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    So we had veryyy poor paeds teaching (as in no bedside teaching at all, 1 or 2 lectures a week on things that are unlikely to come up in exams) Also had exams during paeds placement so didn't focus on it as well as should have.

    Very anxious about upcoming paeds OSCEs - does anyone have any useful material / websites etc? Please? haha

    Thanks!!
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    Do you know what sorts of things you will have in your OSCE?

    Things that come up often:
    - Short cases - "cardiovascular examination' etc
    - Long cases - history from an actor-parent
    - Communication skills / information giving with an actor-parent - "Talk to this worried parent about reflux / asthma / febrile convulsions"
    - Developmental assessment
    - Video stations with eg signs of respiratory distress

    It's useful to know what combination of the above you might get, as that will help you to focus your revision.

    Get slick at paediatric histories - remember to ask about imms, school/attendance/problems, who's at home including all adults, social services involvement, and specific questions pertinent to the presenting complaint such as smokers / pets / FHx of atopy in an asthma hx. If you're worried about doing this, practise by clerking some patients and present them. Most paeds wards have a paeds clerking proforma which is a useful reminder of the 'boxes' that need ticking in a paeds hx. Ask the actor-parent if they've brought the 'red book' with them.

    Developmental examination. This often takes the format of 'George is 2 years old, please assess whether he is developmentally appropriate for his age'. You need to learn the milestones for the 4 areas you're assessing. If you've not had much practice of actually doing an assessment, there are lots of good youtube vidoes showing how it can be done. It's often about being opportunistic and engaging with the child as they often won't want to build blocks or stand on one leg. And that's ok. It's not going to run slickly with doing all of gross motor and then moving to fine motor, it will be a case of doing things as you can, a bit of fine motor and at the same time talking with them and assessing speech and language... - hence why it is obvious who has practised this before and is used to working round things and going with the flow and adapting to the situation. But in your exam you need to show that you can engage well with a child and be nice to them, and try and be creative with trying to get them to do things if they don't want to. You won't lose marks if the child has an uncooperative hissyfit despite your best efforts. It is usually quite obvious who has spent time with children and who hasn't. If you're feeling rusty at developmental assessment, practice - kids on the ward, your own kids, nieces / nephews, your friends' kids… Look at kids on the bus or in the supermarket - try to guess their age from what they're able to do. You might never find out their actual age but just going through things in your head is useful - 'she can talk in short sentences with 3 words strung together therefore…'

    For short cases, it's basically about learning examination techniques, and again at the same time being able to interact with the child appropriately and try to put them at their ease when they're scared of the stethoscope etc. Think carefully about examinations that are 'different' in paeds to adults, eg. it would be cruel of them to give you this but think of neuro exam in a baby / infant. Be good at your surgical scar recognition.

    Counselling / information giving. If you get this, it's often a scenario such as counselling a parent of a child who's had a first febrile convulsion - answering their questions, knowing what safety netting advice to give etc. Again for the most part this just needs learning, but always remember to show that you are listening carefully to the parent / patient rather than just delivering your well-rehearsed speech, remember to ask them if they have any questions, offer them a patient info leaflet, explain what to do if they are worried or have more questions… All gives extra points. If you think there might be a specialist nurse for the topic, eg CF, dermatology nurse, etc - then offer their contact info too.

    Video stations - again youtube is your friend. Look up videos of clinical signs such as infantile spasms, resp distress...

    Overall - paediatrics OSCEs are chaotic, there are howling children everywhere and new smiley ones being brought out from behind the scenes as the one having the meltdown is being dragged away, or the whole OSCE grinds to a halt because Maisie needs the toilet. Be uber friendly to the children. Sit on the floor, engage them, play with them. Some of them will probably cry at you anyway. But if you've at least shown that you can be nice to a child, that's ok, even if your whole station descends into chaos. At times you might be asked to explain what you would have done to assess Johnny's fine motor skills had he not thrown up everywhere first - so be prepared to talk things through with an examiner. Very importantly - always ask the adult who is accompanying the child, who they are / their relationship to the child. It will be very cringey to call mum 'grandma' and vice versa and will not look good in an exam. If the child is old enough, ask them who they've brought with them. And have fun - it's the only OSCE you'll ever do where you'll be able to sit on the floor and play with crayons!
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    (Original post by junior.doctor)
    Do you know what sorts of things you will have in your OSCE?

    Things that come up often:
    - Short cases - "cardiovascular examination' etc
    - Long cases - history from an actor-parent
    - Communication skills / information giving with an actor-parent - "Talk to this worried parent about reflux / asthma / febrile convulsions"
    - Developmental assessment
    - Video stations with eg signs of respiratory distress

    It's useful to know what combination of the above you might get, as that will help you to focus your revision.

    Get slick at paediatric histories - remember to ask about imms, school/attendance/problems, who's at home including all adults, social services involvement, and specific questions pertinent to the presenting complaint such as smokers / pets / FHx of atopy in an asthma hx. If you're worried about doing this, practise by clerking some patients and present them. Most paeds wards have a paeds clerking proforma which is a useful reminder of the 'boxes' that need ticking in a paeds hx. Ask the actor-parent if they've brought the 'red book' with them.

    Developmental examination. This often takes the format of 'George is 2 years old, please assess whether he is developmentally appropriate for his age'. You need to learn the milestones for the 4 areas you're assessing. If you've not had much practice of actually doing an assessment, there are lots of good youtube vidoes showing how it can be done. It's often about being opportunistic and engaging with the child as they often won't want to build blocks or stand on one leg. And that's ok. It's not going to run slickly with doing all of gross motor and then moving to fine motor, it will be a case of doing things as you can, a bit of fine motor and at the same time talking with them and assessing speech and language... - hence why it is obvious who has practised this before and is used to working round things and going with the flow and adapting to the situation. But in your exam you need to show that you can engage well with a child and be nice to them, and try and be creative with trying to get them to do things if they don't want to. You won't lose marks if the child has an uncooperative hissyfit despite your best efforts. It is usually quite obvious who has spent time with children and who hasn't. If you're feeling rusty at developmental assessment, practice - kids on the ward, your own kids, nieces / nephews, your friends' kids… Look at kids on the bus or in the supermarket - try to guess their age from what they're able to do. You might never find out their actual age but just going through things in your head is useful - 'she can talk in short sentences with 3 words strung together therefore…'

    For short cases, it's basically about learning examination techniques, and again at the same time being able to interact with the child appropriately and try to put them at their ease when they're scared of the stethoscope etc. Think carefully about examinations that are 'different' in paeds to adults, eg. it would be cruel of them to give you this but think of neuro exam in a baby / infant. Be good at your surgical scar recognition.

    Counselling / information giving. If you get this, it's often a scenario such as counselling a parent of a child who's had a first febrile convulsion - answering their questions, knowing what safety netting advice to give etc. Again for the most part this just needs learning, but always remember to show that you are listening carefully to the parent / patient rather than just delivering your well-rehearsed speech, remember to ask them if they have any questions, offer them a patient info leaflet, explain what to do if they are worried or have more questions… All gives extra points. If you think there might be a specialist nurse for the topic, eg CF, dermatology nurse, etc - then offer their contact info too.

    Video stations - again youtube is your friend. Look up videos of clinical signs such as infantile spasms, resp distress...

    Overall - paediatrics OSCEs are chaotic, there are howling children everywhere and new smiley ones being brought out from behind the scenes as the one having the meltdown is being dragged away, or the whole OSCE grinds to a halt because Maisie needs the toilet. Be uber friendly to the children. Sit on the floor, engage them, play with them. Some of them will probably cry at you anyway. But if you've at least shown that you can be nice to a child, that's ok, even if your whole station descends into chaos. At times you might be asked to explain what you would have done to assess Johnny's fine motor skills had he not thrown up everywhere first - so be prepared to talk things through with an examiner. Very importantly - always ask the adult who is accompanying the child, who they are / their relationship to the child. It will be very cringey to call mum 'grandma' and vice versa and will not look good in an exam. If the child is old enough, ask them who they've brought with them. And have fun - it's the only OSCE you'll ever do where you'll be able to sit on the floor and play with crayons!
    I haven't even made it to 4th year yet but this advice is a life-saver! If anything Paediatrics is one of the rotations I'm most worried about. Thank you so much for your insight.
 
 
 
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