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Final part 2, Medical
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got the result in Dec 2007 and successfully passed this exam. Thanks.
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:
Decision to forgo treatment.
Respect patient's decision and provide education,
support, and empathy.
Delivering bad news: HIV, Cancer, Death.
Telling the truth.
Confidentiality / Breaking confidentiality.
Competency / Capacity.
Death before arrival.
Pharmacist / health care provider refusal to provide
care.
Brain death and organ donation.
Relative as a decision maker.
Surrogate decision maker.
Women abuse.
Child abuse.
Drug seeking.
Informed consent.
Angry patient.
Violent patient.
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
counseling as needed. Thus, ignore the last statement in the following
sample stations about the available time and required tasks to do.).
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).
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).
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).
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).
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).
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).
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).
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).
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 counseling 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!
Buy
now
"How
To Unlock Difficult Medical Encounters"
Do
not think you will be able to do it completely by yourself,
and then
sit down and wait for good OSCE Exam scores.
If you do, you will never get your
best potential!
Act now.
There is
never any time but now, and there never will be any time but now.
If you
are ever to begin to make yourself ready for what you want for
your OSCE exam, you must begin NOW...