OSCE Tips and Tricks

 

• Lo-Fi – no equipment – iSIM for observations at most – unlikely to be a REAL defib/oxylog/pacer etc

 

• 7mins and only 4 mins to reset – Think about what is possible in that time frame– Can’t be overly complex or involve equipment/scenarios that take time and effort to reset between stations

 

• You will land in the thick of the action – need to get bearings quickly!

 

• LISTEN to the confederates – if they are telling you something or asking you a question it is a clue/is important.

 

• Don’t interrupt them unless absolutely critical e.g. someone has arrested/has sats of 50% and has no O2 on

 

• Entry Patter – have a quick spiel for when you enter the room – but don’t go on forever
  • – I Am/My Role Is/You Are/Listen to handover/State The Situation/The Priorities Are……

“Im Beks the Consultant, I’ll team lead. **LISTEN**, OK, so we have life threatening Asthma with ventilatory difficulties, Priorities are to ensure tube placement and patency, treat bronchospasm with…., exclude tension PTX, exclude ventilator issues and ensure that there is not dynamic hyperinflation/breath stacking. First lets………”

 

• Don’t repeat the stem unless totally stuck – no time

 

• Assume competence of team, they can do what anyone of that level/role would be expected to do. They will not show initiative however. They may have scripted prompt for if you have missed something though – so pay attention to anything they say to you.

 

• What do you see in the room/what are the clues/access/O2/obs/other

 

• SHARE THE MENTAL MODEL – you are doing this to show the examiner what you know – they cant award the marks for thing that are subtly implied.
  • If you think it is resp sepsis and are giving abx for that reason say “I think this is resp sepsis so we need to give ceftriaxone and azithromycin”
  • or If ROSC after undifferentiated paed PEA arrest state  “ we need to consider trauma/NAI/sepsis including meningistis/hypovolaemia/toxins….”
• If something isn’t available it isn’t being assessed – move on

 

• If given an investigation – look at it – interpret – then summarise the interpretation to the team – AND state how this information changes things (don’t just read it out stating whether each value is high or low – that’s what a med student does!)

“this gas shows severe metabolic acidosis with BSL of 40 and severe renal failure suggesting DKA with severe dehydration – we need to start IVF 500mls stat and prepare an insulin infusion”

 Trigger words – write a list of buzz/high yield words for the following :

MTP = 1:1:1, warmed, level 1 infuser, TXA, Ca+, avoid hypothermia, consider source and get surgical haemostasis

 

PPH = Tone/Tissue/Thrombin/Tone, oxytocin/synto, rub up uterus, Urgent O&G, MTP, TXA, risk of coagulopathy and DIC,

 

Asthmatic Crashing Ventilation is often the main issue here, DHI, PTX, hypovolemic, autopeep, DOPES and SHIT mnemonics, chest sepsis requiring abx, permissive hypercapnia pH 7.1, mustn’t forget medical therapy e.g. bronchodil/abx/roids after intubation, low Vt and RR to prevent breath stacking

Pregnancy Trauma – Left lateral tilt, manual this fetus is viable/non viable, if arrests we will be doing a perimortem CSection and the fetus needs to be out in 4 mins, will be potentially hard to intubate due to swollen airway/large boobs, high risk of aspiration, physiological changes will make shock hard to evaluate…..etc

 

The unwell dialysis patient

Undiff shock

Neonatal Resus

Paeds Arrest

Sepsis

Ventilation

Neuroprotective strategies

Multitrauma

Procedure

Intubation

 

Play word association with your exam buddies to ensure that your brain is making the right connections for any given station……