Trial OSCE exam: 'Victory' by Soe Naing

You are taking part in a trial exam created by Soe Naing. There are 9 OSCEs in this exam (90 minutes).
 

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

Scenario:

A 70 yo patient came to your rural regional ED with STEMI. He is haemodynamically stable and awaiting your explanation and management plan in a resus cubicle. A nearest cath lab is 4 hours away by fixed wing.

View attached:   Attachment 1

Instructions for the candidate

Mr(s) Jack/Jo Smith is a 70 year old male who suffers from inferior STEMI. You are an emergency consultant working at a regional hospital where a nearest cardiology service with cath lab is 4 hours’ flight away. You are to discuss management with him.

The patient is from home and normally very fit and active, driving, gardening and regularly exercising. He never had ischaemic heart disease and takes aspirin and perindopril for well controlled hypertension.

Mr Smith has had acute severe left sided chest pain radiating to left shoulder / arm 1 hour prior to presentation : now 30 min after arrival, his pain has resolved with morphine and vital signs are

BP 110/60 HR 80 in sinus rhythm Sat 97% RA Respiratory Rate 18 Temp 37.2

He is alert and comfortable : no problems with comprehending what you are to explain.



Your task is to obtain consent from Jack/Jo Smith regarding thrombolysis to initiate reperfusion therapy for STEMI.

Domains being examined

  • Medical Expertise
  • Communication
  • Health Advocacy
 
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 fit and active person from home. You live with your wife Wendy. This morning you are out in the garden mowing the lawn when severe left sided chest pain developed. The pain was dull and squeezing radiating to left shoulder/arm. Wendy called ambulance and the pain started to ease with morphine by ambulance officers and further morphine on arrival at ED.

You take perindopril for 5 years for hypertension and take aspirin for precaution. You have no allergies. You quit smoking when you returned from services in Vietnam 40 years ago. You drink a couple of glasses of wine with dinner.

You feel very anxious inside because ambulance officers mentioned ‘large heart attack.’ You would like to have any treatment that is indicated but not without understanding the pros and cons very clearly. One of your friends died of complication from ‘clot busting drip’ for stroke.


Specific questions/concerns for you to raise (if not addressed by candidate)

Re heart attack
- How bad is it?
- Am I going to die?
- Do I need a surgery?

Re thrombolysis
- How good is the treatment?
- Can I die from complication? What is the chance?
- What about just waiting until admission under cardiologists?

For the examiner

1) Medical Expertise
Expertise in fibrinolysis as part of STEMI management
• Indications, benefits and potential complications
• Ability to identify contraindications in timely manner
• Time critical nature of treatment
• Key issues of further management post thrombolysis
• Adjunctive therapy
• Transfer for PCI : reasoning and time line

2) Communication
• Freely given, specific, informed and competent
• Concise and plain English
• Acknowledge anxiety with empathy and reassurance
• Two way communication
• Checking comprehension

3) Health Advocacy
• Cardiac rehab in perspective
• Life style changes – risk reduction
• Long term benefits – quality of life as well as survival

Domains Assessment Objectives

Medical Expertise

Communication

Health Advocacy

Other Assessment Notes

informed consent for life saving treatment