OBJECTIVE STRUCTURED CLINICAL EXAMINATION “OSCE” Hassan Nasrat Professor of Obstetrics & Gynecology King Abdulaziz University Hospital

OSCE O : OBJECTIVE S : STRUCTURED C : CLINICAL E : EXAMINATION

OSCE Why OSCE? WHAT DOES IT TEST ? HOW TO RUN IT?

Why OSCE?

Antenatal Labor Postnatal Newborn Gynecology History Obstetric H/R Diagnosis of labour History of Gynecology Physical Obstetric Maneuvers Progress in labour Post natal evaluation ( normal and CS) Delivery relevant complications Tests/investigations/procedures BPP Routine AN tests CTG Instruments Tests in complications Resuscitation of Newborn Specific investigations Data interpretation GTT PET Partogram Postnatal tests: Rubella. RH HSG Semen test Hormone profile Communication and education Nutrition Exercise Breast feeding Contraception

Antenatal Labor Postnatal Newborn Gynecology History Obstetric H/R Diagnosis of labour History of Gynecology Physical Obstetric Maneuvers Progress in labour Post natal evaluation ( normal and CS) Delivery relevant complications Tests/investigations/procedures BPP Routine AN tests CTG Instruments Tests in complications Resuscitation of Newborn Specific investigations Data interpretation GTT PET Partogram Postnatal tests: Rubella. RH HSG Semen test Hormone profile Communication and education Nutrition Exercise Breast feeding Contraception

Antenatal Labor Postnatal Newborn Gynecology History Obstetric H/R Diagnosis of labour History of Gynecology Physical Obstetric Maneuvers Progress in labour Post natal evaluation ( normal and CS) Delivery relevant complications Tests/investigations/procedures BPP Routine AN tests CTG Instruments Tests in complications Resuscitation of Newborn Specific investigations Data interpretation GTT PET Partogram Postnatal tests: Rubella. RH HSG Semen test Hormone profile Communication and education Nutrition Exercise Breast feeding Contraception

Antenatal Labor Postnatal Newborn Gynecology History Obstetric H/R Diagnosis of labour History of Gynecology Physical Obstetric Maneuvers Progress in labour Post natal evaluation ( normal and CS) Delivery relevant complications Tests/investigations/procedures BPP Routine AN tests CTG Instruments Tests in complications Resuscitation of Newborn Specific investigations Data interpretation GTT PET Partogram Postnatal tests: Rubella. RH HSG Semen test Hormone profile Communication and education Nutrition Exercise Breast feeding Contraception

Antenatal Labor Postnatal Newborn Gynecology History Obstetric H/R Diagnosis of labour History of Gynecology Physical Obstetric Maneuvers Progress in labour Post natal evaluation ( normal and CS) Delivery relevant complications Tests/investigations/procedures BPP Routine AN tests CTG Instruments Tests in complications Resuscitation of Newborn Specific investigations Data interpretation GTT PET Partogram Postnatal tests: Rubella. RH HSG Semen test Hormone profile Communication and education Nutrition Exercise Breast feeding Contraception

Antenatal Labor Postnatal Newborn Gynecology History Obstetric H/R Diagnosis of labour History of Gynecology Physical Obstetric Maneuvers Progress in labour Post natal evaluation ( normal and CS) Delivery relevant complications Tests/investigations/procedures BPP Routine AN tests CTG Instruments Tests in complications Resuscitation of Newborn Specific investigations Data interpretation GTT PET Partogram Postnatal tests: Rubella. RH HSG Semen test Hormone profile Communication and education Nutrition Exercise Breast feeding Contraception

This station is to test your ability to take relevant history Mrs. Fatma is 38 weeks pregnant lady complaining of headache

Grade Failure Border line Pass Marks 0.25 0.5 1. Age of patient 2. Duration of symptoms 3. Location of headache 4. Respond to pain killers 5. Nausea or vomiting 6. Blurred vision 7. Swelling of hands, feet and face 8. Pain in upper abdomen ( epigastric) 9. Previous pregnancies (i.e. obstetric history) 11. Menstrual History (regularity) 12. LMP 13.Past medical history 14. Past surgical history 15.Family history

This station is to test your skill in doing abdominal examination and building differential diagnosis 38 years old, P1 + 0 was referred to Gynecology clinic because of recurrent lower abdominal pain Do systematic abdominal examination What is the differential diagnosis

Failure Borderline Pass Grade Failure Border line Pass 1. Introduce him/hers self & ask patient name 0.5 2. Position patient properly for examination 3. Describe systemic general examination (not to do) Inspection 4. Scars 5. Hernia 6.Hair distribution 7. Movement of Abdomen Palpation 8. Ask about pain and start away from site of pain 9. Superficial palpation : start away from pain 10. Deep palpation 11. Feel for renal angles Describe Mass 12. Site 13. Size 14. Surface 15. Mobility 16. Tenderness Differential Diagnosis 17. Ovarian mass 18. Fibroid 19. Pregnancy 20. Bladder Failure Borderline Pass

Failure Borderline Pass Grade Failure Border line Pass 1. Introduce him/hers self & ask patient name 0.5 2. Position patient properly for examination 3. Describe systemic general examination (not to do) Inspection 4. Scars 5. Hernia 6.Hair distribution 7. Movement of Abdomen Palpation 8. Ask about pain and start away from site of pain 9. Superficial palpation : start away from pain 10. Deep palpation 11. Feel for renal angles Describe Mass 12. Site 13. Size 14. Surface 15. Mobility 16. Tenderness Differential Diagnosis 17. Ovarian mass 18. Fibroid 19. Pregnancy 20. Bladder Failure Borderline Pass

Data interpretation A 38 years old patient, Gravida 8 para 6+1. Her previous delivery ended by cesarean section due to failure to progress. Her family doctor have ordered a GTT and she brought the result for you for advise

Instruction for the Simulated Patient (Examiner) Doctor can you tell me is my GTT result normal or not? Is there any danger (complications) for me from this condition? Is there any risk for my baby?

Item Mark Well Average ND Interpretation of test (Positive for GDM) 2 1 Risks to the patient Increased risk of high BP (PET) ½ Increased rate of infection (urinary/vaginal) Risks to the fetus Polyhydramnios Macrosomia Operative / Difficult delivery RDS Neonatal Jaundice Other metabolic disorders Total

Item Mark Well Average ND Interpretation of test (Positive for GDM) 2 1 Risks to the patient Increased risk of high BP (PET) ½ Increased rate of infection (urinary/vaginal) Risks to the fetus Polyhydramnios Macrosomia Operative / Difficult delivery RDS Neonatal Jaundice Other metabolic disorders Total

Item Mark Well Average ND Interpretation of test (Positive for GDM) 2 1 Risks to the patient Increased risk of high BP (PET) ½ Increased rate of infection (urinary/vaginal) Risks to the fetus Polyhydramnios Macrosomia Operative / Difficult delivery RDS Neonatal Jaundice Other metabolic disorders Total

Data Interpretation 28 years old Gravida 10 Para 9+0 at 13 weeks of gestation came to the clinic complaining of: Palpitation and shortness of breath. A complete blood count (CBC) test was performed. You are require to interpret the result of the CBC

Item Mark Well Average ND What does the result of this test shows? (Examiner to show CBC form) Low hemoglobin (anemia) 1 1/2 What type of anemia Hypochromic micorcytic 2 Can it be confused with other type of anemia? Thalassaemia and Sickle cell anemia How would you confirm? Hemoglobin electorphoresis ½ Sickle cell test What do you think of this result? (Examiner to show the result of the electrophoresis) Confirm Iron deficiency anemia 3 Total

Postnatal Examination You are the house officer in the ward and in the morning round you came across this patient who had delivered 24 hours ago. How would you assess her?

Item Mark Well Average ND Initial approach to the patient (introduce him/her self, explain what he/she will be doing) 1 ½ Mode of delivery Delivery outcome (the baby) Lochia / Bleeding Bladder function Perineum/excessive pain (episiotomy) Check vital signs Breast feeding What important investigations you would like to review before discharge CBC 1/2 1/4 Blood Group (RH factor) Rubella test Hepatitis test Total:

Item Mark Well Average ND Initial approach to the patient (introduce him/her self, explain what he/she will be doing) 1 ½ Mode of delivery Delivery outcome (the baby) Lochia / Bleeding Bladder function Perineum/excessive pain (episiotomy) Check vital signs Breast feeding What important investigations you would like to review before discharge CBC 1/2 1/4 Blood Group (RH factor) Rubella test Hepatitis test Total:

Item Mark Well Average ND Initial approach to the patient (introduce him/her self, explain what he/she will be doing) 1 ½ Mode of delivery Delivery outcome (the baby) Lochia / Bleeding Bladder function Perineum/excessive pain (episiotomy) Check vital signs Breast feeding What important investigations you would like to review before discharge CBC 1/2 1/4 Blood Group (RH factor) Rubella test Hepatitis test Total: