The Lion's Den. OSCE by Michelle Johnston

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

Scenario:

You are a consultant in a tertiary ED. You are seeing a 79 year old man, who has presented with a new onset dense left hemiparesis. The symptom onset was 2 hours ago. He is brought in by his daughter, who is a paediatric nurse.
You have organised a CT of the patient's head to occur urgently, which had showed no obvious abnormalities, and consulted the neurology/stroke team.
The Neurology team are out of the hospital, and have asked if you will begin the consent process for thrombolysis.
The patient appears to have limited understanding, and the daughter would like to know details about the proposed treatment.

Instructions for the candidate

Domains being examined

  • Medical Expertise
  • Communication
  • Health Advocacy
  • 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 a nurse, trained in paediatrics, so you have some medical knowledge, but little specifically about thrombolysis in stroke.
You want to know about the risks of the treatment, are there any alternatives, what will happen if your father does not consent, and are there any other treatments available. You want to know how it is given, what dose, and how long it takes to work. You want to know what the evidence is for use of thrombolysis in stroke (as you are rather a devotee of EBM)
(You do not need to ask any of these questions if the candidate continues to talk)
If asked whether your father had expressed any advanced directives, you will say that the only thing he has said to you is that he does not want to live 'if he's going to be a vegetable'
When asked about contraindications to thrombolysis, your father has none.
If the candidate is doing well and has covered all the above issues, you may ask, 'What would you do if this was your father?'

For the examiner

Obviously a difficult issue.
Candidate cannot dissemble, and divest the consenting to the neurology team. Although full consent should not be performed, a thorough understanding of the issues should be articulated.

Domains Assessment Objectives

Medical Expertise
Thrombolysis in stroke
Pt Selection
Contraindications
Adverse effects/risks
Understanding of the complexity of the literature
College Policy Statement

Communication
Appropriate language and communication with medical professional
Dispassionate information'
Ability to navigate the tricky situation of current knowledge limitations

Health Advocacy
Understanding consent

Professionalism

Other Assessment Notes

Minor part is to ensure that daughter is NOK, or NOK's agent, to ensure appropriateness of consent.


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