The OSCE

Neurology and Psychiatry

What is an OSCE?
 An OSCE is an Objective Clinical Skills
Examinations (OSCE) that is designed to
evaluate a distinct realm of clinical
performance.
 They are designed to provide realistic patient
encounters or scenarios that lend
themselves to a proxy evaluation of
physician-patient interaction.

. as well as their personality. the details of their history.  Your method of interviewing the patient is the same as it would be in an actual patient encounter. This includes how they act. They are trained to respond in a consistent manner and they do not lie to try and trick you. how they react to physical examination maneuvers.  All OSCE patients have a rigid script that they portray.Who are the patients?  The individuals you will be examining are actors or standardized patients (SPs).

 You will be expected to do the following:  Neurologic exam – 25 minutes  Clinical interview/mental status exam – 25 minutes  3 clinical examinations of a standardized patient – 25 minutes each .What will the OSCE entail?  There will be 5 parts to the Neurology and Psychiatry OSCE – these may occur in any order.

etc). clinic. a presenting complaint and brief instructions. 16  Bp 114/72  Take a history and perform a focused physical examination.2  Pulse 100  Resp.”  Temp 100. . office.What will the OSCE entail?  The clinical examination of the standardized patient part of the OSCE will start with preliminary information such as where the encounter is taking place (ER.  For example:  Jane Doe  Problem: “I am having difficulties with weakness in my arm. vital signs.

the patient having symptoms of depression may also have neurologic concerns. ask questions about any reasonable possibility.  It is important to maintain as open a mind as to possible problems.   Therefore. .  The patients may have signs and symptoms that cross the borders of specialty specific diagnoses.How many diagnoses do I have to come up with?  You will be asked to list your top three possible diagnoses rather than one. For example.

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a head to toe examination is not needed and. given a particular problem you may have to thoroughly examine several body parts. given the time constraints. However. not advised. .Do I have to do a complete physical exam for each patient?  The physical examinations required on an OSCE are focused exams .

ask permission to untie the gown.  Show consideration for the patient (for example: pull out the foot extension. etc. .).   Properly drape the patient.  Never examine on top of the gown.  Explain to the patient what you plan to examine (“I’m going to listen to your heart now”) and then tell them what you found (“Everything sounds normal”).For each exam part you MUST…  Wash hands with soap prior to examining the patient.

How do I end the exam with the patient?  After gathering the necessary information. . Never ignore a patient question. ask the patient if they have any questions and respond in an appropriate fashion. let the patient know that you will discuss the question with your resident or attending physician and get back with them.   If it is a question you are not prepared to answer.

What if the patient…  Asks a question or behave in a certain way that demands a response on your part OR  The patient may be acting in a certain manner that requires an inquiry on your part OR  Alternatively the patient may present you with a situation that requires a response  YOU must respond as this is part of the interpersonal skills assessment .

. and your initial diagnostic testing plan. rather than a full H&P as long as you include all the pertinent information.   This note is divided into a history portion.  A note will be written in the SOAP format.The Note  After the encounter you will be required to write a note. three diagnoses. physical exam finding.

Remember you are being asked to list diagnostic tests not treatment plans.such as a pelvic or rectal exam .this should be listed in the diagnostic test area in addition to laboratory or imaging tests . Remember to consider relevant neurologic and psychiatric diagnoses.The Note  When compiling your differential diagnosis.  The final task is to list your initial diagnostic plan.  If you wanted to do a particular exam but were not able to due to the restrictions of the OSCE . think expansively.

Timing  You will have a full 25 minutes for the neurologic exam and mental status exam  NOTE: you can address cognition in the clinical interview/mental status exam part of the OSCE  You will have 15 minutes to exam the standardized patient and 10 minutes to write the note  You will receive a warning when 5 minutes remain .

To Succeed…  Be professional in your approach  Perform a thorough focused examination  Let the patient ask questions and tell their story  Think expansively and ask your questions accordingly  See as many patients as you can on the rotation in order to hone your clinical skills  Relax during the encounter and don’t let your test taking anxiety prevent you from .

  Examples of possible scenarios are the following:          Anxiety Depression Encephalopathy (Acute or Chronic) Migraine Psychosis Seizures and epilepsy Substance Abuse Traumatic Brain Injury Weakness (Acute or Chronic) .What kinds of patients should I expect?  Any of the common or serious problems seen on the rotation are possible.

and general reading will enable you to complete the OSCE competently. making eye contact with the patient and introducing yourself.   It is not possible to study for the OSCE.   This requires that you dress professionally. .   Attendance and participation in rounds. including wearing your white coat and name badge. didactics. ambulatory clinics.The Grade  The OSCE grade will be based on the ability to perform the clinical tasks requested and on your professional demeanor and interactions with the patients. and treating each patient as a “real” patient. conferences.

40 points .40 points  OSCE of a combined neurologic and psychiatric complaint.40 points  OSCE of a combined neurologic and psychiatric complaint.40 points  The following will count toward your psychiatry final grade:  Performance of a psychiatry-based clinical interview (with mental status exam): 25 points  OSCE of an isolated psychiatric complaint.The Grade – you will receive 2 grades for the OSCE  The following will count toward your neurology final grade:  Performing the neurologic exam (with mental status exam): 25 points  OSCE of an isolated neurologic complaint.

localization and diagnostic reasoning. Do not spend time on the remainder of the neurologic exam as the findings will be normal. . you should focus on the motor strength (including facial strength) and reflexes.  Discuss your impressions and any initial plans with the patient  After leaving the room. corneal reflex or rectal exam. complete your patient note which will include sections for the history.This is what your instructions will look like…  Examinee Tasks:  Obtain a history pertinent to this patient’s problem  Perform a relevant physical exam (do not perform a breast.) For the purpose of this case. pelvic/genital. physical examination.

This is what your worksheets will look like…  HISTORY: Describe the history you just obtained from this patient.  LOCALIZATION: Given the physical examination findings noted above. Be careful to include only the parts of the exam you performed in this encounter.  PHYSICAL EXAMINATION: Describe any positive and negative findings relevant to the patient’s problem. Include only information (pertinent positives and negatives) relevant to the patient’s problem. . please identify where a single isolated lesion would most likely be located to explain this neurologic dysfunction.

EKG. etc.g. list up to 3 diagnoses that might explain this patient’s complaint. list initial diagnosis studies (if any) you would order for each listed diagnosis (e. List your diagnosis from most to least likely. Please realize this may include both neurologic and psychiatric diagnoses when applicable. EEG. fewer than three diagnoses will be appropriate. Then. Lastly. For some cases.This is what your worksheets will look like…  DIAGNOSTIC REASONING: Based on what you have learned from the history and physical examination. laboratory tests. imaging. enter the positive or negative findings from the history and the physical examination that support each diagnosis.) .

This is what your worksheets will look like…  Diagnosis #1 ______________________________________  Supportive historical features:  Supportive examination findings:  Diagnosis #2  Supportive historical features:     ______________________________________ Supportive examination findings:   Diagnosis #3 (if applicable) ______________________________________ Supportive historical features:  Supportive examination findings: .

This is what your worksheets will look like…  Suggested Diagnostic Studies:  ___________________________  ___________________________ ___________________________  ___________________________ ___________________________ .