OSCE Hub

Mark Scheme:

1. Preparation (checks facts, quiet room, avoids interruptions)
2. Introduces self and sets the scene
3. Checks patient's current understanding ('What do you know so far?')
4. Gives a 'Warning Shot' ('I'm afraid the results are more serious than we hoped')
5. Delivers news clearly (Avoids jargon, uses 'Cancer' if appropriate)
6. Allows for silence and pauses
7. Responds to emotions with empathy (NURS: Name, Understand, Respect, Support)
8. Provides a summary of the next steps (Biopsy, MDT, Specialist Nurse)
9. Checks for understanding and questions
10. Arranges follow-up and offers written information

Key Points:

SPIKES Protocol: Setting, Perception, Invitation, Knowledge, Empathy, Strategy/Summary
Avoid euphemisms like 'nasty cells' or 'growth'; use clear language
Silence is a powerful communication tool
Do not give too much information at once (chunk and check)
Check who the patient has for support at home

Common Errors:

Delivering the news too quickly without a warning shot
Using overly medical terminology (e.g., 'Metastatic Adenocarcinoma')
Talking too much to avoid difficult silences
Giving a prognosis immediately without MDT input
Not checking what the patient already knows

Mark Scheme:

1. Assumes capacity as the starting point
2. Explains the medical problem clearly (Cellulitis and risks of sepsis/death)
3. Explains the proposed treatment and alternatives
4. Assesses Stage 1: Does the patient have an impairment of mind/brain (e.g., delirium, dementia)?
5. Assesses Stage 2, Part 1: Can she UNDERSTAND the information?
6. Assesses Stage 2, Part 2: Can she RETAIN the information?
7. Assesses Stage 2, Part 3: Can she WEIGH UP/USE the information?
8. Assesses Stage 2, Part 4: Can she COMMUNICATE her decision?
9. Remains non-judgmental even if the decision seems unwise
10. Concludes whether she has capacity for this specific decision at this time

Key Points:

Capacity is decision-specific and time-specific
An 'unwise decision' does not equal lack of capacity
All practicable steps must be taken to help the person decide (e.g., hearing aids on)
If capacity is lacking, decisions must be made in the 'Best Interests' (MCA 2005)
Document the specific reasons why a patient failed a part of the test

Common Errors:

Assuming lack of capacity just because a patient has dementia or is confused
Forgetting to explain the risks of NOT having treatment
Not testing all four parts of the MCA test
Thinking capacity is 'all or nothing'
Failing to document the assessment

Mark Scheme:

1. Introduces self and confirms understanding of why they are there
2. Explains Asthma (Inlammation/hypersensitivity of airways and bronchoconstriction)
3. Explains the 'Reliever' (Salbutamol/Blue): What it does and when to use (symptom relief)
4. Explains the 'Preventer' (Steroid/Brown): What it does (reduce inflammation) and that it must be taken EVERY DAY
5. Mentions common side effects (Reliever: tremor/tachycardia; Preventer: oral thrush)
6. Demonstrates inhaler technique (Shake, exhale, seal, inhale steadily, hold breath)
7. Explains the use of a spacer (increases delivery, reduces side effects)
8. Mentions 'Asthma Action Plan' and what to do in an emergency
9. Checks for understanding and addresses concerns
10. Safety nets (Signs of worsening: unable to finish sentences, using reliever >3 times/week)

Key Points:

The preventer inhaler is the most important for long-term control
Rinsing the mouth after the steroid inhaler prevents thrush
Spacers are recommended for all patients using MDI inhalers
A peak flow diary helps monitor progress
Asthma is a variable and reversible condition

Common Errors:

Failing to emphasize that the preventer inhaler must be used daily even if well
Not demonstrating or checking inhaler technique
Forgetting to mention safety netting for an acute attack
Not suggesting a spacer
Using too much medical jargon about 'bronchioles' and 'receptors'