.
You will then hear a buzzer: walk into tbe station and perform the tasks. You
have 7 minutes to complete your tasks.
At 6 minutes, a buzzer will sound, reminding you that there is J minute left
to go At 7 minutes, a buzzer will sound: you must stop whatever you are
doing.
Move on to the next station.
Total examination time: I hour and 36 minutes (excluding any rest stations).
Instructions vary in length, and number of tasks will differ between stations.
If you finish early, remain in the station.
Practising OSCEs over will give you an inherent sense of the timings.
EXAMINATION CONTENT
Basic components of history-taking, examination skills (e.g. cranial nerves,
motor system, fundal examination), practical skills (e.g. application of ECG
leads), emergencies {e.g. resuscitation) and communication skills (e.g.
explaining treatment, consent to treatment, prognosis) are all likely to be
examined.
MAnKING
According to the Royal College of Psychiatrists, a minimum of grade C in at
least nine stations is required to pass. Failing any station witb grade E
(severe fail) means that tbe candidate fails the OSCE overall (see
www.rcpsych.ac.uk/traindev/exams/index.htm). A useful way of revising is
to think, at each station that you practise, about what tbe examiner might
have on his or her mark sheet. In our answers, we have included points that
we believe the examiner will be marking you on.
OSCE TECHNIQUE
Remember: IEP (I'm an Excellent Psychiatrist).
Introduce yourself to the patient (use their name if given): 'Hello Mrs Jones.
My name is Dr Smith:
Explain what it is you have been asked (or would like) to do and make sure
they are okay witb this (permission).
, oscr advice
DEALING WITH THE ACTORS
You are acting as much as they are: you must pretend that all the scenarios
are =I, otherwise you might underperfonn.
Always put the 'patient' at ease.
Try to develop rapport (supportive remarks).
Listen to what they are saying to you - don't ignore important cues. Actors
have been instructed to be difficult or to get upset at certain stations, so don't
take it personally; you can score highly if you handle it well.
EXAM DAY
There have been reports of confusion at the OSCE centres - he prepared for
this.
Be blinkered as you pass through your stations. Don't get distracted by
another candidate performing at their station.
Remember that the candidate before: you is direct competition. You must
'up' your performance on exam day.
Some people find it helpful to record their practice sessions using a small
cassette recorder and listening back to themselves.
I find it hard to keep to the seven minutes
By practising repeatedly, you will get a good feel for 7 minutes. If possible.
do not finish a station too early.
Sdting .the scene is a useful way to start and can give you some ttlinkmg
time should you RqDire iL For example, Tm sony to hear you've been
having side effieds from the medication. Would it be alright if you told me
how the medication bas been affecting you?'
GENERAL ADVICE
Try to impart infunnation to the patient dearly {this needs practice). Clear
speech rommunicares intdligence and competmce.
Speak in lay terms to patients.
/Speak in professional terms in stations where the actor pmrnds to be a
colleague or the 1asks directly involve the examiner.
Start each interview with open qurstions and then become more fuemed. e.g.
'Can you tell me how you &av., been fttling nn:ntly?'
Avoid swing questions. e.g. 'Are you feeling high or low?' - not good. Avoid
leading questions. e.g. 'You're feeling low now. aren't you?'
. Don't ignore non-'ffiiial signs. e.g. tremoL
/ Pauses and moments of silence are acceptable. especially after emotional
responses. Be empathetic in such situations.
Exert control if you find the patient veering off the sul!iect. Bring them back
gently to the task you need to complete. 'We were just tailing about the
voices-.' 'fo come back to the voices you've been hearing._' 'Could you tell
me some more about the voices?'
It is bettez- to say you don't know something than to mate it up. Sommmes,
delaying an answer works well 'I will look into this and get back to yon'.
You must practise doing more than one station at a time so that you learn
how to overcame a poor performance in a previous station.
Although time will often be short; appearing umushed and calm looks
prolessional.
Know the ICD-10 diagnostic criteria fur the common conditions. Think safe
and consider the risk element in each station.
Have a general medical colleague run through physical examinations of the
main systems [cardiovascniar. etc.) with you so you will feel more confident.
DEMEANOUR
Body language 'h vi:,y important. Do not slouch, fold your arms or cross
your legs. Rather, sit on the chah; with both reet on the ground, leaning
slightly towanls the actor, Your hands should be together or holding paper.
most stations. However. in some stations, this will be the principal skill
tested.
lt!Slory taking.
~ of matlal wsonlr:ts
PhysicaJ/neuroJogical examination
disorders, depersonalization.
puerperal psychosis,
Eliciting
collateral
history
from
relatives/carers
regarding
illnesses.
Cranial nerves
Fundi
dYsfunction
Practical skills and use of equipment
These stations assess some of the practical skills an SHO would have learnt
during the fust year of training. The stations concerned will usually involve
anatomical models rather than patients. The candidates must also be able to
use appropriate equipment when carrying out an examination.
Determination of correct settings on an ECT apparatus e Application of ECT
electrodes
History taking
Eliciting psychotic symptoms, including Schneider's first rank symptoms
from patients
with schizophrenia,
schizoaffective
disorder, mania,
dependence.
Eliciting features of frontotemporal dementia, Alzheimer's disease,
multiinfarct dementia, Lewy body dementia, Pick's disease, CreutzfeldtJakob disease, Huntington's disease, Parkinson's disease and multiple
disseminated sclerosis.
Eliciting salient features of schizoid, schizotypal, antisocial (dissocial), and
borderline (emotionally unstable), histrionic and narcissistic personality
disorders.
Eliciting salient features of somatoform disorders, e.g, somatization,
hypochondria, persistent somatoform pain disorder.
patients/carers
in
decision
making
and
checking
their
understanding.
Communicating with other healthcare professionals, e.g. discussing a patient
with a senior medical colleague.
Breaking bad news, building rapport and showing empathy, respect and
sensitivity to others' emotions and coping with strong emotions of other
people.
Seeking informed consent for investigations, electroconvulsive therapy
(ECD, antimanic drugs, antipsychotic depot injections, clozapine.
Dealing with anxious or angry patients or carers.
cognitive-behavioural
therapy
and
other
psychological
Interpreting
ECG,
electroencephalogram
(EEG),
blood
tests,
( stations and advice answers) STATION 1111c maln<rof a tt----ald man has aslml tD ,a, yon. Your mun has rettn1ly
diagnosal her .son with sdlizophn,nia am she has some questions for you.
Before his admission. he had been fiankly p,ytltulic and threalDling towaJd;
her. He thought that 11,115 was afb:r him and that bis life was in danger. His
mother iniliaRy old not bcliew: that he was mentally unwell and lhougltt he
was using illidt drugs and lazing around. Slit admits 1D having hem bosl:iJe
and aitical of him and that there were many arguments at home.
She asks you: What is sthimplua1ia? Is it a spit pe15111131ily?
What will ~ the t:ffttls of 111e illness m hd' son?
What are the diffaatc,es betwcai pasitM and ~ symptoms?
What beatmt:nts are available? - STATION 2
1hest, parenls have a 17-ycir-old dauglm,r Rllddly diagnosal lllilll anorexia
nenrusa. 1hq, had nom,ed for 5IIIUlle time thatshc would notmtwilh 11mn at
meal tinKS and was -.g weight. 1hq, have "'3nl of 1he illness but have a
number of questions lhatff,ey would th 1D ask.
Depression (low mood and suicidal thoughts are common) Low self-esteem
What treabnents are available?
'Firstly, the earlier and quicker someone is diagnosed and treated, the better:
'Some people make a full recovery:
Discuss the importance of the following and their roles in management:
Medication
The multidisciplinary team Family
Day centres and work projects
Psychotherapy [targeted at abnormal perceptions or mood symptoms)
Organisations: Rethink, Mind, SANE
ASK WHETHER SHE HAS ANY OTHER QUESTIONS THANK HER
Control:
may respond better to the advice of someone outside the family, such as an
eating disorders specialist or the family doctor. If she has not already been
referred to a specialist, then this should be recommended.
The Royal College of Psychiatrists advises the following:
Eat regular meals, including breakfast, lunch and dinner. Eat a balanced diet.
Include carbohydrates with each meal. Don't skip meals.
Avoid sugary and high-fat snacks. Take regular exercise.
Try not to be influenced by other people skipping meals or commenting on
weight.
Offer the parents some information leaflets about the disorder.
ASK WHETHER THEY HAVE ANY OTHER QUESTIONS
THANK THEM
'Because lithium can interfere with thyroid function, we like to check the
thyroid before we start treatment, and then 6-monthly thereafter. We also
take a tracing of the heart to confirm that there are no pre-existing
abnormalities that may
worsen with lithium treatment:
A concentration of 0.5-1.0 mmol/L is usually sufficient for clinical effect.
Because the dose has to be kept within certain limits, the blood has to be
monitored initially after 5-7 days, and then weekly until the correct level has
been reached. Finally, levels should be monitored every 3-6 months when
stabilisation has occurred.
Lithium is prescribed as a single dose at night.
ASK WHETHER HE HAS ANY QUESTIONS
THANK HIM
FOR EXTRA MARKS
Toe most common side effects are tremor, polynria, weight gain and nausea.
The tremor can sometimes be treated with a beta-blocker.
Toe nausea can be counteracted by taking the lithium with food; sometimes,
changing the preparation of lithium can make a difference.
Mention interactions with other drugs, e.g. diuretics, NSAIDs, haloperidol.
Offer a patient inforrnation leaflet.