CASC Linked OSCE

STATION TITLE:
ASSESSMENT OF AN ELDERLY MAN
LINKED STATION
(DISCUSSION WITH CONSULTANT)

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CASC Linked OSCE

STATION TITLE: ASSESSMENT OF AN ELDERLY MAN - LINKED STATION

(DISCUSSION WITH CONSULTANT)

Instructions to Candidate

You have called your on-call consultant Psychiatrist to discuss the case you have seen in the

previous station. The on-call consultant lives about 60 minutes away and has returned your

call to discuss the case you saw in the previous station.

Task:

Discuss your findings with the consultant.

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CASC Linked OSCE

STATION TITLE: ASSESSMENT OF AN ELDERLY MAN - LINKED STATION

(DISCUSSION WITH CONSULTANT)

Instructions to Simulated Consultant

You are the on-call Consultant Psychiatrist and have been called by the SHO who has
assessed a patient in the Medical Admissions unit.

You want them to present their assessment and management plan in a coherent and concise
manner. You may have some questions if the candidates are not clear in their presentation.

1. Tell me about the case, including psychopathology, risk assessment and cognitive
functions

2. Ask them to provide the main differentials they are considering?

3. Risk assessment - what is the risk in this case?

4. What factors did you consider while deciding on the risk assessment?

5. What is your management plan? – Medication, ECT, Psychological treatment, Short

term, long term?

6. Where do you want to manage them? Use of Mental Health Act?

7. Detailed questions regarding ECT – Role of ECT in this case including consent,
(indications / contraindications – patient has cardiac and renal problems), the
investigations to be done, Precautions to be taken (anaesthetic due to medical
problems), procedure itself, post ECT treatment, including side effects – memory
issues.

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 CASC Linked OSCE

STATION TITLE: ASSESSMENT OF AN ELDERLY MAN - LINKED STATION

(DISCUSSION WITH CONSULTANT)

Examiner please mark one lozenge for each objective

Key: A=excellent, B=good, C=average, D=fail, E=severe fail

CONSTRUCT: The candidate should be able to communicate the risk assessment and
management plan to the Consultant in a clear and concise manner.

A B C D E
Communication

Concise summary

Risk assessment

Management Plan

Use of Mental Health Act

Information on ECT

GLOBAL RATING

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CASC Linked OSCE

STATION TITLE: ASSESSMENT OF AN ELDERLY MAN - LINKED STATION

(DISCUSSION WITH CONSULTANT)

Notes on communication with the Consultant:

This is a station assessing your communication skills, particularly your ability to summarise
findings in a concise manner and formulate a treatment plan, but being willing to alter it if
advised by a senior colleague.
Mr Wright is suffering from a severe depressive episode with psychotic symptoms. In
addition to this there are associated somatoform pain symptoms and evidence of a
depressive pseudodementia which clouds the picture. The candidate should pick up that
these symptoms emanate from the depressive illness and should also pick up the ongoing
risk of self neglect and the need for rapid treatment. Good candidates should be able to
point out the most relevant aspects including:

1. This is an urgent situation with a risk of death from the consequences of

dehydration if not treated as soon as possible.

2. The most effective and rapid acting treatment for severe depression with
associated threat to life is electroconvulsive therapy.

3. As the patient is currently unable to consent for himself, the need to use the
Mental Health Act as soon as possible to facilitate treatment.

4. You do not think that he should leave the ward he is on immediately because he
will need to be given parenteral fluids while the ECT takes effect. However you
will move him to a psychiatric ward as soon as this is safe.

5. He can continue to be given physical treatment against his will in his best
interests using mental capacity legislation.

6. In addition to the ECT you will also start him on an antidepressant treatment.
This should be one shown to be safe in people with cardiac problems
(e.g.sertraline)

7. Provide full details about the ECT procedure including consent issues,
indications, contraindications, investigations, procedure and side effects.

Good candidates will appreciate the emergency nature of the situation and communicate
that urgency. Good candidates will be responsive to questions posed by a senior
colleague, and show willingness to change management in light of advice. Poor
candidates will take a pseudo didactic lecture format which reflects poor performance
and marks awarded to them should reflect this.