OSCE in Pediatrics OSCE in Pediatrics RG Holla MD DM Head of the Department, Neonatology Fortis Hospital Shalimar Bagh, New Delhi, India Vivek Jain MBBS MRCPCH Consultant, Neonatology Fortis Hospital Shalimar Bagh, New Delhi, India Manish Mittal DCH DNB Senior Registrar Pediatrics and Neonatology Fortis Hospital Shalimar Bagh, New Delhi, India ® JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD New Delhi • St Louis (USA) • Panama City (Panama) • London (UK) Ahmedabad • Bengaluru • Chennai • Hyderabad • Kochi • Kolkata Lucknow • Mumbai • Nagpur Published by Jitendar P Vij Jaypee Brothers Medical Publishers (P) Ltd Corporate Office 4838/24 Ansari Road, Daryaganj, New Delhi - 110002, India, Phone: +91-11-43574357 Fax: +91-11-43574314 Registered Office B-3 EMCA House, 23/23B Ansari Road, Daryaganj, New Delhi - 110 002, India Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021 +91-11-23245672, Rel: +91-11-32558559, Fax: +91-11-23276490, +91-11-23245683 e-mail: [email protected], Website: www.jaypeebrothers.com Offices in India • Ahmedabad, Phone: Rel: +91-79-32988717, e-mail: [email protected] • Bengaluru, Phone: Rel: +91-80-32714073, e-mail: [email protected] • Chennai, Phone: Rel: +91-44-32972089, e-mail: [email protected] • Hyderabad, Phone: Rel:+91-40-32940929, e-mail: [email protected] • Kochi, Phone: +91-484-2395740, e-mail: [email protected] • Kolkata, Phone: +91-33-22276415, e-mail: [email protected] • Lucknow, Phone: +91-522-3040554, e-mail: [email protected] • Mumbai, Phone: Rel: +91-22-32926896, e-mail: [email protected] • Nagpur, Phone: Rel: +91-712-3245220, e-mail: [email protected] Overseas Offices • North America Office, USA, Ph: 001-636-6279734 e-mail: [email protected], [email protected] • Central America Office, Panama City, Panama, Ph: 001-507-317-0160 e-mail: [email protected] Website: www.jphmedical.com • Europe Office, UK, Ph: +44 (0) 2031708910, e-mail: [email protected] OSCE in Pediatrics © 2011, Jaypee Brothers Medical Publishers All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the authors and the publisher. This book has been published in good faith that the material provided by authors is original. Every effort is made to ensure accuracy of material, but the publisher, printer and authors will not be held responsible for any inadvertent error (s). In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only. First Edition: 2011 ISBN 978-93-5025-155-3 Typeset at JPBMP typesetting unit Printed at To Our Parents Mrs Shantha and Mr BV Holla Mrs Sushila and Mr Suresh Chand Jain Mrs Usha and Mr Mahesh Chand Mittal Foreword The system of Objective Structured Clinical Examination (OSCE) has been evolved to make the system of assessment in clinical subjects as objective as possible. While the routine examination system which involves clinical case presentation cannot be totally replaced, yet it tends to be somewhat subjective and is usually unable to test the knowledge and skills of the candidates over the entire syllabus. The OSCE system not only is more objective, but it also provides opportunity to examine the student over a much larger area. The system, in fact, is very helpful to the students as his deficiencies in small areas can get covered in larger areas of the syllabus. However, as the person, who was associated with the National Board in introducing the OSCE system in the specialty of pediatrics, I have noticed great apprehension among the National Board candidates regarding this system of examination. This has largely been due to non-availability of suitable texts on the subject and inability of most centers and teachers imparting training to DNB candidates, to familiarize the students with the ‘new’ system in absence of such texts. Dr Holla is a very experienced DNB examiner, Dr Jain is a Member of Royal College of Paediatrics and Child Health, London, UK. Dr Mittal has cleared the DNB Pediatrics in the new format of examination. They have all done well to fill this very important gap. This book focusing on OSCE system is refreshingly new in concept in that it is not only a source of imparting information (which most textbooks tend to be) but also a great help in structured learning of the subject and imbibing of the knowledge by the student. The teachers involved in training and assessing the DNB candidates will also benefit greatly from this book as it will enable them to understand the basic concepts of OSCE and enable them to develop many more such questions. Although written primarily for DNB candidates, this book will be useful for other postgraduate (MD, DCH) students in pediatrics and even for practicing pediatricians as it provides ready reference tool for various clinical situations. As the book includes multiple choice, it will also help students preparing for clinical skill examinations for the US specialty board and for MRCPCH examinations. SK Mittal Chairman, Department of Pediatrics Pushpanjali Crosslay Hospital, Ghaziabad (NCR) Formerly Director Professor and Head Department of Pediatrics Maulana Azad Medical College, New Delhi, India Preface The traditional case presentation, still in vogue in most postgraduate examinations, covers only a part of the examinee’s medical knowledge. The direction that the discussion takes during a case presentation and the level of interrogation depends both upon the examinee’s and examiner’s approach. This leads to a subjective assessment. Certain areas of clinical pediatrics like interpretation of laboratory and radiological reports, communication skills, problem solving and knowledge of clinical procedures are not tested routinely in the traditional examination. The Objective Structured Clinical Examination (OSCE) attempts to overcome these drawbacks by providing a broad-based format to assess the candidate on multiple aspects of the subject. Objectivity brings with it an element of uniformity. Being structured gives a focus on preparation and assessment. The wide variety of topics inherent to childhood illness (from neonatology to adolescent medicine, from intensive care to social pediatrics, from child development to surgical emergencies and so on…) provides a delightfully wide source for the examiner to draw upon, but is a nightmare for the candidate. However, there is a silver lining. Being broad based, OSCE gives the candidate an opportunity to make up from an easy question, any marks lost in a station in which he has not scored well. With the introduction of the OSCE system as an integral part of the DNB Pediatrics examination, there was a felt need amongst students for a guide which could help them prepare for the examination. Moreover, the requirement to qualify separately in OSCE in order to receive accreditation made the necessity for such a volume all the more imperative. The book OSCE in Pediatrics is neither meant to cover the whole field of pediatrics nor is it intended to serve as a question bank. It is an effort to sensitize and introduce the student to the OSCE format so that the student can prepare accordingly. The ambit of OSCE extends beyond the examination hall. Preparation for OSCE trains the student to approach a problem in a systematic manner and would certainly help in dealing with the real-life patient. The authors have drawn upon a wide variety of inputs in the preparation of the questions. No effort has been spared in trying to ensure accuracy of medical facts, drug dosages and so on. It is, however, possible in the changing world of medicine for error to creep in. We regret any such inadvertent shortcoming and welcome suggestions and criticism. RG Holla Vivek Jain Manish Mittal