• Paediatric life support
• Adult life support
• OSCE examples and news on the 30th/31st January exam.
• History taking and counselling
• OSCE skills
• Contents of Plab-Master-II
• OSCE Examples
• General Points in OSCE
• Dummy Examination for OSCE
• Mock test for all plabmaster osce students
  

• Talk to this patient with post natal depression
• Talk to this woman who has come for HRT advice
• Talk to this woman who has come for OC pill advice
• Counsel this patient's wife, the man has had an MI
• Counsel about "spacer" to this childs father
• Patient comes with bleeding PR, take history
• Patient comes with bleeding PV, take history
• This is a known alchoholic with cirrhosis, take history
• Talk to specialist registar on phone after examining a child with earache who is drowsy and is on antibiotics prescribed by GP
• Talk to this mother who phones, worried that her chils has rash
• Talk to this woman who has excessive bleeding PV
• Talk to this depressed patient who is involved in an RTA
• Ring your consultant and tell hm how you managesd this 30 week pregnant patient and premature labour.
• Talk yo this patient who has been diagnosed with Parkinsonism and is being prescribed drugs
• This patient has come for contraceptive advice, talk to her
• This patient has acute abdominal pain, ask relevant history towards a DD
• This patient has painful joints, ask relevant history
• This patient is an epileptic recently diagnosed. Counsel him, and talk to him about carbamazepine
• 25 year old man with acute severe headache, elicit history towards diagnosis
• 25 year old man with low fever, take history and discuss diagnosis
• Offer appropriate investigation to this woman who is 38 years and is 14 weeks pregnant and is worried that she may be carrying a Down's baby
• Explain this GTT result to this patient
• Counsel this patient who has come for a hernioraphy
• Counsel this patient who has come for a prostatectomy
• Counsel this patient who has come for a sterilisation
• Counsel this patient who has come for a hysterectomy
• Counsel this patient who has come for a radiotherapy for cancer cervix
• Counsel this patient who has come for a ovarian cystectomy in this 30 year old
• This patient has an abnormal smear test, talk to her
• Talk to this patient whose mother says she has lost a lot of weight
• Talk to this mother whose baby has diarrhoea
• Talk to this mother whose baby has UTI
• This patient has come with abdominal pain, ask history to rule out ectopic
• This patient requires blood transfusion, explain about it to him

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• Examination of the foot
• Examination of the painful back
• Examination of hand, case of RA
• Examine an unconcious patient
• Polytrauma secondary survey
• This patient complains of sciatica, examine him
• Examine the sensory system
• Examine the motor system
• Examine the extra-ocular muscles
• Perform examination of all cranial nerves
• Abdo examination
• Examine the thyroid gland
• Male catheterization
• Female catheterization
• Breast Examination
• Venepuncture
• Suture this incision (beware of the "Z" cut)
• Counsel this patient on whom you are performing PT
• Perform PR examination
• Examine the arterial system of this patient with claudication
• Annual check-up in a diabetic
• Record BP
• Perorm retinal examination
• CVS examination
• RS examination
• Examination of chest
• IV drip setting (bag, tube, etc)
• Arterial blood gas sampling
• Lumbar puncture
• Patient has collapsed in the next cubicle, perform CPR
• Cervical smear
• Vaginal examination

Surgery
History taking + Counseling + Models in clinical skills laboratory

Medicine
History taking + Counseling + systemic physical examination + procedures

Paediatrics
History taking + Counseling + ward work and instruments

Resuscitation
Work on mannequins

Obstetrics
History taking + Counseling + model work in clinical skills laboratory and Gynaecology

Y.B. Education Systems Ltd. reserves the right to change the contents of the course if necessary. Our lecturers are practicing clinicians and the timing of a particular session may change depending on their availability.

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Peak expiratory flow meter

Explain to this patient about the use of this instrument. How it can be used to preempt an asthma attack etc. This station often finishes in 2-3 minutes but you need to be careful and cover all points and ask "any other questions" to the patient at the end. The points to cover will include , What is this instrument, What is it's use ("it tests whether your air passage are open enough")"Breath out - then in and then blow forcfully through this. Don’t cough, just short sharp breath out" Best of 3 (not the average)You may actually demonstrate the use to the patient as it becomes simpler that way. When to use it. Even a simple OSCE like this do not forget to introduce yourself and check the patients name. After you have finished this station, keep your ears open, some of your friends have a loud voice and their questions on the forthcoming questions are often heard loud and clear. This warns you about what is coming next and prepares your line of thought, practical hint from a recently successful candidate!

Venepuncture

"Collect blood from this patient" is a common simple osce asked several times. If you are in, you get blood in the tube! You should be ready to collect blood using syringe or vacutainer. Which tubes to use for which tests should be known. Don't forget to dispose the needles safely and label tubes immediately as a part of the osce!

Venepuncture is a common task asked in the OSCE examination, featuring in almost every or every other test. The "arm" is quite realistic and shows prominent veins. While in the earlier OSCE tests, they simply asked to draw blood, in the recent ones they have made the tasks more cerebral by asking you to draw blood for grouping and cross matching or some similar clinical context which will make you choose the tests you have to actually ask for. The tubes should not be remembered by their colour, as the colour codes are not universal. The contents of the tube are written clearly on the sides and you should know that for glucose, you need a fluoride containing tube while for endocrine tests, a plain tube "with no additive" is required. This list is given in the OHCM.

Vaccum tubes have vaccum which determines how much blood it draws. You should not open the stopper nor should you push the blood under pressure in the tube.

Blood can be drawn using either syringe and needle or using a "vacutainer set", shown elsewhere. Remember, your OSCE is not finished unless you have safely disposed the sharps and labelled the tubes!

Fundoscopy

This is a common topic that commonly features in OSCE tests of clinical medicine. Generally you are expected to talk through the procedure while you perform it on a manniquin. You may be asked to explain the procedure to a live subject, an actor (patient simulator).

Introduction: "I am the SHO in casualty, in this hospital, are you Mrs Smith? I am going to look at the back of your eye, the retina, with this instrument.

Explain the procedure: You need to look at that spot across the room (point to a particular spot on the wall) and look at it. I will shine this light (show the opthalmoscope) in your eye and come quite close to you to look in the eye, is that all right? Please do not look at me or the instrument as it comes near you. You may blink, that is OK. The light is not too bright, and it may be a little uncomfortable but should not hurt you. The whole thing wont take more than a couple of minutes. Is that OK.

The mannequin has an iris through which you can see a slide, which is lit at the back. You may be asked to tell your findings or mention the diagnosis, which you should be able to. Typically cases of hypertensive changes, diabetic retinopathy slides or optic atrophy or disc cupping are kept, but it could be any similarly common slide.

The examiner will mark you on your technique as well as the things you say to the patient as well as your diagnosis at the end. They may make the OSCE more complex by asking you to counsel the patient on the basis of the findings you might have noticed (e.g. proliferative retinopathy) though till date the PLAB OSCE's have been kept relatively straight forward.

Conclusion: Mrs Smith, thank you for your time. Do you have anything to say to me ?
(If you are dealing with a mannequin alone, this may not arise)

Explanations: Introduction is the beginning of all interviews and you need to do the following
a. Introduce your self
b. Identify that you are with the right patient. This will change as per the situation. In a clinic type situation checking the name and the complaint may suffice, but in a preoperative situation, you may want to check the identity bracelet on the person as well.
c. Explain the purpose of the visit. This must be done with the simplest terms which a patient can understand.

Explain the procedure and take verbal consent. While highlighting the technical aspects of the test, you must address the common problems that the patient has (can I blink? etc). That the test will not take long is reassuring, say that.

All interviews should end with you allowing the patient to ask you his or her questions. While dealing with mannequins, you are often asked not to speak, and then this question does not arise.

Perform CPR on this patient who has collapsed.

BP check.
This is a simple OSCE but you need to remember a few points. Check the BP in both arms and if appropriate mention about legs as well. Do the test as described classically, not how you did in a busy antenatal clinic! Pulse first, level of the manometer etc. are small but relevant points

Blood Collection :
Vacutainer and blood collection:

This OSCE may be asked in many ways some simple and some more complex

a) Collect blood from this patient
b) This person has come to the A/E with fever, collect blood for relevant tests in appropriate bottles

Blood can be collected with either syringe and needle or with vacutainer system. It is a good idea to be familiar with using the vacutainer, lest they do not give you a choice. While the dummies have "veins" and actually give you blood if you are in the vein, you will be assessed on small points such as did you check the patient identity and did you explain correctly and did you label the tubes and dispense the sharps in the bin! Not getting "blood" will certainly not fail you.

The colour code of the tubes may not be national and it is more prudent to remember what the tube contains and hence what goes in. The OHCM gives a good list for this.

Suturing
"Stich the cut on the forearm with 2 stitches"

Steps:

Introduction
You are srcubbed (gloved, not necessarily gowned)
Clean and drape the arm
Infilterate with lignocaine
Put 2 simple stiches
choice of material (dexon/nylon/vicryl)
Correct knotting method, "crossed and uncrossed knots"
clean and dress the wound
Thank the patient
Other points of note
Holding of the needle
Dont hold the needle with your fingers as far as possible
Dispose the needle in the sharps bin after everything
See that you tidy up afterwards
Primary survey, secondary survey etc are also common topics asked

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Informing "DVLA"

Medical conditions the DVLA must be told about

Whether the person is permitted to drive or not is the decision of the DVLA.

Disclosing informatin about patients to the DVLA

1. The DVLA is legally responsible for deciding if a person is medically unfit to drive. The Agency needs to know when driving licence holders have a condition that may now, or in the future, affect their safety as a driver.

2. Therefore, where patients have such conditions you should:

4. If patients continue to drive when they are not fit to do so, you should make every reasonable effort to persuade them to stop. This may include telling their next of kin.

5. If you do not manage to persuade patients to stop driving, or you are given or find evidence that a patient is continuing to drive contrary to advice, you should disclose relevant medical information immediately, in confidence, to the medical adviser at the DVLA.

6. Before giving information to the DVLA you should try to inform the patient of your decision to do so. Once the DVLA has been informed, you should also write to the patient, to confirm that a disclosure has been made.

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Generally there are 3-4 OSCE batches every day during the examination. Quite a few stations repeat for the second batch, so do try and make friends with the batch before you! On the second day, many stations would change.

One commonly asked question is "are the results from Edinburgh/Leeds centres any worse than that from London" . This is quite like the usual fears that goes with PLAB and is quite baseless. While Scottish accents can be quite difficult to fathom, they will normally choose patient simulators who are not so heavily accented (it is true that in some BBC programmes wherein Scottish, especially Glaswegian people are being interviewed, they run a sub-title, similar to when they show Atal Biharee Vajapayee speak in Hindi).

You get 5 minutes per station (12 in all) with one minute before the commencement of the station. You can have a chance to read from the card even when you are doing the station. Thirty seconds before finishing, they will warn you which more than anything else, makes your pulse race and bumble through the last bits! More embarassing is when you finish your station (say taking bp) in the first 2 minutes and there is nothing more to do or say and the actor and the examiner and you politely staring at each other! In BLS, often the examiner asks you to stop in 2-3 minutes when he sees you have got the concept right. Cruel examiners are known to have made the examinee do the CPR for all the 5 minutes which is quite exhausting!

The actors are quite well trained and will answer questions which they expect you to answer. Any "out of the world" question will be answered by "I do not know". They do not ad-lib the answers, they are well trained and have rehearsed their lines. Actresses often break into tears when receiving bad news or giving history for ectopic pregnancy!

Do you speak with the dummies ? A million dollar question. By and large, you are instructed to keep quite while doing examination on dummies such as PR or PV. However they often instruct you "while working on dummies, run the examiner through the steps" which would mean you speak as you go along doing the examination. In any case, be prepared to speak, rehearse your talk, but shut up if instructed by the card or the examiner!

We take small batches so that each has a chance for hands on training"

Whilst the OSCE course prepares you well enough, there is litle that can prepare you for the exitement of the osce exam itself. The wait outside of the centre, the expectations and the real thing with 1 minute readings and 4 and half minute bells! Will I or wont I understand the accents and the words of the actor simulators on that day, the anxiety is real!

Since last year we have been giving a mock test for our OSCE students. And then the reality of meeting patient simulators who speak real native English and who can actually act and emote and ask you simple but disarming questions!

We now have the mock exam as a regular addition to our course and is free except for disposable and admin charges of £15. The test is has 15 stations and around 8-9 history/counselling station with real British Actors!

The test is typically done a day after the course, so it is important to plan your return journey accordingly.