TocOSCE Pediatrics

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OSCE in Pediatrics


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OSCE in Pediatrics

RG Holla MD DMHead of the Department, Neonatology

Fortis HospitalShalimar Bagh, New Delhi, India

Vivek Jain MBBS MRCPCHConsultant, Neonatology

Fortis HospitalShalimar Bagh, New Delhi, India

Manish Mittal DCH DNB

Senior RegistrarPediatrics and NeonatologyFortis Hospital

Shalimar Bagh, New Delhi, India

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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.

This book has been published in good faith that the material provided by authors is

original. Every effort is made to ensure accuracy of material, but the publisher, printer

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dispute, all legal matters are to be settled under Delhi jurisdiction only.

First Edition: 2011

ISBN 978-93-5025-155-3

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To

Our Parents

Mrs Shantha and Mr BV Holla

Mrs Sushila and Mr Suresh Chand Jain

Mrs Usha and Mr Mahesh Chand Mittal


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Foreword

The system of Objective Structured Clinical Examination (OSCE) has beenevolved to make the system of assessment in clinical subjects as objectiveas possible. While the routine examination system which involves clinicalcase presentation cannot be totally replaced, yet it tends to be somewhatsubjective and is usually unable to test the knowledge and skills of thecandidates over the entire syllabus. The OSCE system not only is moreobjective, but it also provides opportunity to examine the student over amuch larger area. The system, in fact, is very helpful to the students as hisdeficiencies in small areas can get covered in larger areas of the syllabus.However, as the person, who was associated with the National Board inintroducing the OSCE system in the specialty of pediatrics, I have noticedgreat apprehension among the National Board candidates regarding thissystem of examination. This has largely been due to non-availability of suitable texts on the subject and inability of most centers and teachersimparting 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 ChildHealth, London, UK. Dr Mittal has cleared the DNB Pediatrics in the newformat of examination. They have all done well to fill this very importantgap. This book focusing on OSCE system is refreshingly new in conceptin that it is not only a source of imparting information (which mosttextbooks tend to be) but also a great help in structured learning of thesubject and imbibing of the knowledge by the student. The teachersinvolved in training and assessing the DNB candidates will also benefitgreatly from this book as it will enable them to understand the basicconcepts of OSCE and enable them to develop many more such questions.

Although written primarily for DNB candidates, this book will be usefulfor other postgraduate (MD, DCH) students in pediatrics and even forpracticing pediatricians as it provides ready reference tool for variousclinical situations. As the book includes multiple choice, it will also helpstudents preparing for clinical skill examinations for the US specialty boardand for MRCPCH examinations.

SK MittalChairman, Department of Pediatrics

Pushpanjali Crosslay Hospital, Ghaziabad (NCR)

FormerlyDirector Professor and Head

Department of PediatricsMaulana Azad Medical College, New Delhi, India


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Preface

The traditional case presentation, still in vogue in most postgraduateexaminations, covers only a part of the examinee’s medical knowledge.The direction that the discussion takes during a case presentation and thelevel of interrogation depends both upon the examinee’s and examiner’sapproach. This leads to a subjective assessment. Certain areas of clinicalpediatrics like interpretation of laboratory and radiological reports,communication skills, problem solving and knowledge of clinicalprocedures are not tested routinely in the traditional examination.

The Objective Structured Clinical Examination (OSCE) attempts toovercome these drawbacks by providing a broad-based format to assessthe candidate on multiple aspects of the subject. Objectivity brings with itan element of uniformity. Being structured gives a focus on preparationand assessment. The wide variety of topics inherent to childhood illness(from neonatology to adolescent medicine, from intensive care to socialpediatrics, from child development to surgical emergencies and so on…)provides a delightfully wide source for the examiner to draw upon, but isa nightmare for the candidate. However, there is a silver lining. Being broad

based, OSCE gives the candidate an opportunity to make up from an easyquestion, 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 aguide which could help them prepare for the examination. Moreover, therequirement to qualify separately in OSCE in order to receive accreditationmade the necessity for such a volume all the more imperative.

The book OSCE in Pediatrics is neither meant to cover the whole fieldof pediatrics nor is it intended to serve as a question bank. It is an effort tosensitize 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 mannerand would certainly help in dealing with the real-life patient.

The authors have drawn upon a wide variety of inputs in thepreparation of the questions. No effort has been spared in trying to ensureaccuracy of medical facts, drug dosages and so on. It is, however, possiblein the changing world of medicine for error to creep in. We regret any suchinadvertent shortcoming and welcome suggestions and criticism.

RG HollaVivek Jain

Manish Mittal


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1. Connective Tissue .................................................................................... 1

2. Counseling, History and Examination .............................................. 10

3. Drugs and Vaccines ...............................................................................24

4. Endocrinology.......................................................................................... 36

5. Genetics .................................................................................................... 48

6. Gastrointestinal Disorders ...................................................................64

7. Hematology, Oncology ..........................................................................76

8. Infection ...................................................................................................93

9. Neurology ............................................................................................. 109

10. NALS, PALS ......................................................................................... 125

11. Community Medicine ......................................................................... 131

12. Respiratory System ............................................................................. 139

13. Statistics ................................................................................................ 151

14. Miscellaneous ...................................................................................... 162

15. Cardiovascular System ....................................................................... 175

16. Growth, Development and Nutrition .............................................. 185

17. Neonatology.......................................................................................... 196

18. Radiology .............................................................................................. 223

19. Renal System ....................................................................................... 246

Contents


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The OSCE or Objective Structured Clinical Examination is an integral partof the accreditation examination for the Diplomate of National Board inPediatrics. It is conducted as a part of the practical examination, and isheld on one of the three days of the practical examination (depending uponthe number of candidates in a center). The OSCE part of the exam is heldfor 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 stationhas one or more tasks for the candidate to complete in a fixed time, usually5 minutes. The stations consist of questions or problems and usually coverthe 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 oneof the following:a. A situation in neonatal resuscitation. b. A situation in pediatric advanced life support.c. Clinical examination of a system.d. Anthropometry and derivation of indices of growth and nutrition

e. Procedure, e.g. liver biopsy on a dummy, etc.f. 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 keywhich is their guideline for assessment. As such, there is no scope for anexaminer to delve beyond the key to award or deduct additional marks forsupplementary 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 candidateincluding introducing oneself and establishing rapport, taking permissionprior to uncovering and examining a patient, covering a patient after

Introduction


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xiv OSCE in Pediatrics

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 stepsin history taking and clinical examination. Questions related to NALS andPALS stick to the standard guidelines. Thus it is possible to score well inthese stations if one goes prepared.

By and large, the laboratory and radiological investigations given inOSCE are simple and straightforward and stress on the clinical aspect of the illness. Diagnostic skill possessed by a trained pathologist orradiologist is not expected of a student.

Poor performance in OSCE is primarily responsible for a poor outcomein the DNB practical exam and results from lack of knowledge or

preparation for the same. A candidate would benefit from regularlypracticing mock OSCE drills. This does not have to always take the formof a formally organized mock OSCE. Informal bedside rounds, group studysessions, delivery room calls and so on, provide ample opportunity forstudents to pose a problem and assess each other and practice for theobserved stations.

The final word for success in OSCE:Practice, practice, practice.

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TocOSCE Pediatrics