How to approach an OSCE: counselling stations

Chapter 2 How to approach an OSCE: counselling stations



INTRODUCTION


Some OSCEs are designed to concentrate more on candidates’ counselling skills than on their display of medical and technical knowledge. In our interactions with patients in real life, counselling skills are often just as important – and sometimes more important – than our ability to recite medical facts and figures as we tell them what treatment they might need.


The counselling stations allow the examiner to get a sense of how you speak and communicate with patients. Some examples of situations when counselling skills are tested include: the delivery of bad news; dealing with an angry or upset patient; and explaining a complex clinical problem, and/or treatment, to a patient in terms they can understand.



DELIVERY OF BAD NEWS


‘Bad news’ can be defined as any information which radically and negatively alters the patient’s perception about their own future. While it is most commonly associated with the diagnosis of a terminal illness, such as ovarian cancer, in the context of obstetrics and gynaecology it may be the loss of a baby (e.g. fetal death in utero diagnosed on a scan), or the loss of reproductive potential (e.g. a hysterectomy performed to control bleeding in a young woman, or the discovery that a young woman has Turner’s syndrome and has gone through premature menopause, so will be unable to have children naturally). The patient experiences a perceived loss (i.e. of life-span, of a baby, or of reproductive potential), and will go through a variable grief reaction.


Kubler-Ross identified the five stages of the grief reaction to death and dying (denial, anger, bargaining, depression, acceptance), which can easily be applied to any grief reaction by a patient. While the short duration of an OSCE does not fully reflect the reality of dealing with bad news (it will usually take much longer, and multiple consultations with the patient), it is worth remembering some basic counselling skills which may help in an OSCE where the delivery of bad news is assessed.


When the candidate knows that bad news must be delivered it is important to try to prepare the patient before delivering it. Identify yourself to the patient, and to any other family members present. Offer to have family members present, if appropriate (e.g. a husband or partner if a fetal death in utero has occurred; a mother or father if a young girl has been diagnosed with a serious congenital reproductive problem).


The patient should be warned that bad news is about to be delivered, so that they can prepare themselves; for example, “I am sorry to say that I have some bad news from the results of your tests”, or “I am afraid that the results of the ultrasound scan are not good”. It is important that you are empathic in the manner in which you deliver the bad news, and that you indicate from your manner that you care about the patient’s reaction to the news and take the situation very seriously.


The bad news must be delivered clearly and slowly, avoiding the use of technical medical terms. You will need to pause at times to ask the patient if they have understood what you have just explained, and be prepared to ask them if they have any questions about the information you have imparted. Offer to provide written material, if necessary. Also consider the emotional impact of bad news and offer professional counselling, further visits to re-explain things, and patient support groups and resources if appropriate and available. Colleagues should never be criticised when delivering bad news, even when it is perceived that the negative outcome is related to their action or inaction, as this will not help the patient in their immediate situation.

Related posts:

  1. Specialist level practice OSCE questions
  2. Specialist level OSCE answers and discussion
  3. How to approach an OSCE: clinical stations
  4. Practice OSCE questions for medical student exams

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Jun 15, 2016 | Posted by in GYNECOLOGY | Comments Off on How to approach an OSCE: counselling stations

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