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A comprehensive guide for students preparing for the Child Health OSCE exam. It covers various stations such as communication, explanation and planning, examinations, NIPE, developmental assessment, and video viva. The guide includes tips, resources, and key concepts for each station. Students are encouraged to practice and familiarize themselves with the topics to ensure success in the exam.
Typology: Lecture notes
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Authors: Sajeed Ali, Alisha Burman, James Cullen, Amédine Duret, Ben Kilkelly, Tanya Li, Maria Seago, Adam Truelove, Jean Yang This guide is aimed to help give you a starting point for your revision for the Child Health OSCE. It has kindly been put together by current 6th year students with some tips about what they found helpful during their revision and exams. Please bear this in mind when using the guide, and check MedEd or ask the assessment team for the most accurate information about your exam this summer. The notes below are based on the OSCE Workshop that was run by PaedSoc and should cover the same material to help students who were not able to attend this workshop.
(2 minutes reading time, 9 minutes history, 2 minutes viva)
Structure ● The paediatric history station is very similar to the adult history stations you’ve had in the past, just with a few extra components: birth, feeding, growth, development & an expanded social history (safeguarding, home environment, etc) ● A good guide can be found in many places, including here: http://www.oscestop.com/Peads_history.pdf ● The history station in the paeds OSCE will most likely be from the adult parent (actor) of a child who won’t be present in the room. If the child is there, address them and such, but we would imagine that most of the information will be obtained from the adult. Contents ● As with any history, it will need to be altered depending on the presenting complaint. The Oxford Handbook of Clinical Specialties has a very good section of paediatrics which covers the conditions which are relevant to children. ● It is also especially important to do a thorough systems review when taking a paediatric history as often children can present in atypical ways.
Traffic Light system ● The traffic light system is used by clinicians to stratify levels of concern about a child. It has various components, many of which require a complete examination making its use limited for the history taking station. However, it would be worth knowing it roughly as it could give you a guide as to what closed questions you might need to ask and give you confidence in the viva if they were to ask you ‘are you concerned about this child’ or ‘what examination findings would make you more or less concerned’. ● NICE TLS: http://bit.ly/TrafficLightSystem [Further reading] NICE guideline about fever in a child: http://bit.ly/NICEFeverInAChild
● Example: teenager (with or without parent) and you are there to discuss a medical or social issue in teenager’s life ● Main aim is to find out why they’ve come and to work your way through the HEADSS assessment (covered pretty well in CCS leaflet) to understand more about factors surrounding the issue Key tips: ● Ensure the focus is on the teenager as a patient, don’t let the parent do all the talking ● Do remember to offer the teenager a chance to take the consultation on their own (but don’t expect the parent to leave) ● Avoid making assumptions when asking questions (ie. go for open questions where possible) ● Might be worth thinking about the aspects of the HEADSS assessment that are most related to the issue and use that to guide your interview
● Read your brief carefully! Especially note your role and your task ● Practise delivering news or opening the consultation with a friend ● Brainstorm all the possible reactions of the patient or parent, and questions they may ask you
○ Heart ■ Abnormality detected - senior paediatrician review, urgency varies based on clinical condition of baby ○ Testes ■ Bilateral undescended testes - paediatric review in 24 hours ■ Unilateral undescended testes - review at 6-8 week check (if still undescended, GP review at 4-5 months, refer to surgeons by 6 months) ○ Hips ■ Abnormality detected at NIPE - USS by 2 weeks ■ Risk factors for hip abnormality (breech after 36 weeks, breech delivery, external cephalic version, family history) - USS by 6 weeks ● Remember that the 6 week check is basically the same examination but you might ask the parents different background questions
● Try and remember some of the key developmental milestones (these vary a lot from source to source, but this doesn’t matter as they are only median ages! Just be consistent in your own revision), as it can be difficult to remember them all! Find a set of examples below: ○ 4-6 weeks - smiles responsively ○ 6-7 months - sits unsupported ○ 9 months - get to a sitting position ○ 10 months - start of pincer grasp, waves goodbye ○ 12 months - walks unsupported, two/three words, tower of two ○ 18 months - tower of three/four, feeds self with spoon, points ○ 24 months - runs, two words together ○ An example table (with way too much info) can be found here: http://mrcpch.paediatrics.co.uk/wp-content/uploads/2014/06/Development-Assessment-MRCPCH -Website.pdf ● Make sure you test each domain during the exam, e.g. fine motor, gross motor, speech and language etc. It is probably best to do one ‘test’ in each domain first, before moving onto other ways to test the same domain. ○ With practice, you can focus the questions or tasks around the child’s likely age ○ Remember, children younger than 18 months old will have the most development in gross motor and fine motor/vision; 18 months - 2.5 years speech/language and fine motor/vision; and older than 2.5 years speech/language, social/behavioural and some fine motor (more shapes and blocks) ● Practice with real children as much as possible! Project Play is an excellent way to gain practice at interacting with children.
● Young children are not cooperative so you will be under time pressure in the exam. You will need to be flexible - if the child doesn’t want to make a beautiful brick tower like you had planned then move on and try something else! ○ A lot can be gained from inspection alone, so take early notice of the child crawling/walking/running for example ● Try and present the tasks one at a time to not confuse the child ● If you were unable to test something don’t be disheartened. The examiners understand that examining young children can be challenging, especially if the children have been there all day! ○ Try and see as many of the skills as you can for yourself, but don’t be afraid to ask parents if there are some skills you can’t see in the assessment, or if the child is very fed up! ○ At the end of the examination, suggest what other tests you would have liked to perform. ● Although it won’t make or break your mark in the station, you will get some comments from the child’s parent/carer. Introducing yourself to them clearly and the odd friendly comment to them during the assessment can go a long way. ● BONUS MARKS correct for prematurity until the age of 2 (e.g. a 9 month old baby born at 28 weeks (aka 3 months early) should only have the skills of a 6 month old baby)
Community (4 minutes reading, 9 minutes viva) Please see the slides for our Community Station talk: http://www.paedsoc.com/resources-2/revision-material/
If you get a station that has not be described here: