I know something you don't know OSCE by Michael

 
You have 3 minutes reading time. This OSCE will run for a maximum of 7 minutes.

Scenario:

Jayne is a 49-year-old lady who has presented to your ED with altered feeling in her LEFT hand. She recently injured this hand, and has had a repair done by the plastic surgery team in your hospital.

Instructions for the candidate

You are to examine Jayne's hand, and relay your findings to the plastic surgery consultant who will call you in a few minutes.

Domains being examined

  • Medical Expertise
  • Communication
 
The candidate has 3 minutes reading time. This OSCE is expected to run for a maximum of 7 minutes.

For the actor

You are not expected to provide history, but can answer simple, direct questions. Candidates will be asked to thoroughly examine your hand and upper limb as required and will be interrupted near the end of the scenario time for the candidate to describe their findings to one of the examiners.

Ideally, this would be a patient with neurological loss in their hand. In reality, a well versed actor will have to fake a specific nerve injury.

For the examiner

In the case of a real patient, please examine the hand to ensure you are satisfied with the neurological findings prior.

In trial settings, this patient had a penetrating injury to their wrist near the crease, with ?tendon injury and ulnar nerve damage. There was a scar from the injury/surgical exploration. This could be adjusted to cover injuries of any of the nerves to be examined.

Domains Assessment Objectives

Medical Expertise
Thorough examination of the hand and upper limb as required

Communication
Clear explanation and instruction to patient during exam
Clear and precise communication with the plastics consultant

Other Assessment Notes

Correctly identify neurological deficit

Cover key differentials
- due to initial injury
- due to surgery
- due to infection / swelling

Examination checklist for hand / upper limb to supplement assessment can be found at http://adelaideemergencyphysicians.com/2015/04/fellowship-physical-examination-tips/

Focus on neurological changes, especially motor effects and functional abilities with the hand


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