How to pass the international MRCGP OSCE

Patient consultation setting:

Introduce yourself

Verbal
Hi, I am doctor Abc.

Body language
Smile, nod, lean forward slightly to show interest but look professional

OSCE Domains
A: courtesy consideration

Take a history

Again nod you head and look as you are interested in what the patient has to say, look at the patient not anywhere else! Listen carefully Encourage the patient. You mentioned Listen for the cues, Hunt for the hidden diagnosis (pain/ walking the role playing if the history is nebulous or difficulty/ patients will give psychiatric. If the patient dizziness / thirst/ them and expect provides a problem assess chest discomfort / you to pick them their iedas by asking them breathing up! Remember the what they think is the cause, problems etc), can patients will be they might think eczema is you tell me a bit talking in contagious hence they are not more about it? laymans going out in which case you Is there anything language. can address their worries or else on your The actors will try correct through education mind? Are you and look their ideas. If after 1 minute worried about uncomfortable or you can see they are anything else? hesitate this is a rambling and they pause this [Concerns] What cue to a hidden is probably a heart sink do you think is agenda, they may patient and you need to ask causing it? avoid eye contact what their expectations are so [Ideas]. What or say something you can work out what they would you like like There was want you to do? me to do for you something else but today? What its not important. would you like to see happen today? [Expectations] You have a diagnosis in Back pain: Do Use your fingers to mind, think is anything you have demonstrate what serious, ask the important numbness in you mean by in questions, red flags, things between your between. Try and that will sift important from legs. Any use body language less important. Think red problems with to help your flags: Upper GI: weight loss, passing urine such questions. dysphagia. Lower GI: as difficulty

How can I help you today?

A: Full focused history

B: sensitivity to patient, facilitates free expression of ICE (ideas, concerns and expectations) C: Good communication skills E: Considers implications for the patient and others.

A: takes a history sufficient to exclude a serious condition.

Change in bowel habits >6w Resp: Weight loss, sweating at night, cough >2 weeks. Cauda equine lesion: weaknes, bladder bowel control loss, pain raditing to tip of toe etc. Check the NICE fast track referral guidelines! Ask the socio-economic impact of the problem. Examine appropriately, dont do a full exam, concentrate on the bits you need, and dont miss postural hypotension if they are dizzy!

controlling it? Clarify difficult questions. Is this affecting your life or work? Do you find it difficult to deal with the children?

Diagnosis Make your diagnosis, and add 2 differentials if appropriate. If the diagnosis is obvious just state it and do not add differentials unless the patient asks could it be anything else. Dont forget to rule out any concerns that patient had said at the beginning. Dont forget to assess for understanding at the end by asking for any questions.

Management Start with the least expensive (show correct resource management), and offer a couple of options quickly explain the pros and cons of each and then hand over to the patient. Be prepared to

I would like to examine your back / hands is that okay? I will need you to (mention what you need them to do) Let me explain what I think, From what you have said and the exam I think you have A or B or C. I think A is likely but we will need to do some tests to work out if it is A or B or C. Let me explain what A is You mentioned you were worried about skin cancer, I can reassure you that this is not related to skin cancer but is eczema. Do you have any questions? For the depression we can use talking therapies or medications or herbal therapies. Talking therapies work as well but take time, tablets

Pause after asking permission! Demonstrate the exam procedure if simple with your own body, i.e. position your hands etc.

A: Examines patient appropriately and efficiently.

C: Offers clear explanation of symptoms and diagnosis to the patient.

C: Negotiates management of patient. Involves them in decision. D: Treats and investigates appropriately, offers range of

negotiate i.e. I want CBT and medication say we have limited resources and we should try one and then the other

Summarise and Safety Net. Health promote tag this on here.

work quickly while herbal remedies can work but can also be unpredictable. What would you like to do? Let me summarise so I am sure I have explained things well: You have depression. Well treat it with an anti-depressant which is one tablet per day. I would like to review in one week to see how you are getting along. If you have any problems dont hesitate to come back and see on the on call doctors or if it out of hours one of the out of hours services. Just one more thing I would like to add: have you had your cervical smear / do you smoke? (if they say yes) Could we please talk more about this, could you book an appointment in the next few weeks whenever is convenient?

options, safe prescribing.

You could write down basic points on a sheet of paper and give them to the patient. Your prescriptions will be assessed so write fully and

MRCGP case list

Paediatric case (Poor schooling, not growing well, bullying) 1. Elderly case (Deafness, dry eyes, falls, dizziness)

2. 3. 4. 5. 6. 7. 8.

Chronic disease case (DM, IHD) Womens health case (Contraception, PMB) Mens health (ED, LUTS) Infectious disease Case (TB, Pneumonia) Psychiatry case (Depression, GAD or OCD) Bad news (Cancer) Difficult patient (I want screening, I want my partner to be sterlised, Complain about your colleague etc.)Drug problems (EOH, Side effects, hidden agenda) 9. Neuro (CTS, CVA)MSK (Back, shoulder, knee, carpal tunnel, OA) 10. Skin (Eczema, psoriasis, fungal infection)GI (IBS, change of bowel habit) 11. Resp (Asthma, COPD)