Community OSCE

‫ﻫﺬا ﻋﻤﻞ ﻃﻼﺑﻲ ﺣﺮﺻﻨﺎ ﻧﺪرج ﻓﯿﻪ اﻟﺘﺸﻜﻠﺴﺘﺲ اﻟﻠﻲ ﻋﻤﻠﻮﻫﺎ ﺑﻌﺾ ﻣﺠﻤﻮﻋﺎت اﻟﺴﻤﯿﻨﺎر ﻣﻊ دﻛﺎﺗﺮﺗﻬﻢ ﻣﻊ ﺟﻤﻊ ﺗﺸﻜﻠﺴﺘﺲ ﻣﻦ ﻣﻮاﻗﻊ‬
‫" و ﯾﻨﺒﻐﻲ اﻟﺮﺟﻮع‬Smoking, antenatal, TB, DM, Malaria" ‫ﺣﻔﺼﺔ ﻣﺜﻞ‬.‫ﻣﺨﺘﻠﻔﺔ ﻟﺘﻐﻄﯿﺔ اﻟﻤﻮاﺿﯿﻊ اﻟﻠﻲ رﻛﺰت ﻋﻠﯿﻬﺎ د‬
."‫ﺣﻔﺼﺔ ﻟﺘﻐﻄﯿﺔ ﺑﺎﻗﻲ اﻟﻤﻮاﺿﯿﻊ" ﺑﺎﻟﻄﺮﯾﻘﺔ اﻟﻤﻄﻠﻮﺑﺔ‬.‫ اﻟﺬي ﺗﻤﺖ ﻣﺸﺎرﻛﺘﻪ ﻣﻦ ِﻗﺒﻞ د‬OSCE GUIDE ‫ﻟﻤﻠﻒ‬

.‫ﺷﻜﺮ ﺟﺰﯾﻞ ﻟﺠﻤﯿﻊ اﻟﻌﺎﻣﻠﯿﻦ ﻋﻠﻰ ﻫﺬا اﻟﻤﻠﻒ ﻣﻦ ﻃﺎﻟﺒﺎت وﻃﻼب‬

Helpful links regarding community OSCEs:

● http://www.osce-aid.co.uk/communicationscenarios.php
● https://www.researchgate.net/publication/308786415_OSCE_EXAMINER_CH
ECKLIST_2016/citations
● https://cintabukumedis.files.wordpress.com/2015/05/osces-for-medical-finals-
hamed-khan-et-al.pdf
● http://ksumsc.com/download_center/4th/435%20TeamWork/PHC/OSCE/Prim
ary%20Care%20Hx.pdf

Smoking​ ​cessation station

 “Checklist is supervised by dr.Hafsa”

Question: Done Partiall Not

y done done

introduce yourself to the patient, make

appropriate eye contact.

Act professionally and appropriately, explain

what you are going to do and gain consent.

Ensure the patient privacy and that he\she is

comfortable.

personal information: (name, age, occupation,

residence, marital status, special habits like
smoking and alcohol)

Use 5A’s approach

ASK​ about:

Type of smoking

Frequency

Duration

Quitting history and cause of failure

Effect of smoking on patient quality of life

ADVICE
the patient to quit smoking

ASSESS
willing to quit ​A&B:
 ​ SSIST​ the patient to quit through:
A) If willing, A
· Ask for a commitment
· set quitting date
· behavioral methods (progressive
restriction, alternative oral habit)
· Avoid Friends that you use to smoke with
· Avoid smoking cues as ashtrays from
surrounding environment
· Avoid Places and parties that you use to
smoke in
Use self-help materials:
· Learn something that will distract you
· Nicotine replacement therapy (gum,
patch...)
· Smoking cessation programs

ARRANGE
Schedule follow-up visits/phone calls to review
patient progress toward quitting.

​ otivate t​ he patient through

B) If not willing, m
5R’s​ approach:

Risks
Emphasize disadvantages of smoking (medical,
social, etc...)

Reward
Emphasize benefits of smoking cessations
 Relevancy
Focus on short term changes
Focus on the patient special conditions (COPD,
hypertensive, etc.)

Road blocks
Withdrawal symptoms
Weight gain

Repetition
Repeat the information and check the
understanding

Thank the patient and answer his\her questions.

Obesity ​counseling station

“Physical activity, obesity, and nutrition”
“Checklist is supervised by dr.Arfan”
Question: Do Parti Not done
ne ally
don
e

introduce yourself to the patient, make

appropriate eye contact.

Act professionally and appropriately, explain

what you are going to do and gain consent.

Ensure the patient privacy and that he\she is

comfortable.

personal information: (name, age,

occupation, residence, marital status,
special habits like smoking and alcohol)

Use 5A’s approach ASK about:

permission from the patient to discuss
weight problem

explore patient readiness to change

Previous attempts or trials and cause of failure

Effect of obesity on patient quality of life

ASSESS
➢ Patient health status, BMI, waist
circumference and cardiovascular risk
➢ Root causes of gaining weight
(primary and secondary)
➢ Drug history
➢ Effect of weight on psychosocial
functioning
➢ Explain to the patient his classification
of obesity according to BMI

Advice
➢ Advise the patient to lose weight
➢ Obesity risks and expected
complications
 ➢ Benefits of weight loss
➢ Explore all treatment options
• Life Style Modification ( Diet –
Exercise)
• Medical
• Surgical
Agree with the patient upon the
desired plan

A) If willing, ​ASSIST​ the patient to quit through:

• Address patient motives and barriers
• Ask for a commitment
• Set starting date
• Avoid eating at night
• Avoid eating junk food
• Avoid Places and parties that you use to
eat
in
Use self-help materials:
• Learn something that will encourage you
• Physical activity
• Obesity programs

ARRANGE
Schedule follow-up visits/phone calls and referral
to review patient progress toward quitting.

B) If not willing, ​motivate ​the patient through

5R’s​ approach:

Risks
Emphasize disadvantages of obesity (medical,
social, etc...)

Reward
Emphasize benefits of weight loss

Relevancy
Focus on short term changes
Focus on the patient special conditions (DM,
hypertensive, etc.)
 Road blocks
can’t control how much you eat.
lovinh dessert. I can’t give it up

Repetition
Repeat the information and check the
understanding

Thank the patient and answer his\her questions.

Vaccine​ ​station
“This checklist is a student work, not supervised by anyone”

STEP/TASK Partiall Not

Done y Done Done

Opening Session

● Candidate introduces himself to the patient

and uses his name

Data Gathering Domain

1-​ ​Complete personal history

details including name and age of

the child

2-​ ​Explores mother reason for visit

3-​ ​Explores mother Ideas, Concerns

and Expectations regarding missed

vaccinations
 4-​ ​Ask about child present history

details (Birthweight, Nutrition)

5-​ ​Ask about previous diseases as

Measles and Chickenpox

6-​ ​Convulsions

7-​ ​Allergies

8-​ ​CURRENT Medications

9-​ ​Management Schedule and Follow

up plan (Vaccination Schedule)

10-​ ​Check Mother Understanding

Malaria​ ​station
“This checklist is a student work, not supervised by anyone”
Possible OSCE scenario:​ A patient has come to see you because she is going traveling and would like to discuss malaria and

preventative measures she can use to prevent contracting it during her travels. Please discuss this with her and answer any

questions she may have.

Task Done Partially done Not Done

Wash your hands

Introduce yourself

Ask patient's name

Ask permission to discuss malaria with them

Ask patient what they know about the condition

first, then you can offer them further knowledge

to fill the gaps. An example of what to say is

shown below.

● Malaria is an infection by a protozoan

(bug) called plasmodium. This is

transferred into a person's blood through

a bite from a mosquito who has

previously picked up the plasmodium

from another person

● The risk for a traveler acquiring malaria

depends on the region traveled to, even

within a single country

● We make a risk assessment to decide

how at-risk someone is of contracting

malaria whilst abroad. This includes

finding out:

○ The destination country

○ A detailed itinerary, including

specific cities, types of

accommodation, season, and

style of travel.

● Depending on level of risk, it may be

appropriate to recommend: a) no specific

interventions, b) mosquito avoidance

measures only, or c) mosquito avoidance

measures plus chemoprophylaxis

Advise the patient that there are many

preventative measures that they can use whilst

away:

● Against mosquito bites:

○ Mosquito nets over beds

(preferably insecticide treated)

○ Mosquito spray at night around

bed

○ Wear clothes that cover most of

body in bed

○ Use mosquito repellent

● Chemoprophylaxis:

○ All chemoprophylaxis regimens

involve taking a medicine before

travel, during travel, and for a

period of time after leaving the

malaria endemic area.

○ Medications used for prophylaxis:

● Mefloquine

○ Prophylaxis should begin 2

weeks before travel to 4 weeks

after. Take once a week and for 4

weeks after a traveler leaves the

country

○ Contraindicated if a family history

of psychosis

○ Side effects:
 ■ Gastrointestinal

disturbance

■ Headache

■ Abnormal dreams, mood

changes and psychosis

■ Visual disturbances

■ Seizures

● Doxycycline

○ Start 1 day before travel, take

every day and for 4 weeks after

traveler leaves the country

○ Contraindicated in pregnancy

○ Side effects:

○ Photosensitivity - usually with

sunburn (avoid by avoiding

prolonged time under the sun,

use sun cream, etc.)

■ Gastrointestinal

disturbance (advise to

take with food)

○ Malarone

○ Start 1d pre-travel, take once a

day and finish 1 week after

traveler leaves the country

○ Contraindicated in pregnancy

○ Side effects: (usually well

tolerated, side effects rare)

 ■ Gastrointestinal

disturbance

■ Headache

● Chloroquine and Proguanil

○ In areas where Chloroquine is still

sensitive

○ Start 1 week before travel, take

twice a day and continue for 4

weeks after leaving the country

○ Safe in pregnancy

○ Side effects:

■ Itching

■ Abdominal pain

■ Diarrhoea

● Emphasise that it is important to take this

medication as prescribed, as

consequences of malaria can be fatal

● For destinations where malaria cases

occur sporadically and risk for infection

to travelers is assessed as being very

low, it is recommended that travelers use

mosquito avoidance measures only, and

no chemoprophylaxis.

Ask the patient if they have any further

questions

Thank the patient for coming to discuss the

issue
 Offer the patient a leaflet and ask them to

book a further appointment if they have any

other concerns

Wash hands

TB​ ​station
“This checklist is a student work, not supervised by anyone”
​ his 54 year old man has just been diagnosed with active pulmonary TB on your ward and wants to
Possible OSCE scenario:​ ​: T
discuss treatment with you. Please discuss with him the standard treatment for TB and answer any questions he may have.

Task Done Partially Not

done Done

Introduce yourself

Wash your hands

Explain you have been asked to discuss TB

treatment with him and ask his permission to do

so

Start by asking if he has any particular questions

regarding the treatment or anything he wants to

clarify

Treatment specifics
Explain that TB is a serious but treatable disease

using medications

Duration:​ Explain that TB treatment is usually

6-month treatment

Drugs​: Explain that four main drugs are used

(RIPE):

○ Rifampicin, Isoniazid, Pyrazinamide,

Ethambutol

Specifics​: Explain that need to take all four drugs

daily for 2 months, then just Rifampicin and

Isoniazid for a further 4 months

Drug side effects

Explain that the drugs do have side effects,

which we will monitor for and minimise the risk

of, but he should still be aware of, as some can

be serious. Important ones to mention listed

below.

Rifamipicin​: Orange discolouration of sweat,

tears, urine

Isoniazid:​ Peripheral neuropathy (you will

reduce the risk by prescribing concurrent

pyridoxine)

Pyrizinamide:​ Gout, arthralgia, liver toxicity

 Ethambutol​: Colour blindness (must test for

before starting)

General: Hepatitis, rash, fevers

Starting treatment

Usually treatment will be started straight away

Prior to treatment needs:

● LFT’s – drugs can affect liver so would be

cautious in starting if abnormal LFT’s

● Ishihara plates – must test for colour

blindness due to ethambutol toxicity

Infection Control

Explain that it usually take two weeks of treatment

for him to stop being infectious

In hospital:

● While in hospital he will be nursed in a

single room (ideally negative pressure)

● Should wear a respiratory mask if leaves

room

● He needs to stay there until 2 weeks of

therapy completed or discharged

At home:

● Warn of increased infectiousness for first 2

weeks

● Advise him to stay away from children,

elderly or immunocompromised
 ● Ideally he should self-isolate – minimal

contact with others/public

Compliance

Stress the importance of taking medications daily,

as prescribed

Highlight the importance of not stopping when

feel better:

·​ ​“You may start to feel better after two weeks

but this does not mean that the infection is

removed from your lungs”

Raise possibility of resistant (MDR-TB)

● “If you stop taking the medications before

you are supposed to this may lead to

resistant forms of the bacteria, which are

harder to treat and can cause more serious

illness”

Contacts

Ask who he lives with/who he has been in close

contact with (e.g. housemates/work

colleagues/partners)

Explain any close contacts will need to be tested

for TB as well and they will be contacted by the TB

team regarding this

Finish
 Ask the patient if they have any further questions

Offer the patient a leaflet/information as to where

they can get further information

Thank him for his time and give contact details of

TB team/yourself

Lung Cancer​ ​station

“This checklist is a student work, not supervised by anyone”

STEP/TASK Don Partiall Not

e y Done Done

Opening Session

Introduce yourself to the patient and uses his

name

Data Gathering Domain

Explore smoking history details (type of

smoking, frequency and duration)

Calculate the smoking index

​Explore patient Ideas, Concerns and Expectations

Asks about possible symptoms suggestive for

lung cancer as cough, expectoration, hemoptysis,
chest pain, dyspnea, anorexia and weight loss in
the past 6 months …etc.

​Ask about past history of lung cancer or any

organ cancer
​Ask about family history of lung cancers or
cancers in general

Assess psycho-social aspects (depression and

anxiety)

Clinical Management Skills

Explain to the patient regarding eligibility criteria

for lung cancer screen

​Make appropriate decision based on patient

preferences

Counsel patient regarding smoking cessation:

Use the 5 Asframe

(Ask-Advise-Assess-Assist-Arrange) to effectively
counsel about smoking cessation

​Use the 5 R's Frame if the patient is unwilling to

quit smoking (Risk-Reward-Relevancy-Road
Blocks-Repetition)

Diabetes Type 2 ​ ​Counseling Station

“This checklist is a student work, not supervised by anyone”

Task Done Partially Not

Done Done

Introduce yourself - Take permission

Personal Hx​​ ​(Name - Age - Marital status -

Occupation)

Chief Complaint​​ ​(when was diagnosed?

Any similar condition in the family? And which
type?)
HPI ​

● Duration of DM
● Are you on any medication? If yes, What?
(Compliance)​.
Self monitoring at home? Last reading? HbA1c?

Associated symptoms ​(Complications)​.

- Polyuria, polydipsia, polyphagia, skin
changes.
- CVD: Chest pain, Claudications, Foot
ulcer.
- Neurological: Numbness, Weakness,
Blurred vision.
ً- Renal: Frothy urine, edema
- DKA: Abdominal pain, N/V
- Hypolglycemia: Sweating, palpitation,
syncope

Constitutional symptoms:​ ​ ​(Fever, Fatigue, Night

sweats, Weight change appetite)

Medical: Chronic Diseases ​(DM - HTN - IHD -

Stroke - Renal diseases - Endocrine diseases
(​Thyroid​) - ​Obesity​​ ​- Dyslipidemia)

Social:​ ​(Smoking - Alcohol - Stress - exercise)

Pregnancy + GYN hx​​ ​(female pt): (LMP - Regular?

- OCP - Pregnancies)

Counselling:

★ explaine what DM:

1- What do you ​know​​ ​about DM2 ​& its
complications​?
=> then start from there to explain in brief in a
nice way)
2- What are you ​concerned​​ ​about?
=> If the patient asked you why I developed DM?
talk about risk factors
(weight\inactivity\HTN\family hx)
3- What do you ​expect​​ ​from this visit?

★ Types of medications that ​S​he will take

and the importance of taking these
 medications, taking it in a right way and
should not miss it.
★ Talk about management (lifestyle, Oral
hypoglycemic drugs, insulin) & refer him
to the specialist:

- ​Lifestyle:​ ​ ​Low animal diet - Low carb - more

vegetables - offer referral to dietitian to help​.

-​ ​Exercise:​ ​advice the pt to walk 30 minutes 5

days/week.

- Lose weight if the pt is obese and explain how

this will help in improving his/her condition.

- Control other comorbidity and explain how it

will prevent further complications.

★ Talk about complications:

- Eyes => may need to follow up with the

ophthalmologist

- Kidneys => may need referral to nephrology

★ Footcare: use moisturizers, examine

everyday for skin changes/blisters/cuts
/not walk with bare foot
★ Educate the pt about the importance of
self-monitoring at home by glucose meter
★ Investigations: ​ ​CBC - MSU - RFT - Lipids
profile - Albumin/Creatinine ratio - ECG -
24 h urine collection for proteinuria.

Make sure that the patient agree with you in

every step

Do you have anything to add? Or ask?

Appointment for follow up (Ask if the patient

available at that time).

Summarize:​ ​ ​(Age - Gender - Chronic diseases - CC

- Imp. Negatives - Management)

Thank the patient

 Hypertension​ ​station
“This checklist is a student work, not supervised by anyone”
GO BACK TO ​CV risk assessment list!!!!

Task Done Partially Not

Done Done

Introduce yourself - Take permission

Personal Hx​​ ​(Name - Age - Marital status -

Occupation).

Chief Complaint​​ ​(What? - When? - First visit or

referred?)

HPI ​(If already diagnosed)

● - Duration of HTN
● - Are you on any medication? If yes? What?
(Compliance)​.
● Self-monitoring at home? Last reading?
HbA1c?

Associated symptoms
- CVD: ​Chest pain, Claudications
- Neurological: ​Numbness, Weakness,
Blurred vision, Headache
- Renal: ​Frothy urine, edema, hematuria
- Pheochromocytoma: ​palpitation, Sweating,
headache, tremor
- Obstructive sleep apnea​: Fatigue, Sleepy

Constitutional symptoms:​ ​ ​(Fever, Fatigue, Night

sweats? Weight changes? Appetite?)

Previous Hx of similar symptoms? Admissions?

Medical: Chronic Diseases ​(DM - HTN - IHD - Stroke

- Renal diseases - Endocrine diseases - ​Obesity​​ ​-
Dyslipidemia).

Medication: ​Steroids - ​NSAIDs

Surgical

Social:​ ​ ​ (Smoking - Alcohol - Stress – exercise – Diet

(Sodium, cholesterol).

Family Hx: ​Similar Symptoms - HTN - IHD - ​DM​.

Pregnancy + GYN hx​​ ​ (female pt): (LMP - Regular? -

OCP - Pregnancies)

Allergy.

ICE:
1- What do you ​know​​ ​about your symptoms?
2- What are you ​concerned​​ ​about?
3- What do you ​expect​​ ​from this visit?

Counselling:
·​ ​Hypertension is a very common disease
in our country; it is measured by
wrapping an inflatable handcuff around
your arm. If hypertension is not controlled
there would be long term complications
like chronic kidney disease, heart attack,
heart failure and stroke.
·​ ​However, ​give up smoking​, maintaining
the ​normal body weight​, ​change of diet​​ ​by
reducing sodium intake, undertake
regular aerobic exercise​ (30 Mins most of
the week)​ ​ ​and ​medication​​ ​can control it.
·​ ​Tell the patient the BP goal ​ (Depending
on the age)
·​ ​Self-monitoring ​ (If this is his first visit
and slight elevation offer HBPM and
explain).
·​ ​Investigations: CBC - MSU - RFT - ECG -
Lipids profile.

Appointment for follow up (Ask if the patient

available at that time).

Do you have anything to add? Or ask?

Summarize:​ ​ ​(Age - Gender - Chronic diseases - CC -

Imp. Negatives - Management)

Thank the patient

 Antenatal Counseling​ ​station
“This checklist is supervised by Dr.Marwah and revised by dr.Hafsa”
Possible OSCE scenario:​ 3
​ 2 Y\O female … ‫ﺣﻔﺼﺔ واﻓﻘﺖ ﺗﻌﻄﯿﻨﻲ اﻟﺴﯿﻨﺎرﯾﻮ ﺑﻌﺪﯾﻦ ﺳﺤﺒﺖ ﻋﻠﻲ وﻻ ﻛﻤﻠﺘﻪ‬.‫د‬

Before you start:

No Step\Task D PD ND

1 Introduce yourself to the patient, make appropriate eye contact.

Wash hand

Ensure privacy

Ensure the patient is comfortable.

Take permission

Explain what you will do.

Encourage her to ask questions and Actively listen to her.

Start asking:

2 Personal information: (name, age, occupation, residence, marital

status, special habits like smoking and alcohol – or you may ask
about it later)

3 Ask the pregnant woman’s reason for the visit.

History taking

4 Confirm the pregnancy

Missing a menstrual period (amenorrhoea), Breast changes,
Nausea, vomiting and tiredness, Frequent urination,
Darkening of the skin, Abdominal enlargement and
Painless uterine contractions

5 Calculate EDD​ ​(add 9 months and 7 days to the first day of

menstruation)
How many children has she had?
6 Nutrition support​ (anemia, adequate caloric intake)
§ healthy eating and keeping physically active during
pregnancy to prevent excessive weight gain during
pregnancy.
§ Daily oral iron and folic acid supplementation to prevent
maternal anaemia, puerperal sepsis, low birth weight, and
preterm birth.
§ Foods rich in iron; dates, green leafy vegetables, red
beans, gauvas, red Meats.

7 Personal hygiene, dental care, rest (2 hrs) and sleep (8 hrs),

regular bowel habits, enough fiber and fruit intake…avoid
constipation

8 Record symptoms;​ fever, vomiting, abnormal vaginal bleeding,

palpitation, easy fatiguability, breathlessness, generalized swelling,
burning micturition, decreased or absent fetal movement.

9 chronic or current illness;​ asthma, heart disease, jaundice, HTN,

DM (Hyperglycemia first detected at any time during pregnancy
should be classified as either gestational diabetes mellitus (GDM)
or diabetes mellitus in pregnancy), TB, HIV, STIs, thalassemia and
bleeding disorders.

10 Family history​ of twins, congenital malformations

11 Immunization

12 History of drug allergies, or drugs ​Ex:thalidomide (deformed

hands), corticosteroids (impair fetal growth), streptomycin (8th
nerve damage)

13 Past Hx:
previous complications (abortions, still births), any problems with
past pregnancies or births, problems with the placenta (afterbirth),
baby birth defects, caesarean surgery, long labour (a long pushing
stage) or short labor, heavy bleeding before or after the birth and
early birth.

14 Education​ on delivery, care of the new born and birth spacing

15 Importance and management of lactation ​(importance/benefits

of breast feeding, exclusive breast feeding, problems arising from
breast feeding)

16 Identifying high risk pregnancies, smoking and exposure to

passive smoking
 Preventive services

17 A seven-day antibiotic regimen is recommended for all

pregnant women with asymptomatic bacteriuria (ASB) to
prevent persistent bacteriuria, preterm birth and low birth
weight

18 Tetanus toxoid vaccination is recommended for all pregnant

women, depending on previous tetanus vaccination exposure,
to prevent neonatal mortality from tetanus.

Investigations yes with the history you will advice

24 Routine US
One ultrasound scan before 24 weeks of gestation (early
ultrasound) is recommended for pregnant women to estimate
gestational age

25 Pregnancy test for human chorionic gonadotropin (HCG), Hb

estimation( anemia), Urine for albumin and sugar, blood grouping,
Rh factor, VDRL, HIV testing, Blood sugar, HBsAg for Hep B, Fetal
heart tones (FHTs)

Finally

26 Schedule follow-up visits and Plan when the next visit should be?

27 Assure the pregnant woman that she should come back at any
time, for any reason?

28 Thank the pregnant woman for attending for antenatal care