INTERNAL MEDICINE: Sample of OSCE Examination component questions

1. Bedside Station with a Standardized Patient

Scenario read to candidate:

“This patient presents with acute shortness of breath. Demonstrate and describe how
you assess the jugular venous pressure (JVP) and abdominojugular (hepatojugular)
reflux (AJR).”

A successful candidate would:

• Introduce themselves to the patient, appropriately drape the patient and explain
what they are doing, treat the patient with respect.
• Position the patient at an appropriate angle, examine the right internal jugular vein.
• Inspect the JVP, describe how to confirm they are visualizing a venous pulsation
compared to the carotid pulse, measure the height of the JVP above the sternal
angle.
• Demonstrate the AJR with firm pressure on the upper abdomen for at least 10 sec,
looking for a sustained rise of > 4 cm. Know the accuracy of this manoeuvre.

2. Communications Station with Standardized Patient

Scenario read to candidate:

“For this patient, you recommend an ACE Inhibitor for their worsening heart failure.
You have explained the indications for an ACE Inhibitor. She/he then asks you about
the risks of an ACE Inhibitor. In the next 5 minutes, please discuss the consequences
of taking an ACE Inhibitor by conducting a conversation with the patient as you would
in a real life situation.
Assume that the patient is fully competent and able to cooperate.”

Candidates would be assessed primarily on the how they conduct the interview (using
tools such as the Bayer Institute for Health Care Communication E4 Model, Calgary-
Cambridge Observation Guide) and secondarily on the content of the information
conveyed to the patient.

A successful candidate would:

Process:
• Demonstrate appropriate interviewing skills
• Demonstrate appropriate interpersonal skills

Content:
• Discuss a few common side effects of such as cough, worsening renal function,
hyperkalemia, hypotension
• Discuss how they would monitor and manage the side effects e.g. monitor
creatinine and potassium. For cough, lower dose or discontinue and switch to
ARB.

March 2018

3. Clinical scenario in an Objective Structured Clinical Examination (OSCE)
format

Scenario read with candidate:

“A 20-year-old male who lives alone is brought to the Emergency Department after
being found in his apartment which had caught fire. At the time of evaluation, the
patient is alert and oriented but feels short of breath. Describe how you would
approach the management of this patient.”

A successful candidate would:

• Describe how they would assess the stability of the patient.
• Describe the appropriate monitoring for the patient’s problem(s).
• Request from the examiners the pertinent items of a directed history and physical
exam as dictated by the clinical situation.
• Generate an appropriate synthesis of the data.
• Formulate a differential diagnosis and then the appropriate diagnostics to allow
definitive definition of the patient’s problem(s).
• Generate an appropriate management plan and discuss their choice(s) of
treatment as necessary.
• In some scenarios, explain their management choices based on the best available
evidence
• Demonstrates organized, effective, safe, timely and appropriate consultative skills

March 2018