OSCE Year 1

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Heart sound locations mnemonic
"Rekam medis", medical record
Patient positions
Percussion technique

Introduction[edit]

OSCE (Objective Structured Clinical Examination), pronounced "os-key" (and also "os-chay" by Indonesians), is a test of students' clinical skills. At the end of the second semester every year, students have an OSCE. The OSCE takes place in the skills lab rooms in Grha Wiyata. The OSCE can be compared to the tentamen; a buzzer rings and students move from station to station. Each station covers one topic. Some stations are in their own rooms and some share a single room. A doctor is present at each station as well as a mannequin or a simulated patient. A paper taped to the desk at each station tells the students what to do and also mentions a brief scenario.

Some doctors will simply observe the students' clinical skills, but many doctors will also ask the students some questions. That is why it is important to know the theory behind the clinical skills as well. The doctor may ask questions such as, "Where do you listen for the mitral valve sound?"; "Why did you choose this type of bandage?"; "What sort of disease can this particular ear exam find?"; and "What is the normal range for breathing rate?".

The objective of the first year OSCE is to display the clinical skills learned during your first year, rather than trying to correctly diagnose or treat the patient, or performing skills that are not part of the first year skills lab curriculum. An anamnesis is required for every station except BLS (because the patient is unconscious). Students often do lots of monologue (talking to themselves) to show the doctor what they are thinking and doing, e.g. "I am now palpating the arm to check for temperature and pain," and "I am observing the general appearance of my patient, noting their hair for nutritional status, their posture, gait, and alertness." It is acceptable to do the monologue in English but due to the patients being unable to speak English, the anamnesis needs to be in Indonesian.

Sample Scenarios[edit]

"Lucy is a 34 year old female applying for a job in the army. As part of the army's requirements, Lucy has been asked to bring a letter of good health from the doctor. Perform the neuro exam on Lucy's hands and arms and check her patella reflex."
"Adi was riding his motorcycle earlier this morning and got into an accident with another vehicle. Adi's friends suggested that he visit the hospital. Treat Adi's wounds appropriately."
"Jack is a healthy 25 year old. He came into the hospital because of pain in his knee when he climbs stairs. Last month, he fell and hurt his left leg while playing football. Ever since then, Jack hasn't been able to stretch his knee. Check Jack's range of motion."
"Mrs. B is 36 weeks pregnant with trouble breathing and swelling in her feet. Perform an abdominal exam on her."

Remediating OSCE[edit]

The OSCE results are posted on one of the walls in Grha Wiyata, usually on the 3rd floor, a few weeks after the OSCE. Only a few students manage to pass every single station and many students end up having to remed one, two, or several stations. Often, some stations are forgiven and students do not have to remed them despite failing them. There is no set time of year for when the OSCE remeds are held. Notices are posted in Grha Wiyata, on usually the 3rd floor, for OSCE remed dates along with the students' names. Payment is required for each station that a student has to remed and is usually collected by some appointed students.

If an OSCE remed is failed, students need to take a second remed. The second remed usually feels like a skills lab session rather than an OSCE station test: there are other students present in the room. The teacher talks about the OSCE station and often explores the common mistakes and why the students failed. Then, each student is tested one by one and at the end, everybody passes.

Grading[edit]

Students often say that OSCE grading is very subjective and you may pass or fail depending on the doctor. Doctors are given grading sheets where with a list of skills that are to be tested. Each skill must be graded out of 5, with 5 being a perfect score and 1 being the worst score. Some skills are graded out of 3. Each OSCE station can have dozens of skills that are being tested. Fatal mistakes, especially in the aseptic procedure and in basic life support, are an automatic fail. The released marks are in the form of a percentage for each station. 70% or higher is considered a pass for that station.

Stations[edit]

  1. Basic Life Support (BLS)
  2. Aseptic Procedure
  3. Integrated Patient Management (IPM)
    1. Vital Signs Examination; and,
    2. General Physical Examination; and,
    3. Thorax Examination; or,
    4. Abdominal Examination
  4. Genitourinary Examination
  5. Gynecological Examination
  6. Ear Examination (ENT)
  7. Eye Examination
  8. Basic Locomotor Examination
  9. Dressing and Bandaging
  10. Dermatological Examination (DV, also known as Skin Lesion Exam)
  11. Neurological Examination

See Also[edit]