Theme 4: Hypertension in the OSCE

During a station break in the circuit of an Objective Structured Clinical Examination

(OSCE) for final MBBS examinations in Medicine and Therapeutics, two examiners
discuss the last candidate's performance after submitting independent scores.

(The instructions on the door of the station read: "Instructions to Candidates: Please
counsel this patient about his hypertension and salt intake. You will have 5 minutes
to do so and 2 minutes to discuss with the examiners.")

An excerpt of the presentation is shown.

So, what did you think of the last candidate?
Hmmmm. . . . well, I had a tough time deciding on my overall impression on that
performance. Clearly the candidate has some understanding about the impact of
salt intake on blood pressure but seemed unsure on how to counsel the patient
about it.
Yes, I can certainly agree with you there! After clearly identifying that dietary salt intake
had an impact on blood pressure, she then continued to take a focused history on other
risk factors without really counseling about sodium reduction.
And then when asked about what things could be reduced in the diet, she
mentioned not adding table salt as the only modification!
I thought that was interning as well. The patient said, "I heard that some people might
have additional risk with excess sodium intake" and her response was "I see".
And when redirected several times by our simulated patient, she ignored his
concern about "muscle cramps" and "I sweat like a pig".
There was also the annoying use of the phrase "you have to cut down. . . .really, it's bad
for you" but lacked specific details about daily sodium targets and ways to monitor same.
The candidate had no idea how much salt this lady consumed . . . .
Yes of course, a basic skill in counselling would be to find out how much the
patient really knows. It turns out this simulated patient already knew quite a lot
about salt reduction and this was missed completely by the candidate.
After the constant interruptions to the patient's concerns, I had great difficulty passing
her in the global rating on interviewing skill.
And what was also clear was the absence of any summarizing or cross checking
elements. Surely students understand that these are key elements of
communications.
So what was your final score then?


The audio tone sounds to indicate the start of the next station and the examiners return to
their posts.


Task

1. Using the attached OSCE TEMPLATE, create an OSCE checklist for this station. Your
checklist should include at least 10 individual points to be awarded marks at the
station.