Approach to the “teaching” OSCE

APPROACH TO THE

This is a great article written (and reproduced with permission) by Andrew Perry, a FACEM from Adelaide, with input from the venerable Don Liew, FACEM from Melbourne and director of the Teemwork Fellowship Exam preparation course. I hope you find it useful.

APPROACH TO THE “TEACHING” OSCE STATION
It is likely that at least one of your OSCEs will involve teaching a registrar or medical student about a procedure (e.g. pacing), piece of equipment (e.g. intubating LMA) or analysis of an investigation (e.g. blood gas or ECG).

This is because:

  1. It assesses the “Scholarship and Teaching” domains of the ACEM Curriculum Framework
  2. It is low-resource – as opposed to a high-fidelity simulation station
  3. It allows candidates to have a focussed assessment of their knowledge of key procedures/equipment items/investigations using the new format – the “registrar” being “taught” can be provided with a list of key questions to cover if the candidate doesn’t cover them.

Template

Any teaching scenario, (like the ACEM example), is likely to be a 10 minute station (3 minutes reading time, 7 minutes with the candidate) i.e. not a double station, so it is important to have a system that allows you to quickly, yet thoroughly, cover all aspects of the area being taught.

All assessors like candidates to have an easy-to-follow structure as it gives them confidence that the candidate has an ordered as opposed to a scatter-gun approach and if you mention you will cover something at the start and either forget it at the end or run out of time, you have at least mentioned it.

It is likely that the assessment template will include a marking template that is similar to the teaching template below!

TEMPLATE FOR PROCEDURE OR EQUIPMENT OSCE STATION

  • Introduction: say “Hi, I’m ______ (insert name)
    • Generally DO NOT introduce yourself as “Dr _____ (Surname)” as in Australasian EDs this is not considered part of the EM culture as it implies perceived superiority over your colleagues.
    • DO introduce yourself as a consultant as you are being assessed on performing in a consultant capacity and you should have faith that you are.
    • There is no need to shake hands unless this makes you feel comfortable.
  • Clarify level of experience and understanding – including level of training, relevant rotations e.g. anaesthetics, ICU, cardiology
  • Provide teaching plan outline – see next section – “In the next few minutes we are going to cover how to “(insert procedure name)” and we will do this by discussing/covering/looking at the… (use the following teaching plan outline)
    • 1. Indications
    • 2. Contraindications
      • a. Alternate options
    • 3. Procedure
      • a. Preparation
        • i. Consent
        • ii. Staffing
        • iii. Equipment
        • iv. Medications
        • v. Positioning
      • b. Technique – with demonstration, ideally on mannequin
      • c. Pitfalls/Handy tips
    • 4. Complications
    • 5. Post procedure care
  • Provide opportunity for questions and potentially time to practice at end – “At any stage feel free to ask me questions and I will check at the end to make sure I have covered all the areas you wanted to know about”.

HANDY TIPS

Read the question!

Read all parts of the scenario that you are given. There may be areas you are specifically supposed to address. For example:

  • If you are on the floor and a registrar asks you to look at an ECG or ABG and it shows a life-threatening condition your first priority is patient safety e.g. patient with tri-fascicular block presenting with syncope “Is the patient connected to the monitor?”
  • ABG from agitated patient with hypoglycaemia “Has the patient been given glucose?”.

Be observant

As in all OSCEs when you first walk in the room look around and see what is there that may be relevant to the scenario. For example:

  • Is there is anything for you to use to help demonstrate a technique or equipment item.
  • You may have multiple items available to use e.g. showing the difference between a standard LMA and intubating LMA and its implications in terms of seating it against the laryngeal inlet.
  • Keep in mind some items may be there as distractors (i.e. they are not likely to be helpful in any way).

Don’t make stuff up or (even worse) lie!

In exams, the role player and every other party already know all the answers. Any confabulated information is instantly discovered.  It makes the lying candidate appear foolish, deceitful and certainly unworthy of passing.

In case of ignorance, or if you don’t know the specifics:

  • Cite the principles of the topics
  • Establish a framework with these principles
  • Formulate a plan to discover what is not known

Demonstrating resourcefulness helps.

If stuck use phrases like:

  • “These are the principles, and here’s what we know…”
  • “Here’s what we don’t currently know or understand, so after this session we can review the topic using ______”

Investigation stations

With investigation stations, the emphasis will likely shift away from purely teaching to also include diagnosis and likely management – the ACEM website on the Fellowship Exam shows a sample OSCE video where you have to do this exact process with an ECG and junior registrar.

Instructions to candidate

Video available here Click on “Resources” tab, and scroll down to videos

More examples

For further (non-ACEM provided examples) see the following which are available from the excellent ACEM FEx website which is a crowd-sourced #FOAMed database run by Michael Edmonds in Adelaide:

Teaching a procedure to a junior doctor – Intubating LMA

Teaching a procedure to a junior doctor – CVC insertion

By the way, in an homage to our great FACEM exam prep mentor, and professional art historian, Dr James Hayes FACEM, the painting at the top is Hippocrates and Democritus by Pieter Lastman (1583 – 1633) held at the Musée des Beaux Arts, Lille. It is said that Democritus was one of Hippocrates’ teachers, and I think this image is a great reminder that in Emergency Medicine, teaching is a fundamental skill, and that no matter what our experience level, we never cease learning.  So make sure you are prepared to teach a colleague of any level of experience, somewhat ironically, in an exam!

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