I know something you don't know OSCE by Michael
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
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
- 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