The OSCE Orientation

The OSCE
Neurology and Psychiatry
What is an OSCE?
An OSCE is an Objective Clinical Skills
Examinations (OSCE) that is designed to
evaluate a distinct realm of clinical
performance.
They are designed to provide realistic patient
encounters or scenarios that lend
themselves to a proxy evaluation of
physician-patient interaction.
Who are the patients?

The individuals you will be examining are actors or
standardized patients (SPs).
Your method of interviewing the patient is the
same as it would be in an actual patient encounter.
All OSCE patients have a rigid script that they
portray. This includes how they act, the details of
their history, how they react to physical
examination maneuvers, as well as their
personality. They are trained to respond in a
consistent manner and they do not lie to try and
trick you.
What will the OSCE entail?

There will be 5 parts to the Neurology and
Psychiatry OSCE these may occur in any order.
You will be expected to do the following:

Neurologic exam 25 minutes
Clinical interview/mental status exam 25 minutes
3 clinical examinations of a standardized patient
25 minutes each
What will the OSCE entail?

The clinical examination of the standardized patient part of
the OSCE will start with preliminary information such as
where the encounter is taking place (ER, office, clinic, etc),
vital signs, a presenting complaint and brief instructions.
For example:
Jane Doe
Problem: I am having difficulties with weakness in my
arm.
Temp 100.2 Pulse 100 Resp. 16 Bp 114/72

Take a history and perform a focused physical examination.
How many diagnoses do I have

to come up with?
You will be asked to list your top three possible
diagnoses rather than one.
The patients may have signs and symptoms that
cross the borders of specialty specific diagnoses.It
is important to maintain as open a mind as to
possible problems.
Therefore,ask questions about any reasonable
possibility. For example, the patient having
symptoms of depression may also have neurologic
concerns.
Do I have to do a complete
physical exam for each patient?
The physical examinations required on an
OSCE are focused exams - a head to toe
examination is not needed and, given the
time constraints, not advised. However,
given a particular problem you may have to
thoroughly examine several body parts.
For each exam part you

MUST
Wash hands with soap prior to examining the patient.
Show consideration for the patient (for example:pull
out the foot extension, ask permission to untie the
gown, etc.).
Properly drape the patient.
Explain to the patient what you plan to examine (Im
going to listen to your heart now) and then tell them
what you found (Everything sounds normal).
Neverexamine on top of the gown.
How do I end the exam with the

patient?
After gathering the necessary information,
ask the patient if they have any questions
and respond in an appropriate fashion.
If it is a question you are not prepared to
answer, let the patient know that you will
discuss the question with your resident or
attending physician and get back with
them.Never ignore a patient question.
What if the patient

Asks a question or behave in a certain way that
demands a response on your part
OR
The patient may be acting in a certain manner
that requires an inquiry on your part
OR
Alternatively the patient may present you with a

situation that requires a response
YOU must respond as this is part of the
interpersonal skills assessment
The Note
After the encounter you will be required to
write a note.
A note will be written in the SOAP format,
rather than a full H&P as long as you include
all the pertinent information.
This note is divided into a history portion,
physical exam finding, three diagnoses, and
your initial diagnostic testing plan.
The Note
When compiling your differential diagnosis, think expansively.
Remember to consider relevant neurologic and psychiatric
diagnoses.
The final task is to list your initial diagnostic plan. Remember
you are being asked to list diagnostic tests not treatment
plans.
If you wanted to do a particular exam but were not able to due
to the restrictions of the OSCE - such as a pelvic or rectal exam
- this should be listed in the diagnostic test area in addition to
laboratory or imaging tests
Timing
You will have a full 25 minutes for the
neurologic exam and mental status exam
NOTE: you can address cognition in the clinical
interview/mental status exam part of the OSCE
You will have 15 minutes to exam the

standardized patient and 10 minutes to write
the note
You will receive a warning when 5 minutes
remain
To Succeed
Be professional in your approach
Perform a thorough focused examination
Let the patient ask questions and tell their
story
Think expansively and ask your questions
accordingly
See as many patients as you can on the
rotation in order to hone your clinical skills
Relax during the encounter and dont let
your test taking anxiety prevent you from
What kinds of patients should I

expect?
Any of the common or serious problems seen on the rotation
are possible. Examples of possible scenarios are the following:
Anxiety
Depression
Encephalopathy (Acute or Chronic)
Migraine
Psychosis
Seizures and epilepsy
Substance Abuse
Traumatic Brain Injury
Weakness (Acute or Chronic)
The Grade
The OSCE grade will be based on the ability to perform the
clinical tasks requested and on your professional demeanor
and interactions with the patients.
This requires that you dress professionally, including wearing
your white coat and name badge, making eye contact with
the patient and introducing yourself, and treating each
patient as a real patient.
It is not possible to study for the OSCE.
Attendance and participation in rounds, conferences,
didactics, ambulatory clinics, and general reading will enable
you to complete the OSCE competently.
The Grade you will receive 2

grades for the OSCE
The following will count toward your neurology final
grade:
Performing the neurologic exam (with mental status
exam): 25 points
OSCE of an isolated neurologic complaint- 40 points
OSCE of a combined neurologic and psychiatric
complaint- 40 points
The following will count toward your psychiatry final

grade:
Performance of a psychiatry-based clinical interview
(with mental status exam): 25 points
OSCE of an isolated psychiatric complaint- 40 points
OSCE of a combined neurologic and psychiatric
complaint- 40 points
This is what your instructions will

look like
Examinee Tasks:
Obtain a history pertinent to this patients problem
Perform a relevant physical exam (do not perform a breast,
pelvic/genital, corneal reflex or rectal exam.) For the
purpose of this case, you should focus on the motor
strength (including facial strength) and reflexes. Do
not spend time on the remainder of the neurologic
exam as the findings will be normal.
Discuss your impressions and any initial plans with the
patient
After leaving the room, complete your patient note which
will include sections for the history, physical examination,
localization and diagnostic reasoning.
This is what your worksheets will

look like
HISTORY: Describe the history you just obtained from this
patient. Include only information (pertinent positives and
negatives) relevant to the patients problem.
PHYSICAL EXAMINATION: Describe any positive and
negative findings relevant to the patients problem. Be
careful to include only the parts of the exam you performed
in this encounter.
LOCALIZATION: Given the physical examination findings
noted above, please identify where a single isolated
lesion would most likely be located to explain this
neurologic dysfunction.

look like
DIAGNOSTIC REASONING: Based on what you have
learned from the history and physical examination, list up to
3 diagnoses that might explain this patients complaint. List
your diagnosis from most to least likely. Please realize
this may include both neurologic and psychiatric
diagnoses when applicable. For some cases, fewer than
three diagnoses will be appropriate. Then, enter the
positive or negative findings from the history and the
physical examination that support each diagnosis. Lastly,
list initial diagnosis studies (if any) you would order for each
listed diagnosis (e.g. laboratory tests, imaging, EEG, EKG,
etc.)

look like
Diagnosis #1
______________________________________
Supportive historical features:
Supportive examination findings:
Diagnosis #2
______________________________________
Diagnosis #3 (if applicable) ______________________________________


look like
Suggested Diagnostic Studies:
___________________________
___________________________
___________________________
___________________________
___________________________

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The OSCE

Neurology and Psychiatry

Who are the patients?

What will the OSCE entail?

You will be expected to do the following:

What will the OSCE entail?

Temp 100.2 Pulse 100 Resp. 16 Bp 114/72

How many diagnoses do I have

For each exam part you

How do I end the exam with the

What if the patient

demands a response on your part

The patient may be acting in a certain manner

that requires an inquiry on your part

Alternatively the patient may present you with a

You will have 15 minutes to exam the

What kinds of patients should I

The Grade you will receive 2

The following will count toward your psychiatry final

This is what your instructions will

This is what your worksheets will

This is what your worksheets will

This is what your worksheets will

Supportive examination findings:

Diagnosis #3 (if applicable) ______________________________________

Supportive examination findings:

This is what your worksheets will

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