Prepare yourself for these common ethics
topics in Objective Structured Clinical Examinations
The common topics that have been tested in OSCE
exams during USMLE Step 2 CS, MCCQE Part II, PLAB 2,
OSCEs for medical students and medical school clinical finals,
Clinical Skills Assessment for International Medical Graduates are:
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Decision to forgo treatment.
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Respect patient's decision
and provide education, support, and empathy.
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Delivering bad news: HIV,
Cancer, Death.
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Telling the truth.
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Confidentiality / Breaking
confidentiality.
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Competency / Capacity.
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Death before arrival.
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Pharmacist / health care
provider refusal to provide care.
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Brain death and organ
donation.
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Relative as a decision
maker.
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Surrogate decision maker.
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Women abuse.
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Child abuse.
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Drug seeking.
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Informed consent.
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Angry patient.
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Violent patient.
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Seduction.
 Common
ethics OSCEs
Common OSCE exam cases that have been seen in
USMLE Step 2 CS,
MCCQE II, PLAB 2,
OSCEs for medical students and medical school clinical finals,
Clinical Skills Assessment for International Medical Graduates are:
(Please
note: For USMLE Step 2 CS, there is no examiner in the room.
The encounter is video monitored and taped. Thus, there will be no questions
asked in the room other than the patient's questions. However, during
physical examination, you are still required to explain what are you going
to do to the patient before physically touching him/her. All USMLE Step 2 CS
stations are of 15 minutes long and require focused history taking, physical
examination, and counselling as needed. Thus, ignore the last statement in
the following sample stations about the available time and required tasks to
do.).
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Ronald King is a 58 years old diabetic
patient who has got leg gangrene but refusing surgery. Please talk to
him in the next 5/10/15 minutes. (Decision to forgo treatment /
Respect patient's decision and provide education, support, and empathy)
-
Kevin Mcfadden requested HIV test two weeks
ago and the results has come positive. Please talk to him in the next 5/
10/15 minutes. (Refuses to tell his partner: Breaking
confidentiality/ reportable)
-
Sheila Rogers is a young women who comes to
your office complaining of headache. Please interview her in the next 5/
10/15 minutes and address her concerns. (Drug seeking).
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Rosita Lazzam is the daughter of your patient
Mr. John Lazzam, a 68 years old man who just was diagnosed with
pancreatic cancer. Rosita has asked to see you immediately to talk to
you about an important matter. Please talk to her in the next 5/ 10/15
minutes and address her concerns. (Telling the truth / Competency
/ Capacity).
-
You are the ER physician working in a rural
area of 5000 population. Julie Murphy is a 16 years old girl who came to
your office in the morning concerning her unprotected sex last night
with her boyfriend. You prescribed the morning after-pill for this and
she went to the only pharmacy of this area. The pharmacist, Dr. Stewart,
refused to fill the medication for her. You decided to go to the
pharmacy and talk to him directly. Please enter the room and talk to him
in the next 5/ 10/15 minutes. (Pharmacist / health care provider
refusal to provide care).
-
Mrs. Hilary Weston found your appointment
card in her daughter's coat when she was taking it to the laundry. She
has come to your office to find out why her daughter, Laura, came to see
you. Please address her concern in the next 5/ 10/15 minutes. (Confidentiality).
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Kathy Astrom is Mr. David Astrom's wife
waiting in the meeting room to talk to you. David was involved in an
accident 4 days ago with severe head injury and now has all the criteria
of brain death. All attempts to restore his brain function failed. Two
neurologist and neurosurgeon also confirmed that with "apnea test".
Please enter the room and talk to her about this issue and the prognosis
in the next 5/ 10/15 minutes. (Brain death and organ donation/
empathy).
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Mrs. Elaine Young was diagnosed with lung
cancer recently but she refuses to get chemotherapy and surgery as
treatment. She wants to go to Mexico to get homeopathy treatment
for that. Please enter the room and talk to her in the next 5/ 10/15
minutes. (Decision to forgo treatment / Respect patient's decision
and provide education, support, and empathy).
-
Margaret Hart is a 78 year old women known
case of COPD who comes frequently to the ER with severe episodes of
shortness of breath. Yesterday she came with same problem and you
intubated and resuscitated her. She was hospitalized in the ward and now
is alert and fine. Her daughter, heather is requesting to you to write a
"DNR: Do Not Resuscitate" order in her chart. Please enter the room and
talk to her in the next 5/ 10/15 minutes. (Competency / Capacity /
Relative as a decision maker).
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James Ottlyk is the husband of Mary Ottlyk
who got involved in a bad accident six years ago and since then she has
been in a vegetative state. She never regained her consciousness and
only open her eye's but doesn't seem to follow anything. She is 100%
dependent on the nurses care. She has had feeding tube for a long time.
Now Mr Ottlyk is in the meeting room to discuss removal of the feeding
tube. Please enter talk to him in the next 5/ 10/15 minutes. (Competency
/ Capacity / Relative as a decision maker).
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Mrs. Tara McDonald is a 52 year old woman, a
known case of diabetes type I, who was rushed to the hospital in a
profound coma, but dies almost immediately. You are the emergency
physician who saw her first and there was no pulse or respiration. She
was pronounced dead. You must notify the coroner. Her husband and
daughter are waiting to talk to you. Please enter the room and talk to
them in the next 5/ 10/15 minutes. (Note: You'll find that the husband
gave her an extra insulin dose unknowing she already had an overdosed
shot). (Death before arrival/ Delivering bad news).
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Joanne Brown, a middle aged woman, came to
your office because she is very angry and upset with a surgeon colleague
of yours who operated on her father before her father's death during the
bypass surgery last week. She wants to sue this surgeon and wants you to
agree that the surgeon caused her father's death. Please talk to her in
the next 5/ 10/15 minutes. (Angry patient).
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You are working in the emergency. A young man
with a gun shot wound was admitted. Within minutes, officer Stephen
George, a policeman, arrived informing you that this young man has just
shot someone downtown and you must give him his chart for investigation.
Please talk to him in the next 5/ 10/15 minutes. (Confidentiality).
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Lucy Armstrong is 23 year old woman who came
to your office after she felt a lump in her right side of her upper
neck. In the next 10/15 minutes take a focused history and perform a
focused physical exam. (Note: She keeps her bra and thighs exposed with
gestures of seduction and may ask if you are free tonight (even if your
are a female doctor). The case is infectious mononucleosis and she is
sexually active. Take sexual history and safe sex counselling too.) (Lymphadenopathy/
Seduction/ Safe sex).
Now;
What do you have to do in these OSCE
stations in order to cover the checklist?.....
What to ask to be thorough and cover the
differential diagnosis?....
How to ask in an efficient, respectful,
and empathic way?.....
How to wrap up the station?.....
How to counsel the patient?.....
How to perform a complete, safe, and
respectful physical examination?.....
Your biggest challenge in OSCE exams is the limited available time.
You need to memorize sets of questions and actions to be asked and done
while you're in an autopilot manner!
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