Gear Up For MRCGP INT

Guidance for MRCGP[INT] OSCE
Hi Friends I thought I will share my experience of MRCGP[INT] OSCE:

The exam comprises of 19 stations, which include: 14 clinical cases and 5 rest stations. Of 14 cases only 6 cases have clinical examination. Time allotted for each station is 10minutes even for rest station. Before you enter consultation room you will get 1 minute of time to go through patient details. And also, the paper will contain information as to whether examination is required or not. Cases are diversified to assess different aspect of general practice. Points to remember NO pediatric patient but mostly a concerned mother will be seeking consultation. NO Breast, Per vaginal, Per re**al examination in cases where it is required you are supposed to ask patient that you want to do particular examination, In which case patient may say examination not required and hand you a paper with findings.

The exam usually focuses on 14-15 systems (based on my observation):
1 Pediatric case Concerned mother (ADHD, Cerebral palsy, growth retardation, constipation, nocturnal enuresis etc)
1 Urology case (Mostly urge or stress incontinence/BPH),
1 Diabetic case (New onset, Uncontrolled, Counselling for Insulin),
1 Dermatology case (Psoriasis, Eczema, Dermatitis, Urticaria etc),
1 Gynecology case (Amenorrhea, Dysmenorrhea, PCOS, Menopause),
1 Obstetrics case (Antenatal booking, Screening for Downs, Anemia, Thyroid disease, Postpartum problems etc),
1 Psychiatry case (Depression, OCD, Grief reaction etc)
1 Rheumatology Case (Osteoarthritis, Rheumatoid arthritis, SLE, Raynauds, Psoriasis, Ankylosing spondylitis, Gout),
1 Emergency case (Acute abdomen, Acute Coronary syndrome, Acute stroke, DVT, PE),
1 Neurology Case (Falls in elderly, Dementia, Parkinsons disease, Multiple sclerosis, MND, Rehabilitation of patient with Neurological problem)
1 De-addiction/Drug side effect case ( Smoking, Alcohol, Drug abuse, Odema with Amlodepine, Cough with ACE Inhibitors, Betablocker worsening asthma etc)
1 Respiratory case ( Asthma, COPD, Infection)
1 Cardiovascular case ( Hypertension, Dyslipidemia, Heart Failure etc)
1 Eye/ENT Case (Diminished vision, Red eye, Hearing loss, Vertigo, Sinusitis, Nasal polyp, Otitis Media, Tonsilitis etc)
1 Gastroenterology case (GERD,Hepatitis,coeliac disease, crohns disease, ulcerative colitis,IBS, diarrhoeal illness/Infections etc)

The examples are few of the many scenarios which may come in exam.

The Two most essential points one must keep in mind while preparing for OSCE is
Increasing Knowledge base
Improving Consulting skills.

Knowledge base can be increased by reading, reading and reading. I recommend going through Oxford handbook of General Practice from cover to cover (Tip: Don’t try to mug up but just read it over and over again in a systematic way; doing 3 to 4 revisions will be good). There is no alternative to sound knowledge base. A knowledgeable person is better equipped to handle even the most unexpected case scenario.

For Improving Consulting skills one is supposed to follow a structured consultation. So that, consultation is clear and no things are missed. You can make your own consultation style with your own phrases or follow traditional methods from any clinical manual like Macleod’s or Hutchinson’s.

One of the most important aspect of GP consultation is exploring the so called ICE (Ideas, Concerns and Expectations). Believe me when I say - one might pass a station just by addressing ICE of patient. So don’t commit a blunder by ignoring it.

Also Time management is crucial. You wouldn’t want to miss out on the examination part in a station which is predominantly kept to test your clinical examination skill or management aspect. Skills for time management can be mastered by practicing, best is practicing scenarios with colleagues or at least recording yourself.

FOLLOWING ARE EXAMPLE OF TYPICAL SET OF CASES WHICH MIGHT COME FOR MRCGP OSCE:

DIET 1:
1.Bilateral sensorineural hearing loss lady want to listen music
2.Pregnant Female with thumping of heart - Anemia
3.Female c/o racing of heart with ECG – SVT, Normal examination at present
4.Fever for evaluation ? Dengue
5.Daughter concerned with mother becoming forgetful
6.Post CABG and DM with anxiety with lack of sleep
7.39years Female with premature menopause
8.Mother of daughter short height for age genetic cause
9. Rheumatoid arthritis
10.Guy with Diarrhoea for 2 months h/o travel to Bangladesh ?Giardiasis
11.Benign prostatic hyperplasia with urine problem
12.Smoking cessation
13.Viral pneumonia
14.Acute abdomen ? Ectopic pregnancy

DIET 2:
1.Urge incontinence
2.Hypothyroidism
3.DM,HTN with renal problems
4.Acute appendicitis
5.Pap smear
6.Macular degeneration of retina
7.COPD
8.Gout/ Hyperuricemia - patient using thiazide
9.Breaking bad news – patient recurrent abortions
10.Gastroenteritis and travel advice
11.Chest pain in patient with DM, HTN
12.Varicose veins
13.Infantile colic
14.Benzodiazepines withdrawal

DIET 3:
1.Exercise induced Asthma
2. Hair loss in patient using Sodium Valproate
3.Patient having Mumps with pregnant wife
4.Impotence
5.Post natal depression
6.Post CABG Depression
7.Plantar Fascitis
8.Frozen shoulder
9.Heart failure
10.Fatty liver plus high blood sugar plus high cholesterol
11.Patient with faecal occult blood test positive report
12.Mother of child with hearing difficulty
13.UTI in male
14. Allergic Rhinitis

DIET 4:
1.Benign Prostatic Hyperplasia
2.Snoring
3.Exertional dyspnoea
4.DM with fatty liver
5.Patient with Report HIV ELISA Non Reactive 1 month after unprotected s*x
6.Mother refusing vaccination to her baby
7.Hypothyrodism
8.Palpitations with ECG
9.Macular degeneration
10.Peripheral Arterial Disease
11.Systemic sclerosis with Raynaud's phenomenon
12.Erectile Dysfunction in Patient with DM
13.Known case of Motor neuron disease came with difficulty of cough
14. Male patient with severe Right hypochondrial pain with nausea and vomiting

DIET 5:
1.Polymalgia rheumatica
2. Headache with vomiting (BP:160/100, PR:50/min) ?Sub Arachnoid Hemorrhage
3. Post Traumatic Stress Disorder
4. Chest pain with distress (BP130/80, PR:115/minutes) ?Pulmonary Embolism
5. Stool incontinence in child ?Overflow soiling due to constipation
6.Erythema nodosum
7.Benign Prostatic Hyperplasia
8.Common cold
9. 30 yrs old pregnant lady with a report shows IgM positive result for HAV presented with vomiting and ↑Bilirubin level
10. Patient with Report (FBS> 200mg/dl)
11. Son came to discuss Palliative care of his father suffering from Hepato Cellular Carcinoma (concerned about vomiting)
13. Female seeking Contraception advice 6weeks post partum (concerned about effects of pills on breastfeeding)
14.Patient with Chest discomfort and Palpitations, ECG- Right bundle block F/h/o Father died due to heart disease

Hope you find this useful. Wishing you best of luck for your exam.

Dr. Syed Omar Uz Zaman
MBBS, Dip. Family Medicine (AHERF / RCGP, UK), MRCGP[INT]

For Any Help or Queries:
Contact [email protected]

Structured Consultation for MRCGP[INT] OSCE
Key components for structured consultation are:

1. Introduction and History
2. ICE and Summarize
3. Clinical Examination
4. Management and safety netting

Introduction and History:

Introduction: Meet and Greet. You can start with a simple “Hello”

Identification: Address patient with Name and confirm identity of Patient.

Establish purpose of visit: Ask “How can I help you today?”

Extract further details: Ask “Can you tell me more about it?”

Now ask details like history of present problem, any associated symptoms and details about them

Rule out Red Flags relevant to presenting problem

Ask about health in past, any recent or long standing medical condition

If there is any long standing medical condition ask about control of symptoms, compliance with medication and follow up and regular check up

Ask about any recent or long standing medications, any known allergies

Ask if any family member suffer from similar problem

Ask about Social history of patient like Occupation to look for occupational cause of symptoms and to assess financial status, marital status to establish social support available.

Ask about any addictions like Smoking, Alcohol, and Drug abuse

If any addictions are present, explain hazards of such addiction and offer help to know ways to stop it (Use leaflets).

ICE and Summarize:

Breaking ICE (exploring Ideas, Concerns and Expectations of patient)

Exploring Ideas: Ask what patient thinks is happening to him? Or why he thinks he is having these symptoms?

Exploring Concern: Ask why does this problem bothers patient? How does this problem matter to him?

Exploring Expectations: Ask patient whether he wants anything in particular to be done today?

Summarize patient things, which you have come to know by now, in a very brief manner.

Ask patient whether there is anything which was missed.

Clinical Examination:

One in not supposed to do a very detail examination but an organized and focused basic examination is sufficient.

Inform patient that you want to examine him or her

Take permission to go ahead with examination

Wash and clean your hand with sanitizer

Ask the patient to expose relevant area to be examined

Re-position patient for proper inspection

Explain to patient what you’re going to do, like; feeling chest with hands, heartbeat, looking for lumps etc.

Once done with examination thanks patient and allow to re dress.

Management:

Involve patient in managing his problem. Ask if patient can follow your advice or provide alternative strategies. Use information leaflets to educate patient. Give patient options rather than orders.

Reassure patient regarding his concerns and provide information to correct any of his wrong Ideas. Explain to patient his condition, in a simple language avoiding medical jargon.

Provide non-pharmacological advice like Diet, Exercise and Modification of behavior etc.

Give pharmacological advice also provide information of possible side effects and how to deal with them.

Ask for relevant tests (Laboratory tests, Radiology investigations and any special tests like ECG, Echocardiography etc.)

Give referrals.

Arrange follow-up.

Provide safety netting in-case if patient develops any red flags.

Hope you will find this useful.

Dr. Syed Omar Uz Zaman
MBBS, Dip. Family Medicine (AHERF / RCGP, UK), MRCGP[INT]

For Any Help or Queries
Contact: [email protected]