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OSCE in Pediatrics

OSCE in Pediatrics

RG Holla MD DM
Head of the Department, Neonatology
Fortis Hospital
Shalimar Bagh, New Delhi, India
Vivek Jain MBBS MRCPCH
Consultant, Neonatology
Fortis Hospital
Shalimar Bagh, New Delhi, India
Manish Mittal DCH DNB
Senior Registrar
Pediatrics and Neonatology
Fortis Hospital
Shalimar Bagh, New Delhi, India

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OSCE in Pediatrics
2011, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval
system, or transmitted in any form or by any means: electronic, mechanical, photocopying,
recording, or otherwise, without the prior written permission of the authors and the publisher.
This book has been published in good faith that the material provided by authors is
original. Every effort is made to ensure accuracy of material, but the publisher, printer
and authors will not be held responsible for any inadvertent error (s). In case of any
dispute, all legal matters are to be settled under Delhi jurisdiction only.
First Edition: 2011
ISBN 978-93-5025-155-3
Typeset at JPBMP typesetting unit
Printed at

To
Our Parents
Mrs Shantha and Mr BV Holla
Mrs Sushila and Mr Suresh Chand Jain
Mrs Usha and Mr Mahesh Chand Mittal

Foreword
The system of Objective Structured Clinical Examination (OSCE) has been
evolved to make the system of assessment in clinical subjects as objective
as possible. While the routine examination system which involves clinical
case presentation cannot be totally replaced, yet it tends to be somewhat
subjective and is usually unable to test the knowledge and skills of the
candidates over the entire syllabus. The OSCE system not only is more
objective, but it also provides opportunity to examine the student over a
much larger area. The system, in fact, is very helpful to the students as his
deficiencies in small areas can get covered in larger areas of the syllabus.
However, as the person, who was associated with the National Board in
introducing the OSCE system in the specialty of pediatrics, I have noticed
great apprehension among the National Board candidates regarding this
system of examination. This has largely been due to non-availability of
suitable texts on the subject and inability of most centers and teachers
imparting training to DNB candidates, to familiarize the students with the
new system in absence of such texts. Dr Holla is a very experienced DNB
examiner, Dr Jain is a Member of Royal College of Paediatrics and Child
Health, London, UK. Dr Mittal has cleared the DNB Pediatrics in the new
format of examination. They have all done well to fill this very important
gap. This book focusing on OSCE system is refreshingly new in concept
in that it is not only a source of imparting information (which most
textbooks tend to be) but also a great help in structured learning of the
subject and imbibing of the knowledge by the student. The teachers
involved in training and assessing the DNB candidates will also benefit
greatly from this book as it will enable them to understand the basic
concepts of OSCE and enable them to develop many more such questions.
Although written primarily for DNB candidates, this book will be useful
for other postgraduate (MD, DCH) students in pediatrics and even for
practicing pediatricians as it provides ready reference tool for various
clinical situations. As the book includes multiple choice, it will also help
students preparing for clinical skill examinations for the US specialty board
and for MRCPCH examinations.
SK Mittal
Chairman, Department of Pediatrics
Pushpanjali Crosslay Hospital, Ghaziabad (NCR)
Formerly
Director Professor and Head
Department of Pediatrics
Maulana Azad Medical College, New Delhi, India

Preface
The traditional case presentation, still in vogue in most postgraduate
examinations, covers only a part of the examinees medical knowledge.
The direction that the discussion takes during a case presentation and the
level of interrogation depends both upon the examinees and examiners
approach. This leads to a subjective assessment. Certain areas of clinical
pediatrics like interpretation of laboratory and radiological reports,
communication skills, problem solving and knowledge of clinical
procedures are not tested routinely in the traditional examination.
The Objective Structured Clinical Examination (OSCE) attempts to
overcome these drawbacks by providing a broad-based format to assess
the candidate on multiple aspects of the subject. Objectivity brings with it
an element of uniformity. Being structured gives a focus on preparation
and assessment. The wide variety of topics inherent to childhood illness
(from neonatology to adolescent medicine, from intensive care to social
pediatrics, from child development to surgical emergencies and so on)
provides a delightfully wide source for the examiner to draw upon, but is
a nightmare for the candidate. However, there is a silver lining. Being broad
based, OSCE gives the candidate an opportunity to make up from an easy
question, any marks lost in a station in which he has not scored well.
With the introduction of the OSCE system as an integral part of the
DNB Pediatrics examination, there was a felt need amongst students for a
guide which could help them prepare for the examination. Moreover, the
requirement to qualify separately in OSCE in order to receive accreditation
made the necessity for such a volume all the more imperative.
The book OSCE in Pediatrics is neither meant to cover the whole field
of pediatrics nor is it intended to serve as a question bank. It is an effort to
sensitize and introduce the student to the OSCE format so that the student
can prepare accordingly.
The ambit of OSCE extends beyond the examination hall. Preparation
for OSCE trains the student to approach a problem in a systematic manner
and would certainly help in dealing with the real-life patient.
The authors have drawn upon a wide variety of inputs in the
preparation of the questions. No effort has been spared in trying to ensure
accuracy of medical facts, drug dosages and so on. It is, however, possible
in the changing world of medicine for error to creep in. We regret any such
inadvertent shortcoming and welcome suggestions and criticism.
RG Holla
Vivek Jain
Manish Mittal

Contents
1. Connective Tissue .................................................................................... 1
2. Counseling, History and Examination ..............................................10
3. Drugs and Vaccines ...............................................................................24
4. Endocrinology ..........................................................................................36
5. Genetics ....................................................................................................48
6. Gastrointestinal Disorders ...................................................................64
7. Hematology, Oncology ..........................................................................76
8. Infection ...................................................................................................93
9. Neurology ............................................................................................. 109
10. NALS, PALS ......................................................................................... 125
11. Community Medicine ......................................................................... 131
12. Respiratory System ............................................................................. 139
13. Statistics ................................................................................................ 151
14. Miscellaneous ...................................................................................... 162
15. Cardiovascular System ....................................................................... 175
16. Growth, Development and Nutrition .............................................. 185
17. Neonatology .......................................................................................... 196
18. Radiology .............................................................................................. 223
19. Renal System ....................................................................................... 246

Introduction
The OSCE or Objective Structured Clinical Examination is an integral part
of the accreditation examination for the Diplomate of National Board in
Pediatrics. It is conducted as a part of the practical examination, and is
held on one of the three days of the practical examination (depending upon
the number of candidates in a center). The OSCE part of the exam is held
for all candidates on the same day.
The OSCE in Pediatrics conducted by the National Board consists of
25-30 stations that the candidate has to attend by rotation. Each station
has one or more tasks for the candidate to complete in a fixed time, usually
5 minutes. The stations consist of questions or problems and usually cover
the following topics:
1. Case studies.
2. Interpretation of laboratory reports.
3. Interpretation of radiological investigations, which may be
conventional radiographs, ultrasonograms, CT scans or MRIs.
4. Interpretation of ECGs.
5. Clinical photographs.
6. Biostatistics problems.
7. Questions in community medicine related to pediatircs/neonatology.
8. Observed stationsat these stations, an examiner observes the actions
of the candidate while performing a task. The task given may be one
of the following:
a. A situation in neonatal resuscitation.
b. A situation in pediatric advanced life support.
c. Clinical examination of a system.
d. Anthropometry and derivation of indices of growth and nutrition
e. Procedure, e.g. liver biopsy on a dummy, etc.
f. Counselingincludes counseling a patient to use a particular
drug device or of a parent regarding a childs illness.
9. Drug or vaccine.
10. Equipment or instrument.
11. Biomedical waste management.
Each station is usually of five marks. The examiners are given a key
which is their guideline for assessment. As such, there is no scope for an
examiner to delve beyond the key to award or deduct additional marks for
supplementary correct or incorrect information given by the candidate. Most
answers are from standard textbooks in pediatrics.
Observed stations are a challenge but can be easily mastered with a
little practice. Marks are awarded for each point covered by the candidate
including introducing oneself and establishing rapport, taking permission
prior to uncovering and examining a patient, covering a patient after

xiv OSCE in Pediatrics


having completed the examination and wishing the patient before leaving.
In the history taking and counseling stations, the content rather than the
style is assessed. The examiner expects basic competency and basic steps
in history taking and clinical examination. Questions related to NALS and
PALS stick to the standard guidelines. Thus it is possible to score well in
these stations if one goes prepared.
By and large, the laboratory and radiological investigations given in
OSCE are simple and straightforward and stress on the clinical aspect of
the illness. Diagnostic skill possessed by a trained pathologist or
radiologist is not expected of a student.
Poor performance in OSCE is primarily responsible for a poor outcome
in the DNB practical exam and results from lack of knowledge or
preparation for the same. A candidate would benefit from regularly
practicing mock OSCE drills. This does not have to always take the form
of a formally organized mock OSCE. Informal bedside rounds, group study
sessions, delivery room calls and so on, provide ample opportunity for
students to pose a problem and assess each other and practice for the
observed stations.
The final word for success in OSCE:
Practice, practice, practice.