OSCE stations: Questions

Format of and approach to OSCE stations

OSCE is the abbreviation used for objective structured clinical examination. The OSCE stations are written to comply with the ‘2 + 8’ format. This involves 2 minutes’ reading time and 8 minutes’ performance per station.

OSCEs are used for assessment of clinical skills. Typically, a sound performance includes acquiring pertinent clinical information (history and/or examination), requesting and interpreting investigations and formulating and explaining your plan of management. The degree of emphasis on these components varies, and not all will necessarily be included in any particular station. You might during the performance also be required to answer questions posed by the patient/actor.

How is an OSCE performance assessed? Different organizations use different tools, but they all have in common that the performance criteria are linked to the learning outcomes for your course. Some marking systems categorize performance by domains, such as Professionalism, Knowledge, Reasoning and Clinical Practice.

How should you prepare for an OSCE? Know the subject; practise your skills as appropriate with patients, friends and colleagues; and read and answer the question!

Chapter 6

• Setting: Outpatient clinic, general maternity unit

• Role: Junior doctor (intern)

• Scenario: Mary Maxwell is a 35-year-old woman in her third pregnancy attending her local maternity unit for a routine booking visit. Ms Maxwell works full time as a teacher and lives with her husband and their 4-year old child. This pregnancy is planned. Her current medications are atenolol 50 mg daily and folic acid 5 mg daily. She has no allergies.

Ms Maxwell has been weighed, her blood pressure (BP) has been recorded and urinalysis performed.

The results are:

• Height, weight, body mass index (BMI): 160 cm, 88 kg, 34.4 kg/m ²

• Blood pressure: 140/90 mmHg (large cuff)

• Urinalysis: positive for glucose; negative for protein, ketones, white blood cells and nitrites

Tasks:

• Take an obstetric and medical history from Ms Maxwell. (6 minutes)

• Advise Ms Maxwell of the next steps that you will arrange in relation to her ongoing care in this pregnancy. (1 minute)

• Answer any questions she might have. (1 minute)

Note: The actor might not have the stated physical characteristics.

Chapter 7

• Setting: Outpatient clinic, general maternity unit

• Role: Junior doctor (intern)

• Scenario: Hilda Humphries is a 27-year-old woman at 7 weeks’ gestation in her first pregnancy. She works full time as a cook and lives with her 32-year-old partner John Jamieson, who is a long-distance truck driver.

Hilda has a history of subfertility and polycystic ovarian syndrome. She conceived spontaneously after losing 10 kg in weight by dieting and with regular exercise. Her current weight is 82 kg (BMI 29.8 kg/m ² ).

She wants to discuss with you the adjustments, if any, she should make to her diet and in her exercise routine at the gym during her pregnancy.

Tasks:

• Take a directed history from Ms Humphries. (5 minutes)

• Advise Ms Humphries regarding diet and exercise and any other matters you uncover that are relevant to optimizing her health and the outcome of her pregnancy. (2 minutes)

• Answer any questions she might have. (1 minute)

Notes: The actor might not have the described physical characteristics. Assume the dates are certain.

Chapter 8

• Setting: Assessment unit, general maternity unit

• Role: Junior doctor (intern)

• Scenario: Freda Fisher is a 33-year-old woman in her second pregnancy who has presented to the acute assessment unit at her local maternity unit with vaginal bleeding.

Ms Fisher is currently at 34 weeks’ gestation.

The assessment unit midwife has recorded the following observations:

• Pulse: 72 beats/min

• Blood pressure: 130/70 mmHg

• Abdominal palpation: soft abdomen, breech presentation

• Symphysial fundal height: 34 cm

• Fetal heart rate (hand-held Doppler device): 140 bpm

• Urinalysis: positive for blood; negative for leukocytes, nitrites, protein, ketones

Tasks:

• Take a relevant history from Ms Fisher. (6 minutes)

• Explain to Ms Fisher the next steps that you will arrange in the assessment unit. (1 minute)

• Answer any questions she might have. (1 minute)

Note: The actor might not have the stated physical characteristics.

Chapter 9

• Setting: Prenatal counselling clinic, general maternity unit

• Role: Junior doctor (intern)

• Scenario: Mary Morris is a 33-year-old G ₃ P ₁ woman referred to your clinic by her local doctor for prenatal counselling.

Ms Morris lives with her partner and their 4-year-old daughter. She is homozygous for the factor V Leiden gene mutation and has been taking warfarin on a daily basis for several years.

She and her partner want to have another child.

The patient’s current BMI is 28 kg/m ² and her blood pressure is 120/70 mmHg.

Tasks:

• Take a relevant history from Ms Morris. (6 minutes)

• Explain to Ms Morris the next steps that you will arrange in relation to her prenatal care. (1 minute)

• Answer any questions she might have. (1 minute)

Note: The actor might not have the stated physical characteristics.

Chapter 10

• Setting: Outpatient clinic, general maternity unit

• Role: Junior doctor (intern)

• Scenario: Alison Albright is a 39-year-old woman in her fourth pregnancy attending her local maternity unit for an antenatal visit.

Ms Albright is currently at 34 weeks’ gestation (based on a dating scan at 8 weeks’ gestation). She has not attended several routine clinic appointments. She has been caring for her ill mother and has been managing by herself a busy household comprising her three school-aged children. Her husband has been posted overseas on military service for 5 months now and is not due to return home for another month.

At the previous visit (30 weeks’ gestation), routine observations included blood pressure 110/80 mmHg, breech presentation and symphysial–fundal height 28 cm.

At today’s visit:

• Blood pressure: 110/80 mmHg

• Symphysial–fundal height: 28 cm

• Breech presentation

• Urinalysis: normal

Tasks:

• Take a brief directed history from Ms Albright. (3 minutes)

• Advise Ms Albright of the investigations that you will arrange today. (1 minute)

• You will then be provided with some results. Read the results. (1 minute)

• Explain the results to Ms Albright and advise her of your plan of management. (2 minutes)

• Answer any questions she might have. (1 minute)

Note: The actor might not have the stated physical characteristics.