OSCE

➢ Objective Structured Clinical Examination (OSCE) is

one form of objective evaluation method that is
gaining more importance and is being adopted by
educators of various disciplines
➢ Structured interaction between examiner and student
➢ All the candidates are presented with the same test
History taking ,Explanation , Clinical examination,
Procedures
 Advantage-OSCE
• Wider sampling than traditional methods
• Every candidate does same examination
• Greater opportunity for objectivity
• OSCE Stations are re-useable
• Better psychometrics than traditional methods
 Asthma
M B is a 29-year-old woman who presents to the ED for an acute visit due to
shortness of breath since awakening this morning.
She states that she has been using her albuterol every hour for the past 6 hours and
that it doesn’t seem to be helping she also has a fluticasone MDI, which she uses
“most days of the week.”
She reports having to use her albuterol inhaler approximately 3–4 times per week
over the past 2 months, but over the past week she admits to using albuterol almost
daily
Asthma (previously documented as “mild persistent”) since childhood Both parents
living; mother with HTN, osteoporosis, Chest X-Ray Hyper inflated lungs; no infiltrates
, she exercise twice aweek
BP 134/78, HR 110, RR 22, T 37°C; Wt 68 kg
Migraine headache disorder (diagnosed at age 21); currently taking
prophylactic medication; has had only one migraine attack in the
past year.
Past medication history
• Fluticasone 110 mcg, 2 puffs BID
• Albuterol 2 puffs Q 4–6 h PRN shortness of breath
• Propranolol 80 mg po BID for migrane headache
• Known to be allergic to gluten diet diagnosed celiac disease
A systematic approach to patient counseling
1- Give name and title:
My name is….. and I am the pharmacist in charge
here.
2- How may I help you? What is your complain?
3- Ask permission to gather information and
explain rationale: Can I ask you few questions?
4- Privacy This is a confidential place so feel free to
say whatever you want.
Gather information:
1- What is your name?
2- Ask the age/DOB of patient.
3- Have you seen a physician?
I feel shortness of breath since awakening this
morning. And I used albuterol every hour for the
past 6 hours and that it doesn’t seem to be helping I
used it “most days of the week I use her albuterol
inhaler approximately 3–4 times per week over the
past 2 months, but over the past week she admits to
using albuterol almost daily
Yes ok
Yes ok
MB
29 Y
Yes , Iam admitted since aweek
4- Do you have any medical condition I need to be
aware of?
5- Do you have any allergies? What happened?
6- Do you take any medications? Rx including
samples, OTC, herbals, vitamins?
What is it for?
How do you take it?
What side effects have you suffered from?
What about the relieving effect of those
medications?
Some people forget to take their medications
sometimes; do you forget to take yours?
Would you mind if I ask you few questions about
her life style?
Caffeine: do you drink coffee, tea, pops, how often
& how much. \
Alcohol: do you drink alcohol? How often & how
Tobacco? Do you smoke? How many? When is her
first cigarette?
Diet: how would you describe your diet?
eat healthy food.
Exercise: do you exercise? How often?
Asthma since childhood/Migraine headache
disorder
Yes iam on gluten free diet as previously diagnosed
celiac disease
Fluticasone 110 mcg, 2 puffs BID
Albuterol 2 puffs Q 4–6 h PRN shortness of breath
Propranolol 80 mg po BID for migrane headache
Iam still have shortness of breath and attacks of
asthma
No I do not forget medications time
NO
NO
NO
Healthy disease specific gluten free
Regularly twice a week
May I ask you few questions about your asthma symptoms? Yes, sure.

Do you experience shortness of breath? yes

How often does this happen? dialy

How many times a day does this tend to be?. Inhaler I used every hour but now do not
work
How long has it been going on, or is this a recent change Worsening for last month
What makes the shortness of breath better or go away
Do you experience any other symptoms, such as chest pain, light- Yes migraine
headedness, dizziness, cough, fever, or wheezing?
.When do you use your inhaler? Whenever i can’t breathe very well
How many times a day does this tend to be? Usually 6 to 8 times a day.

Does it appear at night? No all day

show me how you use your inhaler at home.
use these together
Do you use a spacer with your inhaler?.
Do you use a peak flow meter to evaluate you breathing
patient demonstrates the following use of her
albuterol inhaler: doesn’t shake the canister,
doesn’t exhale before placing the inhaler in
her mouth, presses down on the canister and
inhales, doesn’t hold her breath, and quickly
exhales
NO
NO
Pateint counseling
• Check for patient understanding : repeat instruction you already did
for him
• finally Do you have any questions?
Heart failure OSCE case

R A is a 65-year-old man who was brought to the ED by ambulance upon request of his endocrinologist.

The patient had called the physician’s office this morning to cancel his routine visit for diabetes follow-up
because he became short of breath and diaphoretic after attempting to climb a flight of stairs.

When evaluated by the paramedics in his home, the diaphoresis had resolved, and his heart rate was in
the range of 100–120 bpm.

The patient states that he has been gaining weight and having progressively worsening dyspnea on
exertion over the last 5 days. His shortness of breath is often worse at night, forcing him to “sit
bolt upright.”

He began sleeping in his recliner about 3 days ago. He is unable to complete physical activities that he
could do 2 weeks ago without difficulty.
 Heart failure OSCE case
R A is a 65-year-old man who was brought to the ED by ambulance upon request of his endocrinologist.

The patient had called the physician’s office this morning to cancel his routine visit for diabetes follow-up
because he became short of breath and diaphoretic after attempting to climb a flight of stairs.

When evaluated by the paramedics in his home, the diaphoresis had resolved, and his heart rate was in
the range of 100–120 bpm.

The patient states that he has been gaining weight and having progressively worsening dyspnea on
exertion over the last 5 days. His shortness of breath is often worse at night, forcing him to “sit
bolt upright.”

He began sleeping in his recliner about 3 days ago. He is unable to complete physical activities that he
could do 2 weeks ago without difficulty.
PMH:-
Type 2 DM × 15 years, untreated until 3 years ago;
HTN × 20 years (uncontrolled most of the time )
Hypercholesterolemia (documented 6 months ago)

VS-:
BP 150/95, P 100–120, RR 22, T 35°C; Wt 103 kg (usual weight 93kg)

Physical examination:-
3+ pitting pedal edema bilaterally

Lab values
Na 139 mEq/L Hgb 12.6 g/dL Mg 1.2 mEq/L CK 20 IU/L
K 3.4 mEq/L Hct 39.5% Ca 8.8 mg/dL
Cl 99 mEq/L Plt 339 × 103/mm3 AST 36 IU/L
WBC 8.6 × 103/mm3 ALT 43 IU/L INR 2.8

2D echocardiogram the presence of severe left ventricular dilation and increased left atrialDimension with EF = 35%
Medication history:-
Rosiglitazone 4 mg po once daily
Metformin XR 1,000 mg po once daily
Glyburide 5 mg po BID
Atorvastatin 20 mg po once daily (LDL 90 mg/dL 1 month ago)
Lisinopril 10 mg po once daily
1- Give name and title:
My name is….. and I am the pharmacist in charge
here.
2- How may I help you? What is your complain? I think I might have the flu. I have been feeling run
down, and I haven't been able to get up the stairs to
my bedroom

3- Ask permission to gather information and explain Yes ok

rationale: Can I ask you few questions?
4- Privacy This is a confidential place so feel free to ok
say whatever you want.
Gather information:
1- What is your name? RA
2- Ask the age/DOB of patient. 65 Y
3- Have you seen a physician? Yes , visited my endocrinologist from 5 days and
cardiologist from 3 days
4- Do you have any medical condition I need to be
aware of?
5- Do you have any allergies? What happened?
6- Do you take any medications? Rx including samples,
OTC, herbals, vitamins?
What is it for?
How do you take it?
What side effects have you suffered from?
Some people forget to take their medications
sometimes; do you forget to take yours?
Would you mind if I ask you few questions about her life style?
Caffeine: do you drink coffee, tea, pops, how often &
how much. \
Alcohol: do you drink alcohol? How often & how
Tobacco? Do you smoke? How many? When is his first
cigarette?
Diet: how would you describe your diet?
eat healthy food.
Exercise: do you exercise? How often?
Yes , I have diabetes from 15 years ago, Hypertension
, and hypercholesteremia
No I don’t have any allergies
Rosiglitazone 4 mg po once daily for diabties
Metformin XR 1,000 mg po once daily for diabetes
Glyburide 5 mg po BID for diabetes
Atorvastatin 20 mg po once daily (LDL 90 mg/dL 1
month ago) hypercholesteremia
Lisinopril 10 mg po once daily for my hypertension
Yes sometimes I don’t take my medications and forget
them
Yes from 2 to 3 cups per day
NO
I was smoker for 10 years but now I quitted
I live alone so most of the food is fast food
No I don’t exercise
May I ask you few questions about your symptoms? Yes, sure.

Do you experience shortness of breath? Yes, specially with any physical activity
How often does this happen? Just when I do physical activity not at rest
How long has it been going on, or is this a recent change from 5 days ago getting worse

Do you experience any other symptoms? Diaphoresis and weight gain

Do you follow up your blood glucose level ? Usually once per month or two months

Does it appear at night? Or when you lay down ? shortness of breath is often worse at night,
forcing me to “sit bolt upright.”
Pateint counseling
• Check for patient understanding : repeat instruction you already did
for him
• finally Do you have any questions?