The document provides information about the structure and tips for the Observed Structured Clinical Examination (OSCE) assessment. It outlines the various stations one may encounter, including observed clinical examinations, procedures, history taking, counseling, and rest stations. It emphasizes arriving prepared with the proper equipment, reading questions carefully, focusing on key details, and maintaining a calm demeanor throughout. Clinical examples and common mistakes made by students are discussed to help optimize performance.

1. OSCE : Observed Stations
Dr Sandeep Kavade
Consultant, Vatsalya Children’s Hospital Bhosari

2. OBSERVED
STATION
OBSERVED
STATION
OBSERVED
STATION
OBSERVED REST
STATION STATION
REST STATION
STATION 1 OBSERVED REST STATION
STATION

3. Clinical Photo Blank OSCE Sheets
X Ray
Clinical Scenario
ECG
ABG
Karyotype
Biostatistics

9. Stay calm
Focused
Don’t spend time mugging things on the last day
OSCE is an skill assessment of your entire post
graduation

10. Things to carry for OSCE
A professional outfit
A good apron
A stethoscope
Roll No card
2 pens
Last but not the least
A cool, calm mind

11. 5 minutes are more than enough
(usually)
Spots designed with around a 3 – 4 minute time frame
Writing never takes more than 2 minutes
Certain stations like statistics may be time-consuming

12. First few OSCEs
Life comes in a circle
Some students get 3 simple OSCEs, some 3 impossible
ones
Some will start on a rest station
Don’t decide your fate on the first OSCE
OSCE goes in a circle too

13. Read the question CORRECTLY
See what the question says
Example:
ECG of SVT followed by question, name the drug
treatment of above condition, please see DRUG.
Do not mention vagal maneuvers / DC conversion
over here

14. We had a OSCE question where we had to take the
height of a child and plot it in the growth chart.
Simple isn't it
There were 4 children of different age groups
Examiner randomly sent any one to each student

15. Trick
We had to remember to ask the name of the child and
write on space provided on growth chart
Also had to attach growth chart to answer sheet and
then give it back

16. NRP question about 18 hrs old baby found apneic in
ward
It is 18 hrs old…do not ask the 4 standard questions

17. At a station for taking child’s length with
infantometer a nursing assistant was standing in
corner
Most students tried to do it on their own
Assistance was provided to only those who asked.

18. Getting the diagnosis or identification of a spot right
is very crucial
Even if you get other answers correct, no marks are
awarded.

19. Go with your gut instinct
Do not diagnose or identify slides with the questions
Many questions have false hints

20. Observed stations are fixed (more or less)
History taking
Clinical examination
Counseling
Indices calculation or some procedure or
Development examination
NALS/PALS/Spirometry/ Rotahaler/Spacer use
etc……

21. Counseling
Introduction and ask about the language
When diagnosed, is it confirmed
Remove the guilt of parents (no one to blame)
Treatment (If available or not for cure)
If not supportive therapy
Treatment of disease complications and their
Complications

22. Counseling
Compliance with Treatment
Antenatal counseling
Recurrence Risk
Support Group
Thanks! All the best, do you want to ask any question

23. Always ask language
No medical jargon
Give options
Never force a decision

24. COUNSELING
24 yr old lady diagnosed as HIV + at 36 weeks of gestation.
Counsel regarding perinatal transmission and follow up.

25. 1. Ensures the presence of husband 0.5
2. Introduces self/ puts the couple at ease. 0.5
3. Explains the disease in simple words 0.5
4. Explains the incidence and modes of perinatal
transmission
20-30% 0.5
Prenatal 0.5
Intranatal 0.5
Breast feeding 0.5

26. 5. Explains modalities of reducing rate of transmission
ART to mother and child 1.0
LSCS Vs Vaginal delivery 1.0
Breast feeding Vs top feeding
1.0
6. Explains effect of measures – reduction by 50% 1.0
7. Explains screening of the infant 0.5
8. Explains safety of cuddling, petting and kissing 1.0
9. Asks for queries if any. 0.5
10. Advises to report back if any problems. 0.5
(Total marks 10.0)

27. COUNSEL THE MOTHER OF A DOWN’S SYNDROME

28. Introduction
Asking for what she knows about the child’s condition.
Telling common problems of downs to watch for
Education and vaccination of present affected child.
Inheritance & Possibility in next child
Antenatal testing in next pregnancy
Ask for and clarifying doubts
Thank the mother.

29. Advise the mother of a child with simple febrile
seizures

30. Greeting the mother
Introduce yourself
Asking the mother what she knows about her child’s
illness.
Explaining what is simple febrile seizure
Management plan and side effects of drugs used
Prognosis
Avoiding technical jargon
Asking for any more doubts and clarifying them.

31. History taking
Introduction
Remove the stress
Main symptoms
Onset, progression, severity
? Similar problem in past
Negative history for D/d
Sibling/Family history
Drug history
Perinatal history, if imp
Social /Environmental history if imp
Thanks

32. A 2 yr old child presents to emergency department
with severe pallor. Take the history of the child from
mother.

33. Introduces himself and tries to make the mother comfortable
0.5 marks
Asks onset sudden or gradual 1 mark
history of bleeding or bluish spots 1 mark
History of associated symptoms : fever, failure to thrive 1 mark
Recurrent blood transfusions 1 mark
history of associated jaundice 1 mark
history of worm infestation 0.5 mark
birth history 0.5 mark
community and religion and history of consanguinity 1 mark
dietary history 1 mark
family history 0.5 mark
drug history 1 mark

34. Take history of a 8 year old child with past history of
repeated cough, breathlessness, not associated with
fever?

35. Identify patient
Introduce yourself
Ask Duration & frequency of symptoms
With expectoration?
Allergic history?-rhinitis, urticaria
Association with exertion
Diurnal variation?

36. Seasonal variation?
H/o growth, weight gain
H/o asthma, cough, allergies in family.
H/ TB contact
Investigation history
Treatment History

37. Procedures
Always remember to wash hands
Informed consent
Check instruments provided
Show the exact technique
Collection of specimen
Advise regarding post procedure observation
Disposal of waste
Thanks

38. ELICITING KNEE JERK

39. Greeting the patient and self introduction
Taking consent and explaining the procedure.
Adequate exposure
Proper position of the patient (supine) and the doctor
Proper technique (Keeping the hand under the knee and
striking the patellar tendon midway between its origin and
insertion).
Looking for quadriceps contraction.
Grading the reflex
Thanking the patient.

40. EXAMINATION OF B.P IN A 10 YEAR OLD

41. Rapport with patient and Bystander
Choice of cuff size
Positioning of the patient
Site of tubing in relation to artery is correct?
Initial palpation, then auscultation method
Rate of deflation is correct
To say if reading is normal or otherwise
Thanking patient and bystander

42. Examination of Head Circumference

43. Introducing oneself and establishing rapport
To explain the procedure
Positioning on right hand side of the patient.
Inspection for skull abnormalities.
Head circumference to be measured with fibre glass tape.
Tape should encircle over the most prominent point on the
occiput and supra orbital frontal ridge.
Ends of the tape should overlap and intersecting value to be
taken.
Accurate reading and plotting on the growth chart, if available.

44. Examination of Height of a 7yr old child by
Stadiometer

45. Introducing oneself and take consent
Explaining the procedure
Examining from right hand side of the patient
Make the child stand against scale bare feet.
Feet together parallel with heel, buttocks, shoulders and occiput
touching the rod.
Ask to look straight head erect with chin up. Frankfurt plane and
biauricular plane being horizontal
Scale brought to touch the vertex, pressing the hair.
Accurate reading and plotting on the growth chart, if available.

46. Do Motor system examination of the child

47. Introduces. ½
Explain to parents & consent ½
Warms hand before examination ½
Posture / tone ½
Nutrition ( wasting etc.) ½
Power : fingers / wrist / elbow / shoulder in all move. ( 0.5*4=2) 2
Power : hip / knee / ankle / 1½
Deep reflexes : AJ /KJ /BJ /TJ / BR.JERK ( 0.5 *5) 2½
PERSISTENT NEONATAL REFLEX (if infant) ½
Abnormal reflex ( jaw jerk) ½
Gait ½
Thanks the Mother ½
TOTAL 10

48. Administer HIB Vaccine to this 4 month old child who
is otherwise normal.

49. Introduces. ½
Explain to parents about vaccine / cost / side effect 1
Wash Hands ½
Take 2 ml syringe and needle to withdraw diluent and Mix it with the ½
lyophilised Powder
Changes the needle ½
Identify the site. Anterolat Thigh middle 1/3 ½
Correct needle ½ inch ( IM) ½
Clean the site ½
Correct direction ( vertical) .. ½
Withdraw and press at the Inj Site ½
Post procedure advise to mother ½
Instructions to wait 20 min and inform on case of problem ½
When to come for the next dose ½
BIOWASTE DISPOSAL 1
Thanks the Mother ½
TOTAL 10

50. Examine the Abdomen of this child.

51. Introduces. ½
Explains to child what exactly has to be done 1
Warms hand before examination ½
Inspection: shape ½
Scar / sinus veins /umbilicus ½
GENITALS / Hernia ½
Palpation: Liver / spleen…superficial and deep ½
Bimanual Palpation ½
Percussion: all quadrant ½
Shifting dullness / coin test ½
Auscultation for 1 min : for peristalsis and Bruit ½
TOTAL 6

52. Do not ask examiner any question
Except the NRP station

53. Rest at the rest station

54. http://groups.yahoo.com/group/PediatricsDNB/
Theory: http://dnbpediatricstheory.blogspot.in/
OSCE: http://oscepediatrics.blogspot.in/
Clinical: http://clinicalpediatrics.blogspot.in/
Practicals: http://practicalpediatrics.blogspot.in/
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