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OSCE in Pediatrics
© 2011, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the authors and the publisher.
First Edition: 2011
Typeset at JPBMP typesetting unit
Mrs Shantha and Mr BV Holla
Mrs Sushila and Mr Suresh Chand JainForeword
The system of Objective Structured Clinical Examination (OSCE) has been evolved to make the system of assessment in clinical subjects as objective as possible. While the routine examination system which involves clinical case presentation cannot be totally replaced, yet it tends to be somewhat subjective and is usually unable to test the knowledge and skills of the candidates over the entire syllabus. The OSCE system not only is more objective, but it also provides opportunity to examine the student over a much larger area. The system, in fact, is very helpful to the students as his deficiencies in small areas can get covered in larger areas of the syllabus. However, as the person, who was associated with the National Board in introducing the OSCE system in the specialty of pediatrics, I have noticed great apprehension among the National Board candidates regarding this system of examination. This has largely been due to non-availability of suitable texts on the subject and inability of most centers and teachers imparting training to DNB candidates, to familiarize the students with the ‘new’ system in absence of such texts. Dr Holla is a very experienced DNB examiner, Dr Jain is a Member of Royal College of Paediatrics and Child Health, London, UK. Dr Mittal has cleared the DNB Pediatrics in the new format of examination. They have all done well to fill this very important gap. This book focusing on OSCE system is refreshingly new in concept in that it is not only a source of imparting information (which most textbooks tend to be) but also a great help in structured learning of the subject and imbibing of the knowledge by the student. The teachers involved in training and assessing the DNB candidates will also benefit greatly from this book as it will enable them to understand the basic concepts of OSCE and enable them to develop many more such questions.
Although written primarily for DNB candidates, this book will be useful for other postgraduate (MD, DCH) students in pediatrics and even for practicing pediatricians as it provides ready reference tool for various clinical situations. As the book includes multiple choice, it will also help students preparing for clinical skill examinations for the US specialty board and for MRCPCH examinations.
Chairman, Department of Pediatrics
Pushpanjali Crosslay Hospital, Ghaziabad (NCR)
Director Professor and Head
Department of PediatricsPreface
The traditional case presentation, still in vogue in most postgraduate examinations, covers only a part of the examinee's medical knowledge. The direction that the discussion takes during a case presentation and the level of interrogation depends both upon the examinee's and examiner's approach. This leads to a subjective assessment. Certain areas of clinical pediatrics like interpretation of laboratory and radiological reports, communication skills, problem solving and knowledge of clinical procedures are not tested routinely in the traditional examination.
The Objective Structured Clinical Examination (OSCE) attempts to overcome these drawbacks by providing a broad-based format to assess the candidate on multiple aspects of the subject. Objectivity brings with it an element of uniformity. Being structured gives a focus on preparation and assessment. The wide variety of topics inherent to childhood illness (from neonatology to adolescent medicine, from intensive care to social pediatrics, from child development to surgical emergencies and so on…) provides a delightfully wide source for the examiner to draw upon, but is a nightmare for the candidate. However, there is a silver lining. Being broad based, OSCE gives the candidate an opportunity to make up from an easy question, any marks lost in a station in which he has not scored well.
With the introduction of the OSCE system as an integral part of the DNB Pediatrics examination, there was a felt need amongst students for a guide which could help them prepare for the examination. Moreover, the requirement to qualify separately in OSCE in order to receive accreditation made the necessity for such a volume all the more imperative.
The book OSCE in Pediatrics is neither meant to cover the whole field of pediatrics nor is it intended to serve as a question bank. It is an effort to sensitize and introduce the student to the OSCE format so that the student can prepare accordingly.
The ambit of OSCE extends beyond the examination hall. Preparation for OSCE trains the student to approach a problem in a systematic manner and would certainly help in dealing with the real-life patient.
The authors have drawn upon a wide variety of inputs in the preparation of the questions. No effort has been spared in trying to ensure accuracy of medical facts, drug dosages and so on. It is, however, possible in the changing world of medicine for error to creep in. We regret any such inadvertent shortcoming and welcome suggestions and criticism.
The OSCE or Objective Structured Clinical Examination is an integral part of the accreditation examination for the Diplomate of National Board in Pediatrics. It is conducted as a part of the practical examination, and is held on one of the three days of the practical examination (depending upon the number of candidates in a center). The OSCE part of the exam is held for all candidates on the same day.
The OSCE in Pediatrics conducted by the National Board consists of 25–30 stations that the candidate has to attend by rotation. Each station has one or more tasks for the candidate to complete in a fixed time, usually 5 minutes. The stations consist of questions or problems and usually cover the following topics:
- Case studies.
- Interpretation of laboratory reports.
- Interpretation of radiological investigations, which may be conventional radiographs, ultrasonograms, CT scans or MRIs.
- Interpretation of ECGs.
- Clinical photographs.
- Biostatistics problems.
- Questions in community medicine related to pediatircs/neonatology.
- Observed stations—at these stations, an examiner observes the actions of the candidate while performing a task. The task given may be one of the following:
- A situation in neonatal resuscitation.
- A situation in pediatric advanced life support.
- Clinical examination of a system.
- Anthropometry and derivation of indices of growth and nutrition
- Procedure, e.g. liver biopsy on a dummy, etc.
- Counseling—includes counseling a patient to use a particular drug device or of a parent regarding a child's illness.
- Drug or vaccine.
- Equipment or instrument.
- Biomedical waste management.
Each station is usually of five marks. The examiners are given a key which is their guideline for assessment. As such, there is no scope for an examiner to delve beyond the key to award or deduct additional marks for supplementary correct or incorrect information given by the candidate. Most answers are from standard textbooks in pediatrics.
Observed stations are a challenge but can be easily mastered with a little practice. Marks are awarded for each point covered by the candidate including introducing oneself and establishing rapport, taking permission prior to uncovering and examining a patient, covering a patient after having completed the examination and wishing the patient before leaving. In the history taking and counseling stations, the content rather than the style is assessed. The examiner expects basic competency and basic steps in history taking and clinical examination. Questions related to NALS and PALS stick to the standard guidelines. Thus it is possible to score well in these stations if one goes prepared.
By and large, the laboratory and radiological investigations given in OSCE are simple and straightforward and stress on the clinical aspect of the illness. Diagnostic skill possessed by a trained pathologist or radiologist is not expected of a student.
Poor performance in OSCE is primarily responsible for a poor outcome in the DNB practical exam and results from lack of knowledge or preparation for the same. A candidate would benefit from regularly practicing mock OSCE drills. This does not have to always take the form of a formally organized mock OSCE. Informal bedside rounds, group study sessions, delivery room calls and so on, provide ample opportunity for students to pose a problem and assess each other and practice for the observed stations.
The final word for success in OSCE:
Practice, practice, practice.