He'll be right! OSCE by Michael

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

Scenario:

You are the consultant on a shift. You have spoken to an orthopaedic registrar, Dr Smith, about 7 year old Matthew, who has a right arm fracture. Matthew is a healthy boy who fell off playground equipment about 1 hour prior. He has no other injuries. He last ate 5 hours ago. He has no contra-indications to any medications or surgical procedure. His parents have been informed, and have consented to surgical intervention. Matthew’s arm is now splinted and he is comfortable. His injured limb currently has no neurovascular compromise. A photograph and X-rays will be shown to you after you enter the room.

Definitive treatment in ED is not a feasible or appropriate option, for several reasons. Dr Smith advised that Matthew should be sent to fracture clinic the next day. He then hung up on you, stating he had to be in theatre. He is not answering his phone any more.

View attached:  Attachment 1  Attachment 2  Attachment 3

Instructions for the candidate

You are to:
- Assess a photograph and X-rays of Matthew’s injury (taken before splinting)
- When ready, ring the orthopaedic consultant to discuss the case with him
- Describe the X-ray to the consultant over the telephone
- Collaborate with him to facilitate appropriate management of Matthew’s injury

Domains being examined

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

For the actor

You are busy orthopaedic surgeon who is operating on a long theatre list today. It is a stressful day. Your staff, including Dr Smith, have been particularly stressed after the unexpected post-operative death of a young patient. She died from a massive fat embolism soon after emergency ORIF for a fractured femur. That case is subject to coronial investigation. That patient’s family remain angry at the outcome, and have threatened legal action against Dr Smith, who was the operator. Dr Smith is usually a competent, industrious professional. In the last few weeks, the workload and the coroner’s case have taken their toll on him. He has been irritable and unpleasant to colleagues at work. Ward nurses have complained about his behaviour. To complicate matters, Dr Smith has recently received a few inappropriate referrals from the ED, typically from junior staff over night. He believes these should have been managed without referral. As such, his regard for ED medical staff is not high.

In this scenario, you should initially be irritable and defensive on the telephone, partly because you have another elective case to start. If the candidate presents the case accurately and professionally, agree to with his/her request. Respond to his/her referral as a reasonable surgeon would.

If the candidate successfully achieves the required task, please extend the scenario time by raising the issue of ED medical staffing overnight, and referrals to the overnight orthopaedic registrar. State that the on-call registrar has normal day duties, so overnight referrals should be reserved for cases needing emergent attention. Ask about ED supervision and education of junior ED staff. Be suggestive of, and receptive to a collaborative approach. This component of the conversation should commence with: “OK, we will organize theatre for Matthew ASAP. BTW, can I quickly raise some issues with you about…”

For the examiner

If a separate individual from the role-player above, introduce yourself, and ask the candidate if s/he understands the scenario briefing.

The candidate may finish the scenario early, if all tasks are completed.

Domains Assessment Objectives

Medical Expertise
Ability to describe the X-ray over telephone

Communication
Verbal clarity, conciseness, specificity

Teamwork and Collaboration
Takes a systems approach to problem, rather than focusing on flaws of individuals
Is collaborative with fellow consultant

Professionalism
Shows respect
Professional demeanour and conduct; avoids aggression

Other Assessment Notes

This OSCE comes from the 2015.1 TEEMwork course: http://teemwork.com.au/


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