Types of OSCE - Observed station

OSCE stations can be broadly divided into observed and un-observed stations.

Understanding different types of OSCE station formats is essential, since the approach to different station differs and also does the mark distribution.

Observed OSCE station alaways carry more marks overall and knowing just the answer is not all that is required. This guide discusess overall anatomy of Observed OSCE station, its types and some examples.

How observed OSCE stations are different from unobserved stations

Mark distribution of OSCE stations in DNB exam.

Observed OSCE more or less account for 50 out of 150 marks in DNB practicals. This subset is therefore crucial for clearing practicals.

What is an observed OSCE station

As the name suggests, an examiner directly observes the Communication, Procedural, examination skills of the student. The examiner then provides marks/rank according to the key answer.

Usually, 8 minutes are allotted for each station in DNB Pediatrics practical exam. Each OSCE exam has approximately 5 to 6 observed stations.

The topics for this type of OSCE station are based on day-to-day ward/OPD cases, procedures, resuscitation scenarios. So if we are thorough during 3 years of residency, no extra efforts are needed to score. However, these stations definitely need orientation and practice.

Here is the list of topics generally asked in observed OSCE stations.

1. Clinical examination.
2. Focused clinical examination based on history/clinical clues given.
3. Counseling
4. History taking
5. Procedures - More on procedure skills for OSCE
6. NRP/PALS
7. Developmental assessment.

Let us see the subtypes of Observed stations in detail.

1. Developmental assessment - OSCE stations

Developmental assessment is an indispensable part of pediatrics clinical examination. You should be thorough with normal developmental milestones. Remember, tt is an important OSCE station.

1. Demonstrating the assessment of development for a particular age group.
2. Obtaining developmental age of a child.

1. Start with a gentle and playful attitude
2. Be-friend the child
3. Perform the task
4. Cover all domains if not specified.
5. Start with higher age which you expect and if a child is unable to do the task then bring it down to lower age.
6. Don't forget to thank the dummy patient at the end.

Sometimes you need to demonstrate to the child a particular task while assessing for the developmental age for eg. - it is better to demonstrate how to jump backward before asking a 5-year-old to do so. For assessment of fine motor skills if you are using cubes then first show a child how to make a bridge/gate/train.

If you are asked to guess the age of the child then you may also need to demonstrate the inability of a child to perform a higher age task.

4 yr old child, confirm the devlopmental age.

In terms of motor domain, a 4 year old can climb down, 1 foot per step. Also try to demonstrate that he cannot jump backward which is a 5th year milestone, thus ruling out that he is not 5 years old.

Remember all object kept in station are their to use.

2. Clinical Examination - OSCE stations

Generally, the station involves a clinical scenario or a clinical examination tool and you will be asked to perform the clinical examination based on that. After reading the task, or having a look at the equipment, give yourself 30 sec to plan your actions.

This could save you from unfortunate mistakes like, not standing on Rt. Side of patient, while examining or not checking/percussing on both sides.

It is always useful to have a revision of clinical methods from clinical books. Here is the list of standard clinical examination textbooks in pediatrics

1. Greet the patient/caregiver
2. Obtain consent for the examiner
3. Observe hand huygiene
4. Explain to patient/caregiver what are you examining, maintain their comfort

You are expected to give a running commentary of what you are doing and what you are looking for to the examiner.

An appropriate examination kit is provided to you, if you find any unexpected object then be smart enough to think out of the box, use logical thinking, it helps sometimes to think beyond usual teaching. Here is the list of tools useful for clinical examination in children.

Example 1

A station where a Measuring tape is provided, and you are asked to perform a clinical examination using it

1. RS - Measure chest circumference and also check after full inspiration.
2. GIT - Abdominal girth, xiphisternum to the umbilicus, and umbilicus to pubic symphysis distance, liver span etc
3. CNS - Head circumference, limb circumference to check nutrition of muscles.

Example 2

At a station, you are provided with a Fundoscope

In this case, Perform an examination with fundoscope and menton that you are looking for following things to be ruled out.

1. CVS - Roths spot for IE.
2. GIT - Cherry red spots for storage disorders.
3. CNS - Pappiloedema.

Whether you get positive findings or not, doesn't matter, the examiner wants to observe whether you know what to look for along with your examination skills.

Remember, this is one of the most scoring observed OSCE stations.

3. Focused clinical examination

These stations are an effective way of history taking and clinical assessment in a short period of time without missing anything related to the particular clinical question, sign or symptomp.

In focused physical examination OSCE, you have to perform the examination required based on history and clinical clues. Remember it is not a head-to-toe examination. The examination-based clinical questions might require the examination of more than one system or body part or system. Read entire post on focused clincal examination below.

4. OSCE station based on communication skills

These types of OSCE stations focus on your communication skill with patients or caregivers.

Counselling about a diagnosis

Most of the time, a clinical scenario is given and you are asked to counsel the parents. Say for eg counsel the parents of this 4 year old with sickle cell disease.

Genetic counselling

I feel these stations are a bit tricky since they also requires understanding/knowing the inheritance pattern and risk in future pregnancies etc. Also, the dummy parents are allowed to ask the questions which you need to answer. for example counsel the parents of this 2 year old with downs syndrome

Taking Consent

You are asked to take consent for a perticular procedure and your skills are tested

Following post briefly discuss how t0 take consent for liver biopsy

Breaking bad news

These counsellng station test your patience and interpersonal skills. You are asked to counsel the caregivers about a bad outcome.

ICU ccounselling

You may be asked to counsel about worsening siutuation, need of inter-hospital transfer to ICU or even transport to another facility for worseining clinical situation.

General principles while attempting counselling stations

These types of OSCE stations test and not only test your knowledge on the topic but also your body language, attitude, confidence, and patience. Here is how should be your body language while facing the examiner.

1. Take 30 sec and have a think about the task and topic.
2. Plan your approach in 10 steps of counseling given in Nelson's textbook of pediatrics.
3. Start with the introduction, greet and ask for the preferred language of communication.
4. Enquire about awareness/knowledge of parents about the situation wherever applicable
5. Give a prompt but brief background on the situation.
6. Try to modify the counseling session focused on the instruction given in the task, For eg focusing on blood transfusion in sickle cell anemia if that is the main task, keeping details of sickle cell disease minimal unless parents ask about it.
7. Instigate and encourage the parent to ask any query.
8. If they ask, be a patient listener and try to answer as much as possible.
9. In case you have no answer at that time, Let them know that you will revert back to them soon with the answer.
10. Do not show dominating or bossy attitude even if you are stimulated. Remember it is a test.
11. Do not ask unnecessary questions to dummy parents or patients. This is a counseling station, not a history-taking station.

There is a high chance of having unexpected points in the Answer Key which are way more specific than we think off and therefore practice is the only way out in these types of OSCE.

Counsel the parents of a child born with ambiguous genitalia (nov-2015)

All points given in the standard textbook were allotted 0.25- 0.5 marks each. But simple advice to delay registration of birth certificate and official documents till final lab results are available would score  1 mark! (Just common sense)

1. Neonatology - Jaundice, breastfeeding, congenital hypothyroidism, prematurity, ambiguous genitalia, etc. Every exam has a minimum of one scenario on neonates.
2. Diet advice on FTT, Renal diet, celiac diet, hepatic diet, etc.
3. Counseling for a child with syndromes, commonly Downs syndrome, microcephaly etc are asked.
4. Take consent for a clinical procedure.
5. Counseling for a child with habit/conduct /behavior/learning disorders.
6. Situational counseling like transfer to ICU from the ward, bad news, etc.

5. OSCE station based on History taking

A clinical scenario or symptom is given. Before starting the conversation, take 30 sec to think of all possible DDs which will help in taking relevant history. Remember the sequence starting with demography, presenting complaints, etc.

Sometimes only specific sections of history taking may be asked. For eg, Obtain relevant negative history in a child presenting with hepatosplenomegaly. Here is the detailed format of history taking. All case presentations.

Again, Practice, practice, and practice !

6. OSCE station based on the procedure skills

These stations involve demonstrating the procedure skills for some of the commonly performed procedures in day-to-day practice including some of the PICU, NICU procedures.

Before starting the task do not forget the initial steps.

1. Greet the patient.
2. Obtain written/Oral consent as relevant after explaining why it is required and what are the side effects.
3. Explain the procedure,
4. Perform hand hygiene
5. Wear relevant PPE
6. Appropriate Pain and sedation where relevant (you can say this verbally).
7. Perform Procedure
8. Biomedical waste management
9. Post Procedure care if needed.

Remember you are expected to give a running commentary of what you are doing.

7. Neonatal resuscitation OSCE

One of the stations in the Exam will be either a neonatal resuscitation or that of pediatric advanced life support. These stations can be at times problematic as they might have negative markings. But at the same time, they can fetch you full marks if you are well practiced with the steps.

8. pGALS examination - OSCE

Pediatric gait, arms, legs, and spine (pGALS) examination is often asked as an observed OSCE in DNB practical examination. You must learn to perform the assessment step by step in a clear manner.

pGALS examination - Everything you should know

So that's all for now, If you want to add more or suggest corrections, let us know by using the comment section below.

Khan KZ, Gaunt K, Ramachandran S, Pushkar P. The Objective Structured Clinical Examination (OSCE): AMEE Guide No. 81. Part II: organisation and administration. Med Teach. 2013 Sep;35(9):e1447-63. doi: 10.3109/0142159X.2013.818635. PMID: 23968324.