From the Guidelines
When approaching an OSCE station, begin by introducing yourself to the patient, confirming their identity with two identifiers (name and date of birth), and obtaining consent for the examination. This initial step is crucial in establishing a professional and respectful relationship with the patient, as emphasized in various guidelines, including those from the American Heart Association 1 and the American Society of Clinical Oncology 1.
Focused History
Start with a focused history relevant to the presenting complaint, asking about:
- Onset
- Duration
- Severity
- Aggravating and relieving factors
- Associated symptoms
This approach is supported by guidelines such as the American College of Physicians and the American Pain Society for the diagnosis and treatment of low back pain 1, which highlights the importance of assessing psychosocial risk factors and symptoms to guide the management plan.
Physical Examination
For the physical examination:
- Wash your hands before and after touching the patient
- Explain what you're about to do
- Ensure patient comfort and privacy throughout Perform a systematic examination relevant to the system involved, such as:
- Cardiovascular
- Respiratory
- Abdominal
- Neurological
- Musculoskeletal
The British Thoracic Society guideline for the initial outpatient management of pulmonary embolism 1 and the American Urological Association/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction guideline on the diagnosis and treatment of idiopathic overactive bladder 1 also emphasize the importance of a thorough physical examination in guiding diagnosis and management.
Documentation and Differential Diagnosis
Document your findings clearly, including both positive and negative findings. Formulate a differential diagnosis based on your assessment, prioritizing the most likely diagnoses. This structured approach is crucial for ensuring that all potential causes of a patient's symptoms are considered, as highlighted in guidelines for managing patients with unstable angina/non-ST-elevation myocardial infarction 1 and those with atrial fibrillation 1.
Management Plan
Develop a management plan that includes:
- Appropriate investigations
- Treatments with specific medications (including names, doses, routes, and durations)
- Follow-up arrangements
Guidelines such as those for the medical management of opioid-induced constipation 1 and for antithrombotic therapy in atrial fibrillation 1 provide evidence-based recommendations for treatment options and highlight the importance of patient-centered care and communication.
Communication
Finally, communicate your findings and plan clearly to the patient in understandable language, addressing any concerns they may have. This is essential for patient-centered care, as emphasized by the American Society of Clinical Oncology 1 and is a critical component of any clinical encounter, ensuring that patients are well-informed and actively involved in their care.
By following this structured approach, healthcare professionals can ensure a thorough and professional assessment that meets the requirements of an OSCE examination while demonstrating clinical competence and patient-centered care, ultimately prioritizing morbidity, mortality, and quality of life outcomes for patients.
From the Research
OSCE Station Approach
To approach an OSCE (Objective Structured Clinical Examination) station, it's essential to have a structured method. Here are the steps to follow:
- Introduce yourself to the patient and explain the purpose of the examination
- Wash your hands and put on gloves if necessary
- Take a thorough medical history, including the patient's chief complaint, history of present illness, past medical history, medications, allergies, and social history
- Perform a physical examination, focusing on the relevant systems and using the appropriate equipment
- Present your findings and diagnosis to the examiner, and discuss the management plan
Pharmacologic Management of Acute Pain
When managing acute pain, the following options are available:
- Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line treatment options for most patients with acute mild to moderate pain 2
- Topical NSAIDs are recommended for non-low back, musculoskeletal injuries 2
- Adjunctive medications may be added as appropriate for specific conditions if the recommended dose and schedule of first-line agents are inadequate 2
- For severe or refractory acute pain, treatment can be briefly escalated with the use of medications that work on opioid and monoamine receptors (e.g., tramadol, tapentadol) or with the use of acetaminophen/opioid or NSAID/opioid combinations 2
Comparison of Ibuprofen and Paracetamol
Ibuprofen and paracetamol are commonly used analgesics. The evidence suggests that:
- Ibuprofen is consistently superior to paracetamol at conventional doses in a range of painful conditions 3
- Ibuprofen was usually superior producing more patients with the degree of pain relief that patients feel worthwhile 3
- There is no good evidence for efficacy of paracetamol in many pain conditions, questioning the practice of routinely using paracetamol as a first line analgesic 3
Situational Awareness in Patient Safety
Situational awareness is crucial for optimizing clinical performance and patient safety. The evidence highlights that:
- Loss of situational awareness can occur in many different settings, particularly during stressful and unexpected situations 4
- Tunnel vision is a classic example where clinicians focus on one aspect of care, often to the detriment of overall patient management 4
- Recognizing the importance of situational awareness and using approaches to safeguard patients and clinicians is essential in the workplace environment 4
Medications for Treating Low Back Pain
When treating low back pain, the following medications may be used:
- Muscle relaxants and NSAIDs may be superior to placebo for reducing pain in acute low back pain 5
- NSAIDs, antidepressants, and opioids may be superior to placebo for reducing pain in chronic low back pain, but opioids have an established profile of harms 5
- Paracetamol provides no additional benefit for acute low back pain, and its effects for chronic low back pain are unclear 5
Biopsychosocial Model in Neurological Treatments
The biopsychosocial model is a holistic approach to patient care, considering biological, psychological, and social-cultural-spiritual factors. The evidence suggests that: