OSCE : Observed Stations

Dr Sandeep Kavade
Consultant, Vatsalya Children’s Hospital Bhosari
 OBSERVED
STATION

OBSERVED
STATION

OBSERVED
STATION
OBSERVED REST
STATION STATION

REST STATION

STATION 1 OBSERVED REST STATION

STATION
Clinical Photo Blank OSCE Sheets
X Ray
Clinical Scenario
ECG
ABG
Karyotype
Biostatistics
 Stay calm
 Focused
 Don’t spend time mugging things on the last day
 OSCE is an skill assessment of your entire post
graduation
 Things to carry for OSCE

 A professional outfit
 A good apron
 A stethoscope
 Roll No card
 2 pens
 Last but not the least
 A cool, calm mind
5 minutes are more than enough
(usually)

 Spots designed with around a 3 – 4 minute time frame

 Writing never takes more than 2 minutes
 Certain stations like statistics may be time-consuming
 First few OSCEs

 Life comes in a circle

 Some students get 3 simple OSCEs, some 3 impossible
ones
 Some will start on a rest station
 Don’t decide your fate on the first OSCE
 OSCE goes in a circle too
Read the question CORRECTLY

 See what the question says

 Example:
 ECG of SVT followed by question, name the drug
treatment of above condition, please see DRUG.
 Do not mention vagal maneuvers / DC conversion
over here
 We had a OSCE question where we had to take the
height of a child and plot it in the growth chart.
 Simple isn't it
 There were 4 children of different age groups
 Examiner randomly sent any one to each student
 Trick
 We had to remember to ask the name of the child and
write on space provided on growth chart
 Also had to attach growth chart to answer sheet and
then give it back
 NRP question about 18 hrs old baby found apneic in
ward
 It is 18 hrs old…do not ask the 4 standard questions
 At a station for taking child’s length with
infantometer a nursing assistant was standing in
corner
 Most students tried to do it on their own
 Assistance was provided to only those who asked.
 Getting the diagnosis or identification of a spot right
is very crucial
 Even if you get other answers correct, no marks are
awarded.
 Go with your gut instinct
 Do not diagnose or identify slides with the questions
 Many questions have false hints
Observed stations are fixed (more or less)

 History taking
 Clinical examination
 Counseling
 Indices calculation or some procedure or
Development examination
 NALS/PALS/Spirometry/ Rotahaler/Spacer use
etc……
 Counseling

 Introduction and ask about the language

 When diagnosed, is it confirmed
 Remove the guilt of parents (no one to blame)
 Treatment (If available or not for cure)
If not supportive therapy
 Treatment of disease complications and their
Complications
 Counseling

 Compliance with Treatment

 Antenatal counseling
 Recurrence Risk
 Support Group
 Thanks! All the best, do you want to ask any question
 Always ask language
 No medical jargon
 Give options
 Never force a decision
 COUNSELING

 24 yr old lady diagnosed as HIV + at 36 weeks of gestation.

Counsel regarding perinatal transmission and follow up.
1. Ensures the presence of husband 0.5
2. Introduces self/ puts the couple at ease. 0.5
3. Explains the disease in simple words 0.5
4. Explains the incidence and modes of perinatal
transmission
20-30% 0.5
Prenatal 0.5
Intranatal 0.5
Breast feeding 0.5
5. Explains modalities of reducing rate of transmission
ART to mother and child 1.0
LSCS Vs Vaginal delivery 1.0
Breast feeding Vs top feeding
1.0
6. Explains effect of measures – reduction by 50% 1.0
7. Explains screening of the infant 0.5
8. Explains safety of cuddling, petting and kissing 1.0
9. Asks for queries if any. 0.5
10. Advises to report back if any problems. 0.5

(Total marks 10.0)

 COUNSEL THE MOTHER OF A DOWN’S SYNDROME
 Introduction
 Asking for what she knows about the child’s condition.
 Telling common problems of downs to watch for
 Education and vaccination of present affected child.
 Inheritance & Possibility in next child
 Antenatal testing in next pregnancy
 Ask for and clarifying doubts
 Thank the mother.
 Advise the mother of a child with simple febrile
seizures
 Greeting the mother
 Introduce yourself
 Asking the mother what she knows about her child’s
illness.
 Explaining what is simple febrile seizure
 Management plan and side effects of drugs used
 Prognosis
 Avoiding technical jargon
 Asking for any more doubts and clarifying them.
 History taking

 Introduction
 Remove the stress
 Main symptoms
 Onset, progression, severity
 ? Similar problem in past
 Negative history for D/d
 Sibling/Family history
 Drug history
 Perinatal history, if imp
 Social /Environmental history if imp
 Thanks
 A 2 yr old child presents to emergency department
with severe pallor. Take the history of the child from
mother.
 Introduces himself and tries to make the mother comfortable
0.5 marks
 Asks onset sudden or gradual 1 mark
 history of bleeding or bluish spots 1 mark
 History of associated symptoms : fever, failure to thrive 1 mark
 Recurrent blood transfusions 1 mark
 history of associated jaundice 1 mark
 history of worm infestation 0.5 mark
 birth history 0.5 mark
 community and religion and history of consanguinity 1 mark
 dietary history 1 mark
 family history 0.5 mark
 drug history 1 mark
 Take history of a 8 year old child with past history of
repeated cough, breathlessness, not associated with
fever?
 Identify patient
 Introduce yourself
 Ask Duration & frequency of symptoms
 With expectoration?
 Allergic history?-rhinitis, urticaria
 Association with exertion
 Diurnal variation?
 Seasonal variation?
 H/o growth, weight gain
 H/o asthma, cough, allergies in family.
 H/ TB contact
 Investigation history
 Treatment History
 Procedures

 Always remember to wash hands

 Informed consent
 Check instruments provided
 Show the exact technique
 Collection of specimen
 Advise regarding post procedure observation
 Disposal of waste
 Thanks
 ELICITING KNEE JERK
 Greeting the patient and self introduction
 Taking consent and explaining the procedure.
 Adequate exposure
 Proper position of the patient (supine) and the doctor
 Proper technique (Keeping the hand under the knee and
striking the patellar tendon midway between its origin and
insertion).
 Looking for quadriceps contraction.
 Grading the reflex
 Thanking the patient.
 EXAMINATION OF B.P IN A 10 YEAR OLD
 Rapport with patient and Bystander
 Choice of cuff size
 Positioning of the patient
 Site of tubing in relation to artery is correct?
 Initial palpation, then auscultation method
 Rate of deflation is correct
 To say if reading is normal or otherwise
 Thanking patient and bystander
 Examination of Head Circumference
 Introducing oneself and establishing rapport
 To explain the procedure
 Positioning on right hand side of the patient.
 Inspection for skull abnormalities.
 Head circumference to be measured with fibre glass tape.
 Tape should encircle over the most prominent point on the
occiput and supra orbital frontal ridge.
 Ends of the tape should overlap and intersecting value to be
taken.
 Accurate reading and plotting on the growth chart, if available.
 Examination of Height of a 7yr old child by
Stadiometer
 Introducing oneself and take consent
 Explaining the procedure
 Examining from right hand side of the patient
 Make the child stand against scale bare feet.
 Feet together parallel with heel, buttocks, shoulders and occiput
touching the rod.
 Ask to look straight head erect with chin up. Frankfurt plane and
biauricular plane being horizontal
 Scale brought to touch the vertex, pressing the hair.
 Accurate reading and plotting on the growth chart, if available.
 Do Motor system examination of the child
Introduces. ½
Explain to parents & consent ½
Warms hand before examination ½
Posture / tone ½
Nutrition ( wasting etc.) ½
Power : fingers / wrist / elbow / shoulder in all move. ( 0.5*4=2) 2
Power : hip / knee / ankle / 1½
Deep reflexes : AJ /KJ /BJ /TJ / BR.JERK ( 0.5 *5) 2½
PERSISTENT NEONATAL REFLEX (if infant) ½
Abnormal reflex ( jaw jerk) ½
Gait ½
Thanks the Mother ½
TOTAL 10
 Administer HIB Vaccine to this 4 month old child who
is otherwise normal.
Introduces. ½
Explain to parents about vaccine / cost / side effect 1
Wash Hands ½
Take 2 ml syringe and needle to withdraw diluent and Mix it with the ½
lyophilised Powder
Changes the needle ½
Identify the site. Anterolat Thigh middle 1/3 ½
Correct needle ½ inch ( IM) ½
Clean the site ½
Correct direction ( vertical) .. ½
Withdraw and press at the Inj Site ½
Post procedure advise to mother ½
Instructions to wait 20 min and inform on case of problem ½
When to come for the next dose ½
BIOWASTE DISPOSAL 1
Thanks the Mother ½
TOTAL 10
 Examine the Abdomen of this child.
Introduces. ½
Explains to child what exactly has to be done 1
Warms hand before examination ½
Inspection: shape ½
Scar / sinus veins /umbilicus ½
GENITALS / Hernia ½
Palpation: Liver / spleen…superficial and deep ½
Bimanual Palpation ½
Percussion: all quadrant ½
Shifting dullness / coin test ½
Auscultation for 1 min : for peristalsis and Bruit ½
TOTAL 6
Do not ask examiner any question

 Except the NRP station

 Rest at the rest station
 http://groups.yahoo.com/group/PediatricsDNB/

Theory: http://dnbpediatricstheory.blogspot.in/
OSCE: http://oscepediatrics.blogspot.in/
Clinical: http://clinicalpediatrics.blogspot.in/
Practicals: http://practicalpediatrics.blogspot.in/
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