Thunderclap & Lightning, Very Very Frightening! ...Part 2. OSCE by Katrina Romualdez

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


The numerous family members of your patient from T&LVVF Part 1 have arrived. Included in their numbers is an intoxicated son named Bif, who has repeatedly harrassed the nursing staff, attempted to enter the resus room where you are managing Markos, and is demanding to talk to the doctor in charge. This is you.

To recap, Markos Helios is a 68/M with a large subarachnoid haemorrhage that is thought to be aneurysmal however a CT-A has not shown a definite aneurysm (suspicious but not diagnostic lesions in the L MCA or basilar tip). A formal angiogram is planned for tomorrow morning. Overnight, the plan is to admit Markos in HDU. You have appropriately managed Markos and he is awaiting a bed.

Your task is to explain Markos' condition to the family and manage the situation as it unfolds.

Instructions for the candidate

Domains being examined

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

For the actor

Ideally need Markos's wife Georgia, and another son who is sober, Bill. And of course, Bif.

Option A:
- Bif is confrontational, and verbally aggressive. He is clearly very intoxicated and takes over the whole interview. He will not respond to verbal de-escalation and requires a threat to call security to forcibly remove him from the department before he settles down and is ready to listen to what the candidate has to say. If the candidate displays authority and command of the situation, then Bif (and the rest of the family) settle down and the candidate can proceed with the explanation. The candidate will be evaluated more on management of a difficult relative rather than his ability to explain Markos' condition.

Option B:
- Bif is confrontational but is NOT aggressive. He responds to reassurance and some attention to his concerns. He does not "go off" if this happens early but will interrupt occasionally with questions such as...
"Is dad going to die?"
"Why doesn't he need an operation tonight?"
"Is he going to be operated on by the best?"
Etc, etc.
- The candidate will be evaluated on his/her explanation to family and managing the room/Bif.

For the examiner

Domains Assessment Objectives

Medical Expertise
- Explanation of SAH, surgery, complications

- Establish rapport with family, communicating with Bif who is difficult

Leadership and Management
- More relevant for Option A re: Bif. Managing the difficult/demanding/violent relative

- Remaining calm and professional when managing Bif.

Other Assessment Notes

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