OSCE exam in surgery –communication

skills in breaking bad news

Dr burkan
 Station NO 1
Your professor ask you to meet a co-patient
( relative ) of a gentleman 63 years old give history
of bleeding per rectum and mucous discharge,, he
will give you histopathological report after taken
biopsy per anus 5cm from the anal verge.
 Please gently break this bad news and arrange
your further management ?
 Histo-patholgy report

Name Ali saeed Ahmed 63 y

Gross : 2 fragments of tissues measuring altogether
1x2x3 cm whitish to gray in color
Micrscpic : high mitosis, scanty cytoplasm,
hypercromatosis
Poorly differentiated
adenocarcinoma of the rectum
SN Points to be asked Done Not SN Points to be asked Done Not
done done

1. Introduce himself, good Post operative chemotherapy

appearance and confidant= 1 6. =1
mark
Try to break this bad news Neoadjvant chemo
2. correctly = 0.5 7. radiotherapy=1
Need of imaging study for
3. distant mets like abdominal 8. Side effect of surgery like
CT= 0.5 impotence =1
Surgical treatment ==
4. abdomino- perineal =1
Surgical treatment = stapler 9. Side effect of chemotherapy
anastomosis =1 =0.5
Colostomy =2
5.
10. Prognosis = 0.5

Total
 Station NO 2
Your professor asking you this morning to meet the
family of an old lady 78 years with metastatic
adenocarcinoma of the body and tail of the pancreas
HB 6g/dl, elevated urea and creatinine
He request to explain her bad recent condition and to
plan an effective terminal care
 Medication like pain control
SN Points to be asked Done Not
Mild
done
Moderate
Greeting the patient ,
severe
introduce yourself,
Explain how bad this cancer
No nonsteriodal
Mets, age
No place for surgery or any Care for
palliative Bed sore
Nutrition Mouth hygiene
Entral - parentral hypothermia

Home care
Assistant

Total
 Station NO 3
While you are operating on young boy with acute
perforated appendicitis

The patient was suddenly arrested and every attempt

was failed to save his life

How can you transmit this bad news to his waiting

worried family.
 Station No4
You received at the emergency room one young man
30 years.

Exposed to gun shot injury to the abdomen

He was in shock

Resuscitations started
His family in the outer door looking for you to explain
the condition of the patient
 Station No 5
You decide to operate on 65 male patient with septic
peritonitis

4 days history of severe abdominal pain

4 years history of gastritis with no documents

The patient and his family refuse to sign a high risk

consent form and they need to meet you
 Station No6
Mr Salim and his wife ,, after 15 years they have the
first born male baby before 20 days

They brought his with frequent vomiting whenever he

feeds

The general practioner prescribe some medication but

the condition become more worse

They are very worried and need your help

 Station No7
A 73 year man with history of bleeding per rectum
associated with alternative bowel habit

CT show rectal mass 6-7 cm from the anal verge

Referred to your clinic for further help and surgical

opinion
 Station No8
Young adult lady of 21 years
Single , present with right lower abdominal pain for
the first time
Diagnosed on clinical ground as case of acute
appendicitis
Taken for surgery
While you are operating , you found normal appendix
But the pelvic cavity full of blood
And when you are searching for the cause you found
ruptured ectopic pregnancy
How can you transmit this information to the patient
and family.
 Station No 9
After total gastrectomy , you decide with the
anesthesiologist to transfer the patient to the ICU.

You transfer him with intubation and on Ambo bag

The family asking to explain what happened to the

patient

What is your response

 Station No 10
56 male with big irreducible right inguinal hernia

Under spinal anesthesia

You couldn’t complete the operation as the patient

developed severe hypotension and hypoxia

 how can you explain these events to the family

 Station NO 11
On the second day after exploratory laparotomy for
gun shot abdomen

The patient noticed small wound made in the

abdominal wall discharging stool

He become very anxious

And asking very angry .. What happened to me

DR……
 Station NO 12
Young female 31

She came to your clinic very frustrated and crying

That one Dr told her …please take your mother home

and let her to die in peace because she has advanced
breast cancer

She asked you ,,, please Dr can you help my mother

 Station NO 13
Diabetic man neglected his disease for 12 years

Present with non salvageable right limb due to severe

wound infection .

He asking you please please do some thing to help

me
 Station No14
Young boy 16 years

Present by his parents with cervical lymphadenopathy

Associated with night fever

Very worried about the result and if this condition is

curable or not

Please if you can help them

 Station NO15
You operate on young female 27 years , before 3
weeks

As incisional hernia post CS

The patient noticed that the swelling seems to be

recurred again

How can you behave at this moment