Phase 4 OSCE 19 June 2012 Group 2 STUDENT Feedback

School of Medicine, Dentistry and Biomedical Sciences
Progress and Assessment Office

Queens University Belfast
Whitla Medical Building
Belfast, BT9 7BL
Tel: 028 9097 2439
Re: Feedback regarding Phase 4 (Summer semester) integrated OSCE

June 2012
Dear Student
The purpose of this letter is to provide you with some general feedback regarding your
recent Phase 4 (Summer Semester) Objective Structured Clinical Examination. Overall,
examiners were impressed with your performance.
I would also like to take the
opportunity to thank you for your engagement in this assessment process. Logistically it
is a huge task to co-ordinate over 250 students, 100 examiners, 40 simulated patients
and 20 floor staff. The primary function of OSCEs is to provide judgement on your clinical
performance. But OSCEs can also have an educational impact. To this end I have
attached the following feedback documents:
Your overall performance at each OSCE station.
This sheet indicates how you
performed compared to your total year group. Your percentage score attained (i.e. your
score that is on Queens Online) has been adjusted by a mathematical formula to
reflect a pass mark of 50% - so this will differ from the score attained on this feedback
report. Please note this as many students contact us having noticed two different
scores!
General examiner feedback about candidates performance at each station.
We would encourage you to reflect on this feedback, review your study notes on these
topics and consider how you will change your practice in the future. We wish you all the
best in your future studies and career.
Yours sincerely
Dr Gerry Gormley
Convenor of Phase 4 OSCEs and on behalf of
Marie Brooks, Carolanne Smith, Jane Fox, Perpetua Lewis (Progress and Assessment Office), Margaret Stirling (CSEC), Dr
Richard Tubman and Dr Angela Bell (Healthcare of Children), Dr Ciaran Mulholland (Psychiatry), Dr Maeve Rea (Ageing and
Health), Dr Barry Kelly, Dr Jan ONeill (Radiology), Mr Michael McMullan (Fractures), Dr Al Dorman / Dr Colin Winter
(Perioperative and Emergency Medicine), Dr Seamus McAleer (Cancer Studies), Dr Inez Cooke, Dr Janitha Costa (Obstetrics &
Gynaecology) and Dr Drew Gilliland (General Practice)
Global station feedback

Phase 4 OSCEs
Summer Semester 2011-2012
Cancer Studies, Care of the Elderly, Fractures, General Practice, Psychiatry
and Radiology
Station 1: POEM: Presentation of DKA

General comments: This station aimed to assess the candidates ability to interpret clinical
data and discuss the treatment of diabetic ketoacidosis. Overall examiners were pleased with
candidates performance in this station and commented on your ability to correctly interpret
blood gases.
Specific comments: The one further investigation which would support the diagnosis of
DKA was urinary ketones or calculation of the anion gap. 27 students failed to mention this.
From the blood gas it was evident that the patient had a metabolic acidosis with attempted
compensatory respiratory alkalosis. In terms of fluid resuscitation the patient required 0.9%
saline or colloid iv with a volume of >500mls, followed by a reassessment after this fluid
challenge.
Station 2: Child Health: Completion of a drug chart

General comments: Candidates in this station were asked to complete a paediatric drug
chart. Overall examiners were reasonably satisfied with how candidates performed in this
station. Completion of a drug chart is an essential skill for foundation programme doctors. We
would encourage you to maintain these skills by observing and practicing this drug chart skills
in your final year attachments and assistantship.
Specific comments: A number of candidates wrote up the stat doses of FLUCLOXACILLIN in
the wrong location in the drug chart (i.e. should have been in the once only and pre
medications section).
25 students failed to attach a patient addressograph label or
handwrite the patient details on to the drug chart. This is an important task, and failure to do
so could result in an adverse patient event. A number of candidates wrote their initials rather
than using their signature.
Station 3: POEM: Opiate toxicity
General comments: This station aimed to assess candidates ability to i) recognise and
interpret deterioration in routinely recorded clinical observations and ii) relate the changes to
prescribed drugs on the kardex. This was a case of opiate toxicity. Overall examiners were
pleased with how candidates performed in this station.
Specific comments: A number of candidates (89) failed to mention that the patients renal
failure may have also contributed to their opiate toxicity. Many candidates gave a good
management plan in how to respond to this situation. However some failed to mentioned that
as a foundation programme doctor you would ensure the patient had iv access and would
seek senior help. These are important steps in such medical emergencies. A few students
were not aware of the antidote for opiate toxicity (i.e. NALOXONE).
Station 4: POEM: Basic airway management

General comments: This station aimed to assess candidates technical ability to use basic
airway adjuncts. Examiners were extremely pleased with your performance in this station.
Specific comments: The FiO2 that can be delivered by a simple face mask at a flow rate of
15 lmin-1 is 50%. Only 38 candidates gave a correct response to this question.
By using a
face mask with a reservoir bag - increased the FiO 2 to 85%. A few candidates failed to
demonstrate how they would inflate the reservoir bag. The correct nasopharyngeal airway for
an adult male is either 6 or 7mm. Only 69 candidates gave this correct response.
Some
candidates had difficulty in correctly locating nasal cannula on to the manikin. We would
encourage those students to practice this in their future clinical attachments.
Correct position of nasal cannula
Station 5: Child Health: BLS

General comments: This station aimed to assess candidates ability to perform one person
basic paediatric life support. Overall examiners were very pleased with your performance in
this station. Performing effective BLS is a core and fundamental skill.
Specific points: 45 candidates failed to check the childs level of responsiveness. A number
of candidates failed to assess the childs airway (e.g. for food debris and other foreign bodies).
Otherwise candidates performed very well in this station.
Station 6: O&G: Missed pill

3
General comments: Candidates in this station were presented with a female patient who
missed some of their contraceptive pills. Overall examiners felt that candidates could have
performed better in this station. The patient in this station was taking MICROGYNON (a
combined oral contraceptive pill). The patient had missed three pills and had only 2 left in
their packet. The ideal management would be to advise the patient to run two packs of pills
together and to use extra precautions. Examiners did comment that candidates displayed
good communication skills.
Specific comments: Surprisingly only 70 candidates actually asked the patient the name of
the oral contraceptive pill that the patient was taking. Only 24 candidates enquired that if the
patient had missed any other pills in her packet. 42 candidates failed to ascertain where the
patient was currently in her pill packet.
Station 7: O&G: Post partum haemorrhage

General comments: Candidates in this station were assessed in their ability to recognise
primary post partum haemorrhage, detail an initial management plan and demonstrate
manoeuvres to improve uterine tone. Generally examiners were quite pleased with
candidates performance in this station.
Specific points: The commonest cause of primary post partum haemorrhage is an atonic
uterus. 45 candidates failed to mention this. Only 74 candidates indicated that they would
seek senior help in this situation. This is an obstetric emergency and requires senior help. 46
candidates failed to mention that they would insert 2 large wide bore iv cannulas. Most
candidates correctly demonstrated how to perform fundal compressions.
Station 9: O&G: Cervical smear

General comments: This station aimed to assess candidates ability to perform a cervical
smear in a sensitive and professional manner. Overall both examiners and simulated patients
were pleased with candidates performance in this station.
Specific comments: Little to add except that some candidates used medical jargon when
talking to the patient. A few examiners noted that some candidates had their stethoscope or
name badge draped around their neck while performing this procedure. This is strongly not
advised as such practice could cause cross infection. Furthermore if you have long hair - you
should tie it up before performing this procedure. A few candidates failed to detect that the
patient was experiencing some discomfort while inserting the speculum. It is very important
that you observe the patients response while you perform this procedure and encourage them
to indicate to you if they experience any discomfort.
Station 10: POEM: Patient presenting with a PE

General comments: Candidates in this station were presented with a post operative patient
who became acutely short of breath. From the clinical history and PEWS chart findings
(hypotension, rising pulse, falling O2 sats and normal temperature) the patient was mostly
likely having a pulmonary embolism. Overall examiners were reasonably pleased with your
performance in this station. They particularly commented on your good communication skills,
especially as the patient was in obvious distress in this station.
Specific points: Such patients require sitting up in bed and the administration of O 2. Iv
access and ENOXAPARIN (or any other HEPARIN derivates) is also required. Given that the
patient was in discomfort they should also have analgesia administered. Requesting a chest
xray, ABG and CTPA or VQ scan would also be required at this stage. Only 35 candidates
requested senior help. In such a medical emergency senior help is of fundamental
importance. Only 64 candidates mentioned that they would gain iv access.
Station 11: Child Health: Bilious vomiting

Candidates in this station were asked to take a history from a parent of a child who presented
with vomiting. The child most likely had Intermittent intestinal volvulus / malrotation - given
that they were generally a well baby, had intermittent abdominal pain, bilious (green)
vomiting and were passing motions. Children of this age who present with bilious vomiting
require an emergency admission to hospital. Evidence would indicate that simply asking if
there is bile in the vomitus is not adequate. Asking about the colour of the vomitus is more
appropriate. Only 55 candidates enquired if there was any blood in the vomitus. Very few
enquired about the first passage of meconium.
Station 12: Child Health: Child presenting with constipation

Candidates in this station were asked to take a history from a parent of a 3 year old boy who
presented with constipation. Constipation is a very common condition in children and
therefore students should have a good understanding of this condition and its management.
Overall examiners were quite pleased with candidates performance in this station. The child
in this station had functional constipation.

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What was the most common error made in completing a drug chart?

What was the most common error made in completing a drug chart?

School of Medicine, Dentistry and Biomedical Sciences

Progress and Assessment Office

Re: Feedback regarding Phase 4 (Summer semester) integrated OSCE

I would also like to take the

Your overall performance at each OSCE station.

This sheet indicates how you

General examiner feedback about candidates performance at each station.

Global station feedback

Station 1: POEM: Presentation of DKA

Station 2: Child Health: Completion of a drug chart

25 students failed to attach a patient addressograph label or

Station 3: POEM: Opiate toxicity

Station 4: POEM: Basic airway management

Correct position of nasal cannula

Station 5: Child Health: BLS

Station 6: O&G: Missed pill

Station 7: O&G: Post partum haemorrhage

Station 9: O&G: Cervical smear

Station 10: POEM: Patient presenting with a PE

Station 11: Child Health: Bilious vomiting

Station 12: Child Health: Child presenting with constipation

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