OSCE in Pediatrics Vivek Jain, RG Holla, Manish Mittal
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1OSCE in Pediatrics2
3OSCE in Pediatrics
Second Edition
Vivek Jain MBBS MRCPCH Additional Director and Head Department of Neonatology Fortis Hospital Shalimar Bagh, New Delhi, India Manish Mittal DCH DNB Fellowship in Neonatology Consultant and In-Charge Department of Neonatology Cocoon Hospital Jaipur, Rajasthan, India RG Holla MBBS MD DM New Delhi, India Foreword Ajay Gambhir
4
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OSCE in Pediatrics
First Edition: 2011
Second Edition: 2016
9789385891670
Printed at
5Dedicated to
Our Parents
Mrs Sushila and Mr Suresh Chand Jain
Mrs Usha and Mr Mahesh Chand Mittal
and
Mrs Shantha and Mr BV Holla6
7Foreword
The objective structured clinical examination (OSCE) is an integral part of final exit examination for the postgraduate students. It is currently used by Diplomate of National Board (DNB) in a few specialties of medicine and surgery to assess the overall knowledge and practical skills of a student who is going to pursue his/her career in that particular field. It is also an integral part of examination for award of Member of Royal College of Paediatrics and Child Health (MRCPCH).
The OSCE system is in addition to traditional method of examining students (long and short clinical cases). This system has an added advantage of analyzing a student's knowledge over larger area in limited timespan. Also, to eliminate bias, all the students are examined on same set of questions simultaneously.
It has been commonly seen that the students are very apprehensive while undertaking OSCE examination, partly due to lack of practise and partly because of experiences shared by their seniors who have undergone the OSCE test. Nowadays, many institutes, where DNB courses are going on, have started focussing over this aspect and have started conducting mock OSCE drills for their students, which is quite encouraging and rewarding for the candidates undertaking their final examination. The second edition of OSCE in Pediatrics will be very helpful for them, especially after seeing tremendous response for the first edition.
Dr Jain is a Member of Royal College of Paediatrics and Child Health, London, UK, and Dr Mittal has been awarded Diplomate of National Board in Pediatrics. Both of them have personally undertaken OSCE examination for award of their degrees.
The book will be of great help for DNB candidates, other postgraduate students and also for practicing pediatricians.
Ajay Gambhir MD
President
National Neonatology Forum8
9Preface to the Second Edition
In response to the success of the first edition of OSCE in Pediatrics, we have come up with this updated second edition. On the basis of feedback, changes are made in the text matter of the first edition.
Medical science is ever evolving and new information is added every day. We have added more than 150 new questions to keep abreast of the recent advances.
The objective remains the same from the first edition. We regret any inadvertent shortcoming, and welcome suggestions and criticisms.
Vivek Jain
Manish Mittal
RG Holla10
11Preface to the First Edition
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, such as 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.
We 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 criticisms.
RG Holla
Vivek Jain
Manish Mittal12
13Acknowledgments
We must acknowledge the contribution of the following distinguished doctors, for providing inputs in the second edition of the book:
  • Dr Akhilesh Singh, Consultant Neonatologist, Fortis Hospital, Shalimar Bagh, New Delhi, India.
  • Dr BS Yadav, Consultant Pediatrician and Neonatologist, Cloud Nine Hospital, Gurgaon, Haryana, India.
  • Dr Hemant Madan, Associate Director, Department of Cardiology, Fortis Hospital, Shalimar Bagh, New Delhi.
  • Dr JK Mittal, Consultant Neonatologist, Neoclinic, Jaipur, Rajasthan, India.
  • Dr Manas Kalra, Consultant Pediatric Hemato-oncologist, Apollo Hospital, New Delhi.
  • Dr Manish Balde, Consultant Pediatrician and Neonatologist, Cloud Nine Hospital, Gurgaon.
  • Dr Pankaj Kumar, Senior Consultant, Department of Radiology, Fortis Hospital, Shalimar Bagh, New Delhi.
  • Dr Pritum Gupta, Senior Registrar, Department of Pediatrics, Cocoon Hospital, Jaipur.
  • Dr Sandeep Dubey, Consultant Pediatrician and Neonatologist, Cloud Nine Hospital, Gurgaon.
  • Dr Sanjay Wazir, Neonatologist, Cloud Nine Hospital, Gurgaon.
  • Dr Sanket Goyal, Fellowship in Neonatology, Sir Ganga Ram Hospital, New Delhi.
  • Dr Satyen Hemrajani, Consultant Neonatologist, Fortis Escorts Hospital, Jaipur.
  • Dr Sourabh Singh, Consultant Neonatologist, Mahatama Gandhi Medical College and Hospital, Jaipur.
  • Dr Surender Kumar, Consultant Pediatrician and Neonatologist, Cloud Nine Hospital, Gurgaon.
We also thank to Mr Himanshu Kumar for compilation and designing of data, graphs, etc.141516
17Introduction
The objective structured clinical examination (OSCE) is an integral part of the accreditation examination for the Diplomate of National Board (DNB) 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 examination 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:
  1. Case studies.
  2. Interpretation of laboratory reports.
  3. Interpretation of radiological investigations, which may be conventional radiographs, ultrasonograms, CT scans or MRIs.
  4. Interpretation of ECGs.
  5. Clinical photographs.
  6. Biostatistics problems.
  7. Questions in community medicine related to pediatircs/neonatology.
  8. 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:
    1. A situation in neonatal resuscitation.
    2. A situation in pediatric advanced life support.
    3. Clinical examination of a system.
    4. Anthropometry and derivation of indices of growth and nutrition.
    5. Procedure, e.g. liver biopsy on a dummy, etc.
    6. Counseling—includes counseling a patient to use a particular drug device or of a parent regarding a child's illness.
  9. Drug or vaccine.
  10. Equipment or instrument.
  11. 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 18prior 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 examination 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.