2019 OSCE past year - EPR

OSCE Question 2019 - EPR Part II

HI again, this is the PART II for past year questions on 2019. The Part I post only explains the past year questions that I took during December 2019 in Hospital USM December.

In this is the post I will talk about the past year OSCE (Examination for Provisional Registration Malaysia) from USM - February session and IMU- July session. 

I am still wondering why there are 3 session of osce on year 2019, but its good news for us unemployed graduates. Not sure if it will be the same for this year 2020, but unlikely. 

P/S:
It would not be as detail as the last post, as I wasn't taking exams for these two session.
But I would like to thank the one who shared his/her experience and topics with us the next batch.
Thank you💓

USM EPR II (Feb 2019)

1, ECG. Describe findings - Atrial fibrillation

- further investigation and management

2. OGTT. 

- explain procedure to patient and interpret the result

3. Postnatal discharge. advice the mother

4. Dengue (with blood result)

 - describe findings

 - diagnosis, what test to confirm (at least 3))

- other 3 Differential diagnosis

- management

5. Measure BP of 8 year old boy, with family history of hypertension

 - demo: which cuff, and why

 - explain how you do the whole procedure

 - BP 125/80, is it normal or hypertensive? 

6. Insert ET tube in manikin. name all instruments, explain and demo, contradictions

7. Primary support (Basic trauma life support)

8. X- ray (Small Intestinal Obstruction)

9. PTSD (a victim who survived in a flood) - interview the patient and give diagnosis

10.Demo Cathether insertion

 - take chief complain and diagnose patient (BPH)

11. Insert Ryle's tube on manikin

 - steps, how do you know if the tube is rightly placed?

12. CTG- cardiotopography

 - describe (FHR, variability, acceleration and deceleration)

- next management

13. Bimanual examination

 - describe suprapubic mass

14.X ray (Galaezi fracture) and label

15: perform lower limb neuro examination

16. Perform eye movement test (H test)

 - any squint, ptosis, diplopia?

- Diagram was given, describe finding (Lateral rectus palsy) 

IMU (July 2019)

1. CPR
2. Febrile seizure
3. Nephritis for children
4. Rib Fracture
5. Posterior Cruciate Ligament (PCL) reconstruct
6. Abdominal pain - peritonitis
7. ECT - Electroconvulsive therapy
8. third degree heart block
9. Thalassemia
10. Deep Vein Thrombosis (DVT)
11. Abortion
12. Pregnancy Full Physical Examination
13. Tuberculosis (TB) radiology interpretation
14. Cholesteatoma
15. Suture
16. Back pain differential diagnosis


So,  that is all the questions I get from year 2017, 2018 and 2019. You can click on the link to go back to the page where they are shared.
2017: https://yu4med.blogspot.com/2020/03/past-year-for-epr-osce-2017.html
2018: https://yu4med.blogspot.com/2020/03/past-year-epr-osce-2018.html
2019 Part I : https://yu4med.blogspot.com/2020/03/past-year-osce-topics-usm-2019.html

Good luck Doctors!

USM OSCE - EPR 2019 Dec

Past Year Topics for USM OSCE - 2019 - Part I

Hi all, in this post I am going to share the topics they have on year 2019 for Examination for Provisional Registration-/EPR. (the year I took my exams😁Thank God I passed)

** EPR is a special exam where International Medical Graduates must take to get full licence to work in Malaysia. 

So I will provide more details on how the questions were asked and what I experienced specifically for the USM December 2019 session. However I won't be able to recall the questions fully word by word, but will try my best to explain what was being asked.
The other session for 2019 are USM-Feb  and IMU-July will be posted in another post.

Reminder:

You have 1 minute to read the questions outside the room and once the bell rang, you have 9 minutes to finish the station. the second bell will ring, and you will have to move to the next station quickly to read the next question.

USM (December 2019)

Emergency medicine
1. Patient involve in motor vehicle accident, access the patient and do immediate management
   - Emergency management of Pneumothorax
   - Name all the equipment needed in ED (we have to name the equipments shown on the table)
   - explain the safe triangle position in detail
   - perform the procedure from the safe triangle


Orthopedics
2. Patient involve in motor vehicle accident and have problem walking, you are require to do a lower limb PE
  -  identify short limb gait (at least that is what I think it is) ** real patient walking
  - so I proceed with full lower limb physical examination and LLD(Limb Length Discrepancy) diagnosis
  - Physical examination necessary to identify LLD

3. Hip X-ray with a problem, patient short history provided
   -  Describe the X-ray, give a diagnosis and explain your further management
   - identify all structures shown in the picture and explain their functions.

P/S: remember to check patient name and date


Internal medicine
4. Patient with chest pain and SOB, take the history and explain further management if needed
  - history taking and I suspect its AMI

5. Interpret chest X-ray and give diagnosis with treatment + physical examination of the chest
   - Tips: there is a mass in the chest x-ray

P/S: treatment plan must be specific***


Surgery
6. Patient present with mass at inguinal area, diagnose and focus physical examination
  - Inguinal Hernia - after history taking, ask for permission to do examination
  - physical examination is done on the manikin. (you can refer to this to understand the scoring)

** The examiner asked the differences of direct and indirect hernia physical examinations and their respective treatments.

7. Pneumoperitoneum - X- ray interpretation and management plan
  - management is specific

Tips: if you plan to have iv fluid, what do you want to do? (is it fluid bolus? how much you want to give? how long you plan to administer the fluid? etc.)


Pediatrics

8. Growth Chart interpretation
  - scenario given was about short stature. (explain the cause, QOL, management)

 Tips: calm the child down first so they can cooperate

9. Lumbar Puncture Consent from Parents
  - get the consent is the aim. make sure you explain all about lumbar puncture from the cause to the treatment values.
   - reassure the patient


OBGYN

10. Bimanual Examination
   - there is a huge mass in the manikin.
   - explain your examination specifically on inspection and palpation,
  - the examiner will ask for your diagnosis and your management plan for the patient

11. Patient complain is stomach pain and discomfort (a little aggitated)
  - After history taking, i suspect its a Placenta Abruption case.
  - the examiner asked for our diagnosis
  - present your case from history taking
remember to include: Gestational age calculation, GPO - all OBGYn necessary history
  - treatment plan

*P/S: I finish this station when the bell rang for us to leave the room. We only have 9 minutes to do all the above, make sure you manage your time well. 


Anesthesiology

12. Patient need to prep for surgery, as a junior doctor apply adequate oxygenation before anesthesiologist arrive.

  - full airway assessment and use the Bag valve mask (if  you observe well, you will see it lying on the table beside the manikin) -explain the indication and possible complications.

*P/S:   - the procedure was easy as i did a lot during my internship in china (finish smoothly in a few minutes), but the examiner asked a lot of questions and fully utilized the 9 minutes. Be ready to answer a lot of questions and make sure you know what and why you do what you have done.


Psychiatry

13. The patient is very sad and depressed. If you have good observation, you will see a plaster on her wrist.

 - The patient has history of suicide, so after accessing the patient and confirm it is related to suicide, I used the suicide risk assessment to confirm the diagnosis.
 - the examiner will ask how you come out with your diagnosis, luckily i still remember the specific components for the assessment. (the examiner asked how I get the score)


ENT

14. ASOM
 - acute suppurative otitis media

* I am very thankful to be able to work as a clinic assistant for an ENT doctor for almost a year. 
Really grateful I know how to use the equipment, give diagnosis, explain the cause, complication and management to the patient very quickly and specifically. I spend a lot of time sitting outside the station to wait for the next bell to ring.😄Thank you Doctor Koay! 


Radiology

15. Two CT was showed
 - I suspect it's a CT with Epidural hematoma and subdural hematoma
 - we are require to explain the CT in detail to support our diagnosis

 *P/S: this is the only station I don't know if what i did is right or wrong. because he is not satisfied with the answer i gave, and when I asked the other students, they say the same thing.. 
 Until now I still don't know what the doctor showed us, because I forgot how the CT looks like... (sad)


Community Medicine

16. Consultation on family planning
 -  asking for pregnancy advice and how to have a healthy

*P/S: the patient has diabetes after minutes of asking... So I have to quickly brief her the pros and cons on the complication of pregnancy while having an uncontrolled diabetes situation. 


If you have more questions can leave a comment below, I will try to reply as soon as possible.
Good luck!

2018 OSCE Past Year for EPR

Past year OSCE 2018

This is the past year topics asked in USM 2018 and specifically for those who took the examination for provisional registration. I didnt have the past years from those who took the exam in IMU, so if there is anyone who took the exam that year and would like to share, you are welcome to share it in the comments.^^



If you are interested in what they asked in 2017, refer to the previous post.

USM EPR OSCE questions 2018

Gynecology
1. COCP
2. Speculum Examination and high vaginal swab

Pediatrics
3. ORS usage advice for children
4. G6PD counseling

Orthopedics
5. neurovascular examination (lower limbs)
6. Elbow Joint Dislocation (interpret the X-ray)

Psychiatry
7. PTSD

Emergency Medicine
8. CPR
9. Mallampati classification + Airway assessment

Internal Medicine
10. Hypertension
11. GI perforation
12. Pneumoperitonium

Opthamology
13. Visual Acuity Test (patient with hypertension and diabeter)

Surgery
14. DRE
15. Colonoscopy consent

Others
16. ABG interpretation and Heart attack evaluation

2017 OSCE Past year

Past Year Questions Year 2017

The topics below are the topics from the students who took the  Examination for Provisional Registration(EPR) OSCE on 2017. I do not have the specific questions but having a main topic is sufficient for me to prepare for exam after knowing the rating rubrics for osce.

Study each topic in detail to make sure you get it.
&
Hopefully it is helpful for you!

P/S: For reference only!

IMU July 2017 OSCE

1. Hemiplegia
2. IDA
3. Cataract
4. AOM (Acute Otitis Media)
5. Rib Fracture
6. Diabetis Mellitus foot ulcer
7. MMSE + Bipolar
8. Constitutional Small gestational Age (SGA)
9. Thalassemia
10. Hepatomegaly
11. PUD
12. Contraceptive methods
13. Nephrotic Syndrome
14. Gall bladder Stone
15. Break bad news (Patient diagnosed cancer)

USM Jan 2017 OSCE

1. Schizophrenia
2. Bipolar
3. GCS and its usage
4. Snellen Chart
5. Nephritis
6. Hepatomegaly
7. Septal Deviation
8. Hemiplegia
9. COPD and Lipoma
10. choledolithiasis
11. Diverticulitis
12. HPN + IUCD
13. Fundal height (Prenatal check up)
14. Dysfunctional Uterine bleeding
15. Knee Physical Examination

Good luck!

How is your OSCE graded for EPR - Part II

The Rating Rubrics of OSCE (Part 2) - for EPR Malaysia

Notes: 

• BOLD: Must do
• Underline: clinical related

Lets continue from what we left in the last post 😁

Part 2 - History Examination

• Uses a structured, fluent and focused approach to history taking, relevant to the station
• Uses a combination of open question and closed questions where appropriate
• Respond to information given by the patient, rather than strictly appearing to follow a standard/ guided formula of questions.
• Obtains key an relevant information and shows the ability to use the information appropriately
• Question reflect the depth of understanding of the clinical condition/ pathology, where applicable.
• Repeats, reflects, summaries and clarifies any misconceptions as necessary
• Allows the patient to ask questions and endaevours to answer those
• Able to ask the patients to give more information missed earlier.
• Avoid premature or false reassurance

Part 3 - Physical Examination

• Wash your hands before starting
• Seeks permission to examine and explains the nature of the examination 
• Asks for chaperone where appropriate
• Does not distress, embarrass or hurt the patient unduly
• Respect patient's modesty
• Asks the patient if any areas to be palpated or moved are painful
• Positions the patient correctly and comfortably
• Uses a methodical and fluent approach indicating familiarity with the examination skill.
• Examines/suggests examining all the relevant areas with the correct technique.
• Completes the task in the allocated time, thanks the patient and covers up the exposed areas.

Part 4 - Procedural Skills

• Introduces and explains the procedure and gains consent
• Ensure privacy - asks for chaperone where appropriate
• Prepares the patient with correct exposure and position for the procedure
• Checks that all relevant equipment are available, appropriate and functioning
• Ensures aseptic precautions and correct methods are taken.
• Ensures correct and safe placement of equipment wherever necessary
• Avoids any unnecessary/ dangerous steps
• Disposes equipment appropriately and safely.
• Thanks the patient.
• Document and/or labels the process or samples appropriately.
• Completes the task in the allocated time. 

Part 5 - Professional Skills

• Explores patient's understanding before providing information.
• Encourages the patient to ask questions and responds appropriately.
• Provides correct information and options without the use of jargon.
• Discover the impact of the problem on the patient's life and acknowledge concerns.
• Respects the patient's autonomy and negotiates with the patient appropriately.
• Reviews the patient's understanding during the interview - clarifies and summaries where appropriate.
• Appears to have a grasp of the issue and its ramifications - minimizing conflict.
• Acts assertively and within the codes of practice and law.
• Reaches and agreement with the patient about a strategy to progress.

Part 6 - Content Knowledge

• Systematic approach in collecting and/or understanding the data/ scenario/ information presented.
• Able to interpret the data or information provided and correlate it with clinical relevant context.
• Able to identify and recognize the pattern of the underlying problem.
• Able to integrate the information provided.
• Able to make a conclusion/ diagnosis / differential diagnosis if applicable.
• Able to apply knowledge to the problem presented such as listing possible complications and management. 

So these are the 5 details that are important and vital for your exam preparation. 

Once you fully understand these, don't forget to practice with the questions in the books (Question samples can be found in sams) !!!

How is your OSCE graded in the each station? -Part I

The Rating Rubrics of OSCE

How did you know how well you did in OSCE ? 

Advantages of understanding the SYSTEM

1. The scoring system is vital to ensure you score on the parts that you can do well, so it could help you with the other parts that you lacking.
2. To understand the flow of thoughts of a doctor, when you are with a patient. 
• Do you know what question to ask next based on their response, which could aid in deciding the final diagnosis?
3. To practice it on the topics that you are studying with a direction, instead of trying to memorise everything into your brain.

      4. Since you know how they give you the score, you will also know which station you didn't do  well. But do not give up, this gives you the opportunity to reflect on what you did wrong, so you can score better in another station.

Practice, Practice, Practice!

The key to passing OSCE is not just about having good basics and knowledge 

but also constant practice either with yourself (using the mirror) or with a friend, 

and the best if you have the opportunity to talk to patients

Scoring Block

It is separated into 6 parts which consist of 

From the table above, you can see there other than the 6 main criteria, there are also scoring based on your performance. 

Each Part will have a total point of 10, 

However in the end of the session, they will add all points together and finalise with a 0-10 score. 

For example: 

A student scored 5 for each part, therefore the total points in the end she get is 5, despite the total score is 30 points/60 points

The scoring board is further explained into detail actions that you should do during the examination.

1. General Approach

• establish rapport early with examiner and patient and maintains it. 
• example: greetings to examiner and patient, try to make them comfortable with your presence with a SMILE :D
• Positive and appropriate body language and eye contact
• It is understandable to be nervous at first, but try to breath in deep breathes to calm yourself before entering the room or do something brash (impolite, talk too fast, not considerate, avoid eye contact) , be polite
• Demonstrate a fluent, coherent and confident approach
• Be like how a doctor should be when talking to patients, reassure them and not being lead astray by their questions. Be patient and explain till they understand
• be confident but humble at the same time
• Able to communicate answers clearly
• it is useful to give some pauses for the patient to think about their condition (especially in breaking bad news).
• Ask the patient if they have any question after your consultation session/ follow up session is complete. -  This helps to understand what the patient do not understand while you are explaining. 
• When relevant
• Clearly explain the purpose of consultation and seeks consent where applicable
• Ensure the patient is safe
• Identification, name , age
• use alcohol rub/ washing hands before and after procedure
• Maintains a courteous and caring attitude
• be concern when patient is crying, hand her some tissues, 
• ask if the patient wants to have some space and breath, 
• ask if the patient wants to her relative to be with her.
• try to understand why the patient is upset/angry/frustrated.
• Listen attentively and acts with Empathy (similar point above)
• Avoids or explains medical jargon and provides accurate information
• do not explain their condition using medical terms!

The detailed criteria above helps the examiner to determine which score you deserve. 

(from 0-10 )

This section is the easiest/ hardest to score, as it depends on the situation,

Tips: 

Stay calm, smile, greet and say thank you.😁

ToBeContinue ... ... in Part 2 ← click here

- History Examination
- Physical Examination
- Procedural Skills
- Professional Skills
- Content Knowledge

The scoring system above is applicable for those who are taking the malaysia medical board exam (examination for provisional registration).

OSCE Books (Examination Provisional Registration)

Which book would I recommend for Part 2 Exam?

This post is mainly about the study materials needed for the OSCE part of Examination for Provisional Registration (EPR) in Malaysia. If you are looking for Part 1(theory) click here.

Resources

There are a few resources I used which I find useful while getting ready for the exam which includes

1. Samson Handbook

2. Oxford handbooks

3. Ten teachers

4.  Books used by local graduates

5.  Online resources

Book References

Samson Handbook of PLAB 2 and Clinical Assessment 

By Dr Samson Chissi

This comprehensive and friendly book is a good guide for the EPR step 2 exam. 

It covers most of the topics and scenarios that you can be tested on in the EPR2 OSCE.

I find it most useful especially in guiding us how we should react and talk in front of the patients. 

This book has a step by step guide on how you start your conversations to your posture and respect for the patient,

Pocket Guide to Physical Examination and History taking

by Lynn S. Bickley

If you graduated from other countries such as: China, India, Indonesia, etc. This book is a good guide for you to understand how the malaysian's expect from you when you are required to do a physical examination.

The sequence(you learn in another country) can be a little different, but there is nothing that you could not overcome with the guidance of this book. 

Oxford Handbook of Clinical Medicine

It doesn't matter which edition you have, the most important is to know the content. 
The medication and prescription they use in this book are quite similar with what the doctors use in malaysia. 
- Good to refer to if you forgot some information about a specific condition.

Oxford Handbook of Clinical Specialties

I love to use this book as a reference for specific subjects like orthopedics and trauma, pediatrics, Primary care and other sub topics like ENT and Opthalmology.

The obstetric and gynecology here is quite good but I prefer to use the ten teachers for reference.