Surgery Clinical Skills Exercise

This case along with its accompanying computer program is the clinical skills exercise for the surgery clerkship.   The case is based directly on one of your learning blocks from the clerkship. The intent of this clinical skills encounter is to reflect the knowledge, skills, and attitudes you should have acquired from the surgery clerkship.  Our ultimate goal is to provide a better mechanism for the teaching and evaluation of your clinical competency throughout your medical school training.

Format of OSCE

1. 20 minute patient encounter- focused history and physical
2. 10 minutes- begin to organize your notes as you wait for patient feedback.  The standardized patient is filling out two checklists; one is a history and physical exam checklist, the second is their patient perception scale.
3. 10 minutes- feedback.  The standardized patient will meet with you briefly and provide feedback on your interpersonal skills through use of their patient perception scale.
4. 60 minutes- computer program.  You will be documenting the following:

• List the pertinent positive and negative findings from both the history and the physical exam
• Problem List of items that need to be addressed in the care of this patient
• Differential Diagnosis, listing your top 6 diagnoses for your patient
• List those labs or imaging studies that you would order at this time.  Provide a brief justification for each item
• Your final diagnosis for this patient.  Clearly justify why you have chosen this diagnosis and ruled out others that were on your differential diagnosis
• Your initial management of this patient

5. 45 minutes- group simulation.  This formative experience will allow students to manage a code situation using a human patient simulator and receive immediate feedback from faculty. 

Patient Charts: Patient charts are located on the door of each examination room providing basic information about your patient.  You will be given time to review the chart before entering the exam room.  You may take the chart into the room with you.  Please note: It is not possible to have SPs simulate vitals on the chart, i.e., blood pressure, pulse, etc.  Therefore it is not our intent to "throw" you if your SP's vitals differ from those on the chart.   You should use the vitals listed on the patient's chart in your assessment of the patient's health.

Finding Charts :  You will have 20 minutes to interview and perform any physical exam step(s) you feel are essential in aiding your ability to diagnose this patient. In instances where a standardized patient cannot simulate a pertinent physical exam finding, the SP will provide you with a findings card after you have completed that physical exam step.  If you need to perform an evasive exam (breast, pelvic or rectal), you need to inform the SP that the exam needs to be done and why.  The SP will then provide you with the findings card.