Jumat, 23 Maret 2012

HOW CAN I DO WELL ON AN OSCE

 

The OSCE is an assessment of clinical knowledge, skills, and attitude. The communication skills you demonstrate and the process you go through in obtaining a history or performing a physical examination are more important than determining a diagnosis.
The best way to prepare for an OSCE is repetitive practice. When you are able to perform all of the tasks on the course objectives for a complete medical history and physical examination in an organized and efficient fashion, you are ready for the OSCE.
After the first year, it is important to understand that some cases are designed to present more than one diagnostic possibility. Keep your mind open to all possible diagnoses and explore the relevant ones as time permits.
Students are encouraged to use the Clinical Skills Center to practice clinical skills on each other.

GENERAL TIPS

  • Dress neatly and professionally.
  • Clip your fingernails before the exam.
  • Do not attempt to communicate with the patient out of role or other than as a physician to a patient.
  • Stay in the room and use all the allotted time.
  • Do not try to make a diagnosis.
  • Be as complete as possible. Do not skip clinical skills just because you know (or think you know) the diagnosis.
  • Let the proctors know if you have any problems.

COMMUNICATION TIPS (to all station)
  • Knock before entering the exam room.
  • Greet the patient warmly.
  • Make physical contact with the patient (shake hands or appropriate touch).
  • Introduce yourself by name and as a student.
  • Elicit or confirm the patient’s name.
  • Explain your task to the patient.
  • Make and maintain eye contact.
  • Ask clear questions.
  • If you use medical jargon, explain yourself.
  • If you don’t know the answer to a patient’s question, say so.
  • Acknowledge the patient’s concerns.
  • Be direct and honest, but also be sensitive.
  • Close the encounter when the audio signal is given to leave the station.

HISTORY STATION
  • Sit at eye level with the patient (don’t “hover over” the patient).
  • Use an open posture (arms uncrossed, leaning forward).
  • Begin with broad, open questions, and then move from the general to the specific.
  • Avoid multiple questions. They confuse the patient and can cause you to miss important checklist items.
  • Use nonverbal encouragement.
  • Use pauses and give the patient time to answer. Don't rush the answers or cut the patient off with another question.
  • Ask follow-up questions. You said you don’t smoke. Did you ever smoke?
  • Elicit the 8 attributes of any symptom.
  • Keep your mind open to all possible diagnoses and explore the relevant ones as time permits.
  • Summarize!!!!


PHYSICAL EXAMINATION STATION
  • Use a stethoscope with separate bell and diaphragm heads.
  • Remember that proper auscultation technique requires that the stethoscope be placed directly on the patient's skin. Wash your hands with soap in front of the patient before beginning the physical examination.
  • Talk before you touch. Tell the patient when you are ready to begin the physical exam.
  • Describe the maneuvers either before or as you perform them.
  • Always use patient gowns and drapes to maintain patient modesty and comfort.
  • Never examine through the patient’s gown.
  • Do a focused (not comprehensive) physical examination based on the presenting problem.
  • If you believe a rectal, pelvic/genital, or female breast exam is indicated, tell the patient. The patients are trained to deal with this part of the physical examination.
  • If you ask a patient to lie back on the examination table, pull the leg rest out, then help the patient sit back up and return the leg rest. Help the patient on and off the exam table.
  • After the first year, some SPs will have positive physical findings. Some findings may be simulated, but should be accepted as real.

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