Cabrini Practice OSCE 1 2017: Burns and resident counselling OSCE by Dane Horsfall

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

Scenario:

Station Summary: Providing advice and education to a junior resident regarding the assessment of burn patients, and counselling juniors who are having trouble adapting to the emergency department as a workplace.

View attached:  Attachment 1

Instructions for the candidate

Cabrini Practice OSCE Station ONE



Candidate Instructions:

You are a FACEM at a tertiary hospital emergency department. One of your junior residents has asked to speak to you about a burns patients they managed on night shift last week. This patient presented with forearm burns following a boiling water spill. Your resident had planned to discharge the patient home with silver-based dressings and outpatient clinic review but was told at clinical handover that this was not appropriate.


Your tasks are to:

• Establish the resident’s understanding of burn assessment
• Provide appropriate education regarding burn assessment
• Assess and counsel the resident regarding their emergency rotation



Domains assessed:

Medical Expertise 10%
Scholarship & Education 30%
Leadership & Management 60%

Domains being examined

  • Medical Expertise
  • Leadership and Management
  • Scholarship and Teaching
 
The candidate has 3 minutes reading time. This OSCE is expected to run for a maximum of 7 minutes.

For the actor

Role Player Instructions:

You are – use your own name. You are a 2nd year resident doing a 3-month rotation in the emergency department. You plan to enter physician training next year and are studying for this. You have found the emergency medicine rotation has put you outside of your comfort zone. You have found night shift particularly challenging with minimal support from the senior registrars and have had trouble juggling the workload required of you.

Last week you looked after a patient with burns to his forearms from a boiling water spill. You have had little experience in assessing and managing burn patients and therefore sought advice from the plastic surgery registrar and followed their advice regarding burns dressings and outpatient follow-up. You even texted a photo of the burns to the plastics registrar.

You thought you had appropriately managed the patient, however, at handover to the morning emergency department staff, the consultant in-charge told you that you had made incorrect decisions about the assessment and management of the patient and that you should have had the emergency department senior registrar review the patient. The consultant in-charge then proceeded to examine your knowledge of burns assessment in front of the other staff at handover. You felt belittled and embarrassed. In fact, you have found handover to be incredibly stressful as the senior emergency doctors rush through the process and you feel you don’t get the opportunity to discuss your patients’ issues in detail and you don’t get any constructive feedback on your clinical decisions. You wonder what the value of this rotation has been for your future career as a general physician.

Subsequently you have doubted your clinical decisions even with patients who have simple medical problems that you are usually confident in managing. You are keen to learn from your encounter with the burns patient and have asked to speak to one of the other emergency consultants (the exam candidate).

The candidate should establish your level of experience in emergency medicine and briefly determine your knowledge of burn patient assessment.


Prompts:

If the candidate hasn’t moved on to discuss your issues coping in the emergency department by 3 minutes then say, “I’m just not seeing the point in this rotation.”

Other questions/statements you can ask/make:

“I’m finding handover a real challenge”
“Everyone is just so busy on-the-floor, it’s hard to get anyone’s attention”
“How is this job helping me in my physician training?”

For the examiner

Please use the following criteria to inform your ratings above (mandatory items in bold italics)

Medical Expertise
• Review assessment of burns
- type, extent depth
- special areas (face, hands, perineum, joints)

Scholarship & Teaching
• Establish resident’s level of experience in emergency medicine and knowledge of burns
• Appropriate use of open and closed questions
• Offer advice or other resources for resident
• Provide opportunity for resident to learn from case - present at education sessions / grand rounds

Leadership & Management
• Identify resident’s difficulties coping in emergency rotation
• Suggest ways to better cope with handover
- use of standardised handover tools
- taking time prior to handover to prepare
• Techniques for better performance on-the-floor
- Advise seeking feedback with senior reg or consultant on the floor regarding patients
- Need to be more forceful on-the-floor at times
• Highlight opportunities of emergency rotation for this resident's future physician career
- understanding the competing priorities faced by emergency clinicians
- learning how to assess and manage critically ill patients that may also occur in the ward setting
- gaining experience in rapidly assessing the undifferentiated patient
- providing education to other emergency residents in areas candidate is strong
• Provide feedback to consultant group about appropriate behaviours in handover and in interactions with junior staff

Domains Assessment Objectives

Medical Expertise
Review assessment of burns
- type, extent depth
- special areas (face, hands, perineum, joints)

Leadership and Management
Identify resident’s difficulties coping in emergency rotation
• Suggest ways to better cope with handover
- use of standardised handover tools
- taking time prior to handover to prepare
• Techniques for better performance on-the-floor
- Advise seeking feedback with senior reg or consultant on the floor regarding patients
- Need to be more forceful on-the-floor at times
• Highlight opportunities of emergency rotation for this resident's future physician career
- understanding the competing priorities faced by emergency clinicians
- learning how to assess and manage critically ill patients that may also occur in the ward setting
- gaining experience in rapidly assessing the undifferentiated patient
- providing education to other emergency residents in areas candidate is strong
• Provide feedback to consultant group about appropriate behaviours in handover and in interactions with junior staff

Scholarship and Teaching
Establish resident’s level of experience in emergency medicine and knowledge of burns
• Appropriate use of open and closed questions
• Offer advice or other resources for resident
• Provide opportunity for resident to learn from case - present at education sessions / grand rounds

Other Assessment Notes


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