I'm sorry to say OSCE by Michael

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

Scenario:

You have spent the last 30 minutes assessing and managing Mr John Linke, a 72 year old man. He presented following a sudden collapse at
home. His GCS was 5 on arrival to hospital and he was intubated to enable CT imaging of his brain, which reveals a massive, inoperable
intracranial haemorrhage. His wife, Mrs Linke, has just arrived by taxi and has been placed in a quiet room by the triage nurse to await your attendance. There is an airway capable registrar present to manage the patient whilst you speak with the patient’s wife.

Instructions for the candidate

Please discuss with Mrs Linke her husband’s current medical condition, the likely prognosis and ongoing management plans. A nurse is available to attend the discussion with you.

Domains being examined

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

For the actor

Mrs Linke:
You arrive at the hospital having been told by a neighbour that your husband had a faint and was taken to hospital for a check up by the doctor. You aren’t really aware of the gravity of his condition. He has previously been in good health and you want full measures to be taken, but are reasonable to palliation if adequate explanation/reassurances are given by the doctor.

Nurse:
Offer support to Mrs Linke and follow any directions given by the candidate. Do not offer additional information unless directly instructed to by the candidate.

For the examiner

None

Domains Assessment Objectives

Medical Expertise

Prioritisation And Decision Making

Communication

Other Assessment Notes

An excellent candidate will demonstrate/cover most/all of the following:
- Demonstrate a compassionate yet professional approach. Not hurried.
- Will ensure both themselves and the patients wife are seated.
- Will identify themselves and confirm who they are speaking to.
- Will check if further family are enroute or aware to attend, in order to offer support to Mrs Linke.
- Will find out what Mrs Linke knows so far before further explanation is given.
- Will give a brief summary of what actually happened.
---collapse/unconscious

Will explain in clear, simple non medical terminology the findings of the CT scan
- a large bleed in the brain
-cannot be fixed by an operation, too severe, too much damage
-is not survivable/expect he will not survive
-if he did survive (highly unlikely) would be significantly incapacitated/disabled/poor quality of life

Will allow time for this information to register/grief response/questions

Will discuss options for ongoing management:
-explain/justification for a palliative approach “given that this is catastrophic and irreversible keeping him comfortable would be best”
-explain how this would actually occur –extubate and ensure no pain, family presence, possibility of breathing ceasing on removal of tube
-will answer any queries/questions this might raise in a compassionate and sensitive manner
-will give some sort of time line dependant on wife’s response (extubation imminently if very accepting, allow for a little more time or other family to attend if required)

Offer opportunity to answer any further questions/address concerns/queries

Offer assistance (via nurse) to contact other family members/support people/religious


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