What is the OSCE?

Class of 2015Year 3 Objective Structured Clinical Exam(OSCE)

Class of 2014 Year 3 OSCEOSCE Facts Process Grading Tips

OSCE FactsAn OSCE is:a performance-based exam in which you are observed demonstrating various clinical skills as you rotate through a series of stations.

an exam to evaluate the process by which you interact with patients.

OSCE FactsAn OSCE:

evaluates your basic clinical skills

measures your minimal competencies

provides feedback on your performance

gives you an idea of what the NBOME COMLEX-PE will be likeOSCE FactsConfidentiality

You must adhere to the Honor Code.

After the OSCE, sign into E*Value and complete OSCE honor code course work.

You must not share information with others.

5OSCE Facts

Videotaping

Your OSCE will be videotaped for the purpose of evaluation

6OSCE Process: Wear your white lab coat and OU-HCOM ID badge (bring these with you) over professional clothingPut on arm bands (provided at the time of the exam) Keep a pen and a stethoscope with youEmpty your pockets of everything except your stethoscopeNo pocket guidesNo cells or beepersNo drug guidesNo ChapStick, tissues, etc.

Everything you need for the exam will be in the room

OSCE Process: Hallway SequenceDetermine your designated start room. You will stay in the same color sequence (pink, green, gold or white) for the entire exam.

No talking in the hallway, please!

8OSCE Process: Hallway SequenceIf you are scheduled to start at Green Station 1 for your first patient, your second patient will be at Green 2, your 3rd patient at Green 3, your 4th patient at Green 4.

If you are scheduled to start at Pink Station 2 for your first patient, your 2nd patient will be at Pink 3, your 3rd patient at Pink 4, your 4th at Pink 1.

If you are scheduled to start at Gold Station 4, your 2nd patient will be at Gold 1, your 3rd patient at Gold 2, and your 4th patient at Gold 3.

Etc.

9OSCE Process: CasesThere will be 4 cases using standardized patients (SPs).SPs are required to stay in characterIf you recognize an SP from a previous lab, please do not acknowledge this One of the 4 stations will be a formal OMM case where you are expected to assess, diagnose, treat with OMM and reassess. This year this is the back pain case you must provide OMM to this patientNo HVLA techniques are allowed on any patientsNBOME does not have a formal OMM case. OPP should be considered in all cases during the COMLEX PE.

Note:.10OSCE Process: ScheduleThe OSCE will take approximately 2- 2.5 hours

You will have a total of 23 minutes for each station:14 minutes to complete the appropriate tasks for each station, and9 minutes for SOAP note writing

OSCE Process: DebriefingThe last component of the OSCE is a debriefing.

We value your feedback!

OSCE Process: Patient EncounterWait outside each room until you are instructed to begin. When instructed to begin, you may pick up and read the chart. The chart contains instructions, a worksheet (to take notes), approved abbreviations, and relevant diagnostic information. The instructions in each chart include: the setting: outpatient, primary care, or ERpatient demographic informationvital signs

You may enter the room when you are ready; take the chart with you into the room.

A sample chart will be provided for you to review prior to the exam.

OSCE Process: Patient EncounterUse your 14 minutes to evaluate and treat each patient as you see fit.

Do not pretend there is someone else in the room or that the patient has taken medication you prescribed in the past dont make things up!

No pelvic, rectal, GU, or breast exams are allowed on standardized patients. (You may document your intention to do so in SOAP note.)

OSCE Process: OMTUse OMT as appropriate.

Develop a treatment plan in response to presented symptoms there may be no physical findings.

When using OMT, be sure to:Gently position the patientExplain what you are doingLimit the amount of time for OMT to 3-5 minutesComplete all steps of the process, including reassessment

Remember: Do not use HVLA, but you may document in the SOAP note that you would like to include it in your treatment.15OSCE Process: Patient Encounter TimingCompleting an encounter in the time allotted is difficult for most students. We suggest you practice timing the process.

Twelve minutes after the encounter begins, you will receive a two-minute warning.

Fourteen minutes after the encounter begins, you will be instructed to leave the room.

You must take the chart and your worksheet out of the room with you.

You may leave the room before instructed. However, if you do leave, you will not be able to re-enter.

OSCE Process: SOAP Note TimingDuring the 9 minutes allowed for SOAP note writing:

Type your note into the computer at the desk outside the room.

Also type patient name, date and time, your name, OMS III.

After 7 minutes, you will hear an announcement indicating that two minutes remain.

After 9 minutes of SOAP note typing, you will be instructed to stop typing.

Leave the chart and worksheet on the desk and move to stand in front of the next station.17OSCE Process: SOAP NotesFor the SOAP Note:

Use the Worksheet for jotting down pertinent information while in the room.

Include three, ranked, differential diagnoses (for at least 3 possible etiologies).

Use only the abbreviations provided in the chart.

Be concise but thorough.OSCE Process: SOAP NotesPlease be aware that according to NBOME:falsification of the medical record (written SOAP Notes) in COMLEX-USA Level 2-PE by documenting medical history that was not elicited, or physical examination maneuvers that were not performed, is considered irregular behavior and will be thoroughly investigated and dealt with as specified in NBOMEs Bulletin of Information.Irregular conduct will appear on the score report and transcript.More than 16 students to date have received failing scores for this infraction.NBOME checks/compares SOAP notes with videotapes.19OSCE Process: SOAP NotesSample SOAP notes are posted on OSCE web page.

Use abbreviations that are not on the list provided in each chart at your own risk.

OSCE ProcessThis entire process is repeated three times.

OSCE ProcessIf you need assistance at any time during the exam, proctors will be available in the hallways to help you.

OSCE GradingSuccessful completion of the year 3 OSCE is a requirement for OU-HCOM graduation.

You will receive a pass/fail grade.

You must earn at least a 70% in each of the skill sets in order to receive a passing grade.

If your original grade is not passing, your CORE Assistant Dean will develop a plan for remediation. When your remediation plan is completed, you will have met the OSCE requirements for graduation.

Grade sheets are available for your review on the OSCE web page.

OSCE Grading PassScore of 70% or above on each skill set

*Fail (Failure ratings are given based on any of the following): Illogical sequencing Deficient knowledge base Lack of ability to focus Interpersonal skills deficits Unprofessional behavior

OSCE Grading

Checklists will be used by standardized patients (SP) to document student performance.

Checklists will be used by physicians to evaluate both OMM performance and SOAP note quality.OSCE GradingSP documentation checklists include:History-taking skills Did you ask the appropriate questions?

Physical exam skillsDid you perform the appropriate exams?

Professionalism Did you interact with the patient appropriately?OSCE Grading: Standardized Patientsorganization courtesycompassion empathy listening skills eye contact respectthe language you use

demeanor dresshand washingdrape appropriatelywhether or not the standardized patient would select the examinee as their personal physician.Documentation of professionalism includes:OSCE Grading: Physicians

Dr. CechDr. ZidronDr. ClarkDr. CoonDr. HealyDr. SchwartzDr. ShubrookDr. Guo

Dr. LawDr. BalboDr. Kuttner-SandsDr. RutterDr. SorokaDr. WalkowskiDr. ReganDr. Eland

SOAP notes and OMM techniques will be evaluated by:28OSCE Grading: OMMPhysicians will be checking the videotape of your OMM encounter for:

Assessment SkillsDemonstration of OMM technique Explanation of OMM techniqueCommunication with patientReassessment SkillsProfessional behavior

Very nice update 29OSCE Grading: SOAP NotesPhysicians will be checking your SOAP notes for:

Subjective findingsObjective findingsAssessment (3 differential diagnoses)PlanOrganizationVerification with videotaped content

OSCE Grading

Results will be available in approximately one month

Your CORE Assistant Dean will review the results with you.

OSCE TipsWash your hands as soon as you enter the room, before you touch or shake hands with the patient.

OSCE TipsWhen auscultating, listen on the patients skin.

OSCE TipsPace yourself.

Read the doorway instructions and take them at face value to be correct.There is no need to repeat vital signs.

Introduce yourself as Student Doctor + Your Last Name.

Treat each patient with respect.

Communicate in clear lay terminology.

OSCE TipsAsk one question at a time and let the patient answer that question before you ask the next one.

Elicit appropriate history.psychosocialoccupationalmedical/surgical

Elicit current medications and allergies.

OSCE TipsUse the patients history to guide the scope of your focused examination. A complete exam is not required.

Do not turn off the lights if you examine a patients eyes (if you turn off the lights, we cannot see the videotape!).

Explain to the patient what you are going to do before you do it; ask the patients permission to perform examination.

36OSCE TipsDrape the patient appropriately.

Be sure you have considered osteopathic principles in all cases.

You may want to go to the restroom before the OSCE starts.

Thank you for your cooperation and good luck!

38