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Analyzing OSCE
For PEBC Candidates
07/07
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OSCE stands for Objective Structured Clinical Examination and is a type of exam that
examines not only the knowledge of the candidates but also other clinical skills such as
communication and interpretation of results.
In other words OSCE is more about: WHAT YOUSAY and HOW YOUSAY IT in a certain
amount of TIME.
It consists of interactive stations, in which you communicate with an actor/actress, and
non-interactive stations, which focus more on your professional experience and/or
judgment.
Like any other exam there are several key factors that one should follow to pass the
exam. Once you learn these factors and stick to them youll find that its not really that
hard to pass this exam. Here you can find some tips that you may find useful in taking
the exam. These were helpful for me so I decided to share themwith you.
Make sure to check back often as i will try and update this as much as i can.
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Preparing For OSCE:
Practice, Practice, Practice
Practice is the key to success!
I believe this really applies to this exam. Form a study group with 3 or 4 friends and start
practicing as soon as possible. Working as an assistant or a student will help too, but
group study is much more focused. Prepare a checklist for interviewing the patients can
(I have attached 2 samples in the appendix. These are just samples, prepare your own!),
memorize it and try to ask the questions as fast as you can - But dont forget to listen to
the answers given by the patient and to take notes. This way you will save a lot of time
and will always make sure that you dont miss any important question. Time yourselves
(4min + 2 min) and try to cover all the important parts in each case.
References
- PSC & TC
Study the PSC (Patient Self-Care) as much as you can, especially the Patient
Information Sheets.
Read the TC (Therapeutic Choices) at least once and reviewthe Table of Contents and
the titles of each chapter. You really dont need to memorize the TC for OSCE as you
would for MCQ. It is important to know where you can find specific information in TC.
DO NOT rely on the index (at least for the forth edition). The new TC is coming out this
summer, so make sure to contact the PEBC and ask themwhich edition will be provided
in the next exam.
- CPS
Spend as much as time as you can on this book. Study the lilac pages. Read [all] the
CPhA monographs (118 monographs). Try to become familiar with the warnings, bold
prints, etc. The 2007 edition is more organized than the previous editions, which will
save you a lot of time during the exam. Try to read the monographs for the most
prescribed/important medications in Canada (Check the Appendix). Always check the
administration with food section. After getting familiar with the book, give yourself 2
minutes (or less) to extract all the info for a drug which is newto you.
- Product Leaflets
When you get tired of studying, go to the largest pharmacy near you and read the
information on OTC products. Your eyes should become familiar with the small prints
(French/English) on the boxes. For some unknown reason, most people go to the
French instructions first, during the exam! And after spending some time staring at the
box, they find out that this is not English! This is pretty normal and may happen to you
too. So, be aware and dont panic. Try not to miss the important info. If possible open
the product and read the leaflet or ask the pharmacist to counsel you on the product.
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During the exam if you want to suggest a product to the patient, dont forget to read all
the info on the box and/or the leaflet (usually, in the exam, the boxes are open and you
can take the leaflets out).
- Devices
Devices are very important, make a list of different devices with your friends and try to
find some used products/demonstrators. You can download the leaflets from the
manufacturers websites (some companies provide you with free demonstrators for
example for Twinjectauto-injector go to: http://www.twinject.ca/en/accessories.php).
- Other references
A list of all the references that may be provided in OSCE is provided in the PEBC
booklet. If you have time it might be a good idea to go to a reference library (like
Toronto Reference Library) and try to get familiar with these books (one day would be
enough for all the references).
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Taking the OSCE
o Interactive Stations:
No Misinformation / Risk to Patient!!!
If you read the PEBC Qualifying Examination Information Booklet which is a must do
youll see that at the bottom of assessors Checklist (expected responses, there is a
section for:
Misinformation Yes No
Risk to Patient Yes No
Usually getting one Yes in these areas will lead to failing the exam! The logic behind
this is that the exam is open book and candidates should double check anything that
they are not sure about. I personally believe that many knowledgeable candidates fail
because of these factors. They believe that they know the correct answer and dont
check the references to save time; however, because of many different factors such as
stress, especially designed questions - they give misinformation or put the patient at
risk.
Read the patient
The first thing you should always remember is that during the exam youre not dealing
with real patients! But rather with trained actors who are there to help you pass the
exam. So it is very important to communicate with them and try to get the necessary
information fromthem. You should also be able to read the patient.
Always find out what is the patients main concern first. Although it may take 30-40
seconds of your precious time at the beginning, but it will save a lot of time later in the
station. At the end of the station, always leave enough time to ask the patients if they
have any questions and to answer them. NEVER give an uncertain answer just because
youre running out of time (big risk of giving misinformation!). If you dont have time to
check the answer, tell the patient that you need more time and will contact them later.
You will certainly loose the mark for that question but still there is a great chance that
you pass the exam.
Be polite with the assessors
You can not communicate with the assessors during the exam and even if you do they
will not answer you however, there is no harm in saying Hello to them at the
beginning and thanking them at the end of the station. When finishing the station,
close the books and try to put the station materials in the order which they where in at
the beginning.
Dont Panic
We all forget things or make mistakes during the exam. Even if you mess up in a couple
of stations, you can pass by doing well at the other stations. It is very important not to
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panic when you see a difficult station or something you dont know. Always remember
Youre not the only one! and many other candidates feel the same.
Informing the physician
There are some stations where you are supposed to refer the patient to the doctor (for
example where a red flag is raised) and some stations where you should not refer the
patient but rather suggest an OTC medication. In the latter, its always a good idea to
tell the patient that you will contact his doctor and let him know about the medication
you have dispensed.
o Non-interactive Stations
There are a couple of non-interactive stations as well. If have worked in a pharmacy you
shouldnt have any problemwith these.
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Appendix
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1 - Patient with a newRx - Counselling
1. Good morning/evening, Im..., the Pharmacist, Howmay I help you?
2. This prescription is for , is that you?
3. OK Mr. / Ms. .
1. Sensitive situations:
Would you like to go to a more private area? Please have a seat.
2. Normal Situation:
Please have a seat in our private counselling area, and we will talk about
this.
4. What did the doctor tell you this medication is for?
What made you go to the doc?
5. It sounds like (empathy); Ill try to do my best to help you,
6. But first I need to ask you some questions, just to make sure youre getting the
best benefit fromyour Mdns,
7. and all the information youre giving me, will be confidential. Is that ok?
1 A 3
Do you have any Allergies to any foods, medications or substances?
What happened when you first .
2 MC
any medical conditions such as high blood pressure?
3
Mdn
3
Are you currently taking any medications including over the counter
medications, vitamins and herbal products?
Do you remember the strength? Howoften do you take it? Any other?
4
C
A
S
D
E
P
I also need to ask you some questions about your lifestyle, as it may
affect the way that the medications work
Do you drink Caffeinated beverages such as coffee?
Howoften/howmuch?
Howabout Alcoholic beverages? Howoften/howmuch?
It may or may not apply to you, but I need to ask if/ Do you Smoke?
Howmuch?
Do you followany special Diet, such as vegetarianism?
Do you get a chance to Exercise regularly?
I also need to ask if you are Pregnant or planning to become pregnant?
Howabout nursing?
Thnx
Well , Thank you for answering all the questions. Let me check my
references/ get your Mdn, and I'll get back to you shortly.
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Take note FromReferences
CPS:
Drug Admin &Food (Lilac pages)
Dosage, Administration
Supplied (DF, Strength), Storage
Adverse Effects (S/E)
Indication
Brand, Generic, Pharmaco (Mechanism)
C/I, Precautions , Warnings, Bold letters
Ix, Pregnancy, Lactation (if appropriate)
PSC:
Px Info Sheet
Non-Pharm
Monitoring (When to see Doc, )
Advice for the patient
Patient Profile:
Place in treatment
Thank you for waiting mr/ms,
Your doc has prescribed Brand, Dosage Form
Which contains Generic(s), Strength(s)
B
DF
Gen
Strength
4
Howdid the doc tell u to take this med?
If taken as directed, this Mdn shouldIndications/Mechanism.
Directions (e.g. w/ or w/o food, Do not crush, Grapefruit ), Dosage
Ind
Dir
Dos
3
Well, In addition to their beneficial effects, Mdns may have some
unwanted S/E, which you may or may not experience. What did the doc
tell u about these S/E? S/E, Management:
- 2 x Common: Some ppl may experience
These should not cause major problems, however, if they persist or
become bothersome please contact us and we will discuss them.
- 2 x Rare: Rarely do ppl experience
If you notice skin rashes, swelling, SOB or any unusual changes you
should contact your physician immediately.
S/E
Mngmnt 2
Storage: Keep this Storage 1
Find DRP (if any): Check the patients profile and see howthe new
medication fits into the patients treatment plan.
DRP 0
Along with your medication, there are some non-pharmaceutical / non-
drug measures that may be considered to improve
Non-Ph 1
Patient Information Sheet.
Any Questions / Concerns?
Info Sheet
Any Q
2
Followup:
Please do not hesitate to contact us if you have any concerns.
If you do not see any improvement within , or you condition worsens,
you should contact your doctor.
If you dont mind I will call you in days, to see howyou are doing
[with this Mdn].
Call
Call Me
Call your Doc
I Call you
3
I hope you feel better soon. Thank you for choosing/using our
pharmacy and have a great/wonderful day/evening.
Thanx
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2 - Patient comes with a concern/pain/
1. Good morning/evening, Im..., the
Pharmacist, Howmay I help you?
Patient has a question
2. Would you like to go to a more
private area? Please have a seat.
3. So tell me about your concern
4. [empathy] It sounds like / it must
have been hard for you ;
5. Ill try to do my best to help you. But
in order to help you better I need to ask
you some questions.
1. Good morning/evening, Im..., the
Pharmacist, Howmay I help you?
Patient Complains of
2. [empathy] It sounds like / it must
have been hard for you ;
3. I may be able to help you feel better,
But in order to help you better I need
to ask you some questions
4. Would you like to go to a more private
area? Please have a seat.
Patient Assessment (followthe charts in PSC):
Could you describe your symptoms for me? Where is the location of the sx?
Have you made any changes in your lifestyle recently?
Have you ever had these sx before? / What did you do last time?
Is there anything that aggravates/relieves these symptoms?
What is your perception of the cause of these sx? / What is most likely the cause of
your symptoms? / What was going on when the symptoms first started?
Could you tell me why you believe it is ?
Have you talked to your doctor about this?
Did you try anything to relieve your symptoms?
. . .
Ask Only Relevant Questions:
1 A 3
Do you have any Allergies to any foods, medications or substances?
What happened when you first .
2 MC any medical conditions such as high blood pressure?
3
Mdn
3
Are you taking any medications including vitamins and herbal products?
Howoften do you take it? Do you remember the strength? Any other?
4
C
A
S
D
E
P
I also need to ask you some questions about your lifestyle, as it may
affect the way that the medications work
3. Do you drink Caffeinated beverages such as coffee? How often/how
much?
4. Howabout Alcoholic beverages? Howoften/howmuch?
5. It may or may not apply to you, but I need to ask if/Do you Smoke?
Howmuch?
6. Are you on/Do you followany special Diet, such as vegetarianism?
7. Do you get a chance to Exercise regularly?
8. I also need to ask if you are Pregnant or planning to become
pregnant? Howabout nursing?
Thnx
Well , Thank you for answering all the questions. Let me check my
references and I'll get back to you shortly.
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Check References:
PSC/etc:
Check the Tx Approach Charts: Choose a product or Refer*
Px Info Sheet (Non-Pharm)
Monitoring (When to see Doc, Wear bracelet )
Advice for the patient
Read the label on the OTC product
Thank you for waiting mr/ms,
Based on you r sx/sx, I believe that .
I suggest that you try this mdn: Brand, Dosage Form
Which contains Generic(s), Strength(s)
B
DF
Gen
Strength
4
If taken as directed, this Mdn shouldIndications/Mechanism.
and youre going to take: Directions (e.g. w/ or w/o food, Do not
crush, Grapefruit ), Dosage
Ind
Dir
Dos
3
Well, In addition to its beneficial effects, this medication may
have some unwanted S/Es too which you may or may not
experience.
S/E: 2xCommon + 2xRare, then Management
Some ppl may experience Rarely do ppl experience
S/E
Mngmnt 2
Storage: Keep this Storage 1
Along with your medication, there are some non-pharmaceutical /
non-drug measures that you may consider to improveVERY IMP
Non-Ph 1
Patient Information Sheet.
Any Questions / Concerns?
Info Sheet
Any Q
2
Followup:
Please do not hesitate to contact us if you have any concerns.
If you do not see any improvement within , or you condition
worsens, you should contact your doctor.
If you dont mind I will call you in days, to see howyou are doing
[with this Mdn].
Call
Call Me
I Call you
Call your Doc
3
I hope you feel better soon. Thank you for choosing/using our
pharmacy and have a great/wonderful day/evening.
Thanx
* Referral:
Fromwhat youve descried, I think it would be best to see your doctor about this.
Challenge:
Im really concerned about your health and I think its important that you doctor see
you ASAP. If you like, I can fax them a note to let them know what weve already
discussed and medications youve tried.
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Important drugs
Link:
http://www.imshealth.com/vgn/images/portal/cit_40000873/0/33/78325950prescription_drug_purchases_reach_16.57billion.pdf#page=7
Lipitor
- Your doctor has prescribed Lipitor, also known as Atorvastatin, it comes in the form
of oral tablets, and each tablet contains 10/20/40/80mg of medication.
- Youre going to take one tablet once daily with or w/o food at the same time every
day, preferably in the evening. Do not drink grapefruit juice while youre taking this
medication. This medication works by regulating cholesterol metabolism and if
taken as prescribed should help you to control your blood cholesterol level. Results
can be seen in 2-4 weeks. It is important that you take this medication regularly and
not to change the dose or stop taking it without consulting your doctor. If you miss
a dose take the missed dose as soon as you remember, if it is almost time for your
next dose, skip the missed dose. Do not double the next dose.
- Lipitor is generally well tolerated, however, like any other medication, it can have
some unwanted side effects as well, that you may or may not experience. These
include headache and heartburn. If you experience these side effects and if they
persistent or become bothersome, please contact us and we will discuss them.
Also, after taking this medication if you notice rashes on your body, shortness of
breath, unexplained muscle pain and weakness or yellowish skin or eyes, contact
your doctor before taking the next dose.
- Store this mediation in a cool dry place out of the reach of children.
- Along with this medication there are some non-drug measures that you may
consider to improve your condition, such as: following a low fat diet and exercising
regularly.
- I will give you a patient information sheet which has more detailed information
regarding these measures and your medication. Please read this information and do
not hesitate to contact us if you have any questions.
- Do you have any concerns or questions regarding your medication?
- When is your next appointment with your doctor? It is important that you keep
appointments with your doctor.
- If you dont mind I will call you in 1 week to see how youre doing with your new
medication.
- Thank you for choosing our pharmacy and have a good day.
Note:
- Lovastatin: Take with food
- Pravastatin, Rosuvastatin &Fluvastatin: no Ix with Grapefruit
- Atorvastatin: also indicated for elevated TG with Normal LDL (Fredrickson)
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Altace (Ramipril): Oral Caps 1.25/2.5/5/10 mg
- Works by relaxing blood vessels and by making the heart pump more efficiently
- Take w/ or w/o food, Swallowhole, Do not crush or chew.
- C/I: allergic, angioedema
- Warning: Pregnancy
- S/E: Hypotension, persistent dry Cough
- Contact Doc: Allergic reaction, any swelling in the face or other parts of body, sign
of infection (fever, sore throat)
- Ix: Diuretics, lowsalt diet, K supplement, Iron, NSAIDs, Sun exposure
- Non-pharm for HTN: Weight control, Healthy Diet (high in fresh fruits & vegs, low
fat, low salt), Regular physical activity, low alcohol consumption, smoke-free
environment.
Note:
- May cause hyperkalmia with k-sparing drugs or k supplement
- Quinapril decreases tetracycline absorption.
- Captopril (and others): Taste disturbances
- Fosinopril: No dosage adjustment in renal failure with normal liver and vice versa
Accutane (Isotretinoin): Oral Caps 10/40 mg
- Start on 2
nd
/3
rd
day of menses. Take w/ food, missed dose,
- During first weeks acne may get worst, it takes 4-6 wks to see improvement
- S/E: inflammation of the lip, Dry skin/mouth, Itchiness.
- See Doc: if you notice any changes in your mood such as feeling sad or loosing
appetite, hives and SOB, yellowing of the skin or eyes.
- Preg: Cat. X, 2 Contraception methods (not low dose OCP e.g. minipill) at least 1
month before, during and 1 month after d/c.
- Lact: Do not breastfeed during till 1 month after d/c of med.
- Do not give blood, avoid wax epilation, Do not take Vit A supplement
- Non-pharm: be patient, takes time to see the results.
o Shampoo hair regularly
o Wash area with mild soap and water max. bid
o try not to use make-up if you need to use, use oil-free cosmetics
o Protect fromsunlight
o Keep appointment with doc
Note:
- 10 mg Caps Contain Peanut oil (Canthaxanthin). Both caps contain: Soybean Oil
- History of depression
- Tetracycline? Contact doc to stop
- Duration: 12-16 wks. If needed Second course: Start 8 wks after completion of first
course.
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Coumadin (Warfarin): Oral Tabs 1/2/2.5/3/4/5/6/10 mg
- Is a blood thinner; Inhibits production of [Vit k dependent] clotting factors
- Prevents / Treats heart problems such as MI, DVT, and CHF.
- Take w/ or w/o food. At the same time every day.
- Initial Dose: 2-5 mg/day
- S/E: Nausea, Dizziness, haemorrhage fromany tissue or organ.
- Storage: Tabs: Store at room temp. (Injection: Store at room temp, do not
refrigerate, use 4h after reconstitution.)
- Go to ER: abnormal bleeding (stool, urine, excessive, bruises - dark purplish spots
under skin) Tx: IV Vit K / Blood / Factor IX Complex
- Non-Pharm:
o Avoid abrupt changes in diet. (Specially leafy/green vegetables/legumes)
o Keep your appointment with your doctor; your doctor will perform INR tests
to evaluate the results of the therapy.
o Wear a MedicAlert bracelet / Tell anyone providing medical or dental care
that you are taking warfarin / ask pharmacist before choosing any
OTC/Herbal product.
- Ix: Vit K, St. Johns Wort, Co-Q10, CYP2V9 inhibitors (Check CPS) , Garlic,
Gingko, Danshen, Dong quai , Bromelains
- C/I in: pregnancy, recent surgery, bleeding (GI, CNS,), spinal puncture.
- Pregnancy: C/I Lactation: Safe but monitoring required.
- INR target: 2-3 / More intense: 2.5-3.5
Methotrexate: Oral Tabs 2.5 mg
For R.A.:
- interferes with the growth of certain cells of the body
- Take w/ or w/o food. Dont take with alcohol.
- Weekly single dose oral/iv/im 7.5 mg or Divided oral dose 2.5 q12h x 3doses
(Emphasise on WEEKLY). Max 20mg/wk. It takes 3-6 weeks to see improvement
- S/E: inflammation of the oral mucosa, Nausea/Vomiting, upset stomach, dizziness,
tired feeling.
- See Doc: Rashes/SOB, Infection (fever, sore throat), yellowing of the skin or eyes.
Symptoms overdose: pale skin, easy bruising or bleeding, unusual weakness, mouth
sores, nausea, vomiting, black or bloody stools.
- Preg/Lact: C/I
- Non-Pharm:
o Balance of rest, activity and exercise
o Pain modulation w/ heat and cold application
o Maintaining joint range of motion and muscle strength
Note
- Safe handling and disposal
- Lowdose folates admin to decrease S/E
- Dont take NSAIDs unless doctor prescribes
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Do the same for:
Zyban
Xenical
Zoloft
Oral Contraceptive Pills
Lanoxin
Carbamazepine
Antacids
Evista
Lyrica
Estrogen (Patch, Gel)
Tretinoin
Mobicox
Naproxen
Amerge
Arthrotec
Aricept
Entocort (Budesonide)
Avelox
actos
Biaxin
Cipro HC
Zithromax
Cardura
Canesten
Xalantan
Diane 35
Plavix
Synthroid
Proscar
Ciprodex
Imitrex
Fosamax / Fosavance
Famvir
Misoprostol
Cialis/Viagra/Levitra
Tozarac
Salbutamol
Nitro-Dur
Pulmicort
Advair
Spiriva
Epipen
Corte enema
Combivent
Pensaid
Nasonex
Flonase
Flomax
Prometrium
HP-PAC
Prevacid
Pantoloc
Dovonex
Paxil
Celexa
MacroBID
Imovane
Lamisil (Cr, Tab)

GOOD LUCK ! ! !