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OSCE Structure for Nurses in the UK
The OSCE is made up of 10 stations (15 minutes each) and is divided into two components:
A. APIE Stations (4 Stations)
- Assessment: The candidate must complete a patient assessment, gathering relevant data about their condition.
- Planning: Based on the assessment, the candidate must create a care plan addressing the patient’s needs.
- Implementation: The candidate is required to demonstrate a nursing intervention, such as administering medication or performing a wound dressing.
- Evaluation: The candidate reflects on the care provided, discussing whether the goals were met and any necessary adjustments.
B. Skills Stations (6 Stations)
These stations test practical nursing skills. Examples include:
- Vital signs measurement (e.g., blood pressure, temperature)
- Administration of medications
- Catheterization
- Wound dressing
- Basic life support (BLS)
What to Expect in Each Station
- Each station typically lasts 15 minutes.
- The candidate is expected to interact with a standardized patient (an actor playing the role of a patient) or demonstrate procedures on mannequins or equipment.
- Stations are objective, meaning they follow specific checklists to assess performance.
Key Areas Assessed
- Communication: Explaining procedures, obtaining consent, and providing patient-centered care.
- Clinical Skills: Demonstrating competency in tasks such as medication administration, catheter insertion, or wound care.
- Decision-Making: Using clinical judgment to assess, plan, and implement care.
- Documentation: Recording findings and care plans accurately.
Scenarios
1. History-Taking
- Similar to the example you saw, these stations require the student to obtain a detailed medical history from a patient. This could involve:
- Presenting complaints (e.g., chest pain, headache, fatigue)
- Past medical history
- Family or social history
2. Physical Examination
- These stations assess a student’s ability to perform a structured physical exam. Examples include:
- Cardiovascular examination: Listening for heart murmurs, checking for edema
- Respiratory examination: Auscultating lung sounds, checking respiratory effort
- Abdominal examination: Palpation of the abdomen, listening for bowel sounds
3. Procedural Skills
- Students are expected to demonstrate proficiency in performing specific clinical procedures. Examples include:
- Venipuncture (drawing blood)
- Urinary catheter insertion
- Suturing a wound
- These stations often use mannequins or simulation devices, and the student must explain the procedure to the patient (simulated or real).
4. Communication and Counseling
- These stations assess the student’s ability to communicate medical information effectively. Common tasks include:
- Breaking bad news: Telling a patient they have cancer
- Informed consent: Explaining risks and benefits of surgery or treatment
- Lifestyle counseling: Discussing smoking cessation or dietary changes for diabetes management
5. Clinical Reasoning
- These stations test the student’s ability to interpret clinical information, make a diagnosis, and develop a management plan. Examples include:
- Diagnostic reasoning: Given a case with lab results or images, students must make a diagnosis.
- Next steps: Identifying appropriate investigations or treatments based on a patient’s symptoms.
6. Emergency Management
- Some OSCE stations simulate acute situations where students must demonstrate the ability to manage medical emergencies. Examples include:
- Cardiopulmonary resuscitation (CPR)
- Managing an anaphylactic reaction
- Treating a patient in shock
7. Ethical and Legal Scenarios
- These assess the student’s understanding of medical ethics or legal obligations. Examples include:
- Dealing with patient confidentiality
- Informed consent issues
- Reporting unsafe practices or negligence
Station 1 Samples
Here are 10 examples of scenarios that might be used in the first station of an Objective Structured Clinical Examination (OSCE) focused on assessment skills:
- Chest Pain Assessment: A patient presents with chest pain radiating to the left arm. The candidate must take a detailed history, including the onset, duration, and characteristics of the pain, and conduct a physical examination.
- Abdominal Pain Assessment: A patient complains of acute abdominal pain. The candidate should ask about the location, nature, and associated symptoms, followed by a focused abdominal examination.
- Headache Evaluation: A patient reports persistent headaches. The candidate needs to gather information about the headache’s frequency, intensity, triggers, and any neurological symptoms.
- Shortness of Breath Assessment: A patient is experiencing difficulty breathing. The candidate must assess the patient’s respiratory rate, oxygen saturation, and relevant medical history to identify possible causes.
- Mental Health Assessment: A patient presents with anxiety and depression symptoms. The candidate should conduct a mental health assessment, including screening for suicidal ideation and evaluating coping mechanisms.
- Skin Rash Evaluation: A patient has a new skin rash. The candidate must assess the rash’s appearance, location, duration, and associated symptoms, and may need to perform a skin examination.
- Diabetes Management Review: A diabetic patient seeks advice on managing their condition. The candidate should evaluate the patient’s blood glucose logs, medication adherence, and lifestyle choices.
- Elderly Fall Risk Assessment: An elderly patient reports having fallen recently. The candidate should assess the patient’s fall history, home environment, and any medications that may contribute to fall risk.
- Pediatric Assessment for Fever: A parent brings in their child with a high fever. The candidate must take a detailed history of the fever, any associated symptoms, and perform a physical examination on the child.
- Post-Operative Recovery Assessment: A patient is one day post-operative from abdominal surgery. The candidate should assess the patient’s pain levels, wound site, and any signs of complications.
Sample Test with Answer
OSCE Station 1: Chest Pain AssessmentExaminer: “Hello, welcome to this station. My name is [Examiner’s Name], and I will be your examiner today.”
Candidate: “Hi, nice to meet you.”
Examiner: “This station will last for 15 minutes. You will first have 2 minutes to read the instructions and prepare, followed by 13 minutes to demonstrate your skills. In this scenario, you will be assessing a patient presenting with chest pain that radiates to the left arm. Please gather a detailed history and perform a physical examination.”
Candidate: “Understood. I will get started.”
Candidate: [Reads the provided instructions and mentally prepares for the assessment.]
Candidate: “Hello, my name is [Candidate’s Name], and I will be your nurse today. Can I have your name, please?”
Standardized Patient (SP): “My name is John.”
Candidate: “Nice to meet you, John. What brings you in today?”
SP: “I’ve been having chest pain that radiates to my left arm.”
Candidate: “I’m sorry to hear that. When did this pain start?”
SP: “It started about two hours ago.”
Candidate: “Can you describe the pain for me? Is it sharp, dull, or something else?”
SP: “It feels like a tight pressure.”
Candidate: “Has the pain been constant, or does it come and go?”
SP: “It comes and goes, but it’s been pretty intense.”
Candidate: “Are you experiencing any other symptoms, like shortness of breath, sweating, or nausea?”
SP: “Yes, I feel a bit short of breath and a little dizzy.”
Permission for Examination
Candidate: “Thank you for sharing that with me. I would like to check your vital signs and perform a brief physical examination. Is that alright with you?”
SP: “Yes, that’s fine.”
Candidate: [Checks blood pressure, heart rate, and respiratory rate.] “Your blood pressure is [XXX], your heart rate is [XXX], and your respiratory rate is [XXX].”
Auscultation
Candidate: “I’m going to listen to your heart and lungs now.” [Proceeds to auscultate the chest.] “Take a deep breath for me… and out.”
Candidate: “Now, I’m going to gently press on your chest to check for any tenderness.” [Palpates areas around the chest.]
Candidate: “Based on what you’ve told me and the examination, I’m concerned that your symptoms might indicate a cardiac issue. I recommend further tests, such as an ECG and possible blood tests.”
SP: “I understand. What does that involve?”
Candidate: “We will monitor your heart rhythm and check for any markers of a heart attack. I’ll ensure you’re comfortable during this process. Do you have any questions or concerns?”
SP: “No, thank you. I appreciate your help.”
Examiner: “Thank you, [Candidate’s Name]. That concludes your assessment. You demonstrated good communication and assessment skills.”
Candidate: “Thank you for the feedback.”
Examiner: “Do you have any questions about your performance today?”
Candidate: “No, I feel good about it. Thank you!”
Examiner: “You can now proceed to the next station. Good luck!”
Candidate: “Thank you!”
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