You will be given 4 long cases and 4 short cases. You would be given 15 minutes to take history, examine, and format a diagnosis and plan of care for a long case. You will be given 5 minutes to do the same for a short case, however the history and the examination will be limited to the organ / part of body in question.
Long case 25 marks each case – total 100 marks
Short case 10 marks each case – total 40 marks
The long cases are one case each in:
c. Trauma and Orthopaedics
c. Obstetrics & Gynaecology
The EM books that I read for cases were:
• Tintinallis 8th edition
• Emergency Medicine Oral Board Review , 2 nd edition
• MRCEM 125 OSCE
Other books that may help are:
• The RESUSCITATION CRISIS MANUAL Scott D. Weingart David C. Borshoff
• The Atlas of Emergency Medicine by Kevin J Knoop , Lawrence B Stack , Alan B Storrow, R Jason Thurman
• Clinical books used as reference in MBBS
It is an objective assessment, so gather all your points here. You say the right thing in the right order and narrate your resuscitation algorithm, you are awarded points. Each right point mentioned, will fetch you a mark and grab them all. It is very doable with repeated revision. These are listed under OSCE stations and called Skill stations in the “GUIDELINES FOR CONDUCT OF DNB EMERGENCY MEDICINE PRACTICAL EXAMINATION INCLUDING OSCE”. Like most of you would have, I had completed BLS, ACLS, ATLS, PALS provider courses and had revised the respective manuals for this station.
1. BLS (5 marks)
2. ACLS (10 marks) the examiner may take you from a stable patient with stable rhythm to stable tachy to unstable tachy to brady to arrest. Be well versed with drugs and doses, and defib or cardioversion joules.
I got a hypothetical polytrauma case with extremity fracture, tension pneumothorax and FAST positive internal bleeding, and had to go through the entire ATLS format.
After that I was asked to demonstrate Helmet removal for another hypothetical case. I thought the question was straight forward and went ahead to remove the helmet according to the protocol, when my examiner interrupted asking me if Primary assessment was not important before I proceeded with the helmet removal. So treat the mannequin as a real patient and do what you would do in real life scenario. These approaches are however subject to the exam centre and your examiner, and you will get familiar with what he/she wants on call.
Yes, you have to know NALS, as perfectly as you know ACLS. No compensation.
I was given a case scenario by the examiner, and I was required to arrive at the diagnosis (mine was anaphylaxis) and list down the assessment and approach to a difficult airway. This will require you to read an anaesthesia book for the same. Any suitable handbook would do. You need to be familiar with all the assessments of the airway, all the devices used and their indication for use, advantages and disadvantages of each over one another, surgical airways and narration of the surgical procedures for the airway. Watch videos on youtube and familiarise yourself with verbalising the procedures. You may include MRCEM PART C videos as a preparation material for this, but it won’t suffice as a sole source.
If you are given a suturing scenario, it begins with assessment of the wound, which will include the depth, character of the wound, indication for suturing, wound cleaning, need for prophylactic antibiotic or not, consent, types of suture materials, advise for suture removal, types of sutures, demonstration of suturing technique (you will have to be familiar with atleast a couple of different suturing techniques other than simple interrupted sutures). Whether you will be asked all of this is left to the discretion of the examiner, but your preparation will have to include all this. Watch appropriate videos online for this station as well. You may include MRCEM PART C videos as a preparation material for this, but it won’t suffice as a sole source.
I was asked to demonstrate application of a pelvic binder , and here again my examiner expected me to go through the primary survey of ATLS , I had to determine a hypothetical pelvic bleed with the ultrasound machine , stabilise vitals with basic resuscitation , and end the examination with the observation that BP had improved a little with the binder placement. To what length he wants to keep the station active and assess you is completely upto the examiner, but never fail to be in your most alert senses to answer the questions and use presence of mind.
Don’t expect to be provided with clues if you are fumbling with order of examination or assessment. The examiner is more likely to keep silent and mark you than help you with clues to move forward.
This is one thing that I had prepared for from only one source the MRCEM part C OSCE book, Communication skills chapter. But what you need to know is you can only gather the format of dealing with these situations from the OSCE book, but the actual way of answering an Indian relative/patient in stress can be more beneficial from practicing with friends or seniors.
My scenario was talking to an angry parent whose son had developed complications of dengue on day 3, and had been sent home from ER on day 1.
My job was not just “talking to an angry relative”, but it included arriving at a diagnosis of a probable viral hemorrhagic fever from the history and hypothetical examination, answering about risks of dengue in Indian environment and what I planned to do with the patient further.
Similarly, if your scenario is breaking bad news or death of the patient to the relative and you want to address organ donation with him/ her, you have to be familiar with laws regarding the same in the Indian scenario.
A good area to score points, but needs a good amount of preparation.
We had 10 spotters, 2 minutes for each spotter, and 2 questions to be answered for each spotter.
The areas that you need to cover are :
1. USG (image / video)
2. X-ray chest and Ortho related X ray
3. CT brain
6. Clinical photograph
• ECG made easy
• X ray made easy
• Emergency ultrasound made easy
• Paul Marino ICU book for ABG
Kindly don’t limit yourself to only the above-mentioned books, keep reading anything relevant that you find online.
Another good station to score points. We did not have a separate station for ultrasound, for us it was clubbed with the ATLS station.so only USG we had to demonstrate was EFAST. Will not be the case with all centers. Don’t rely on it.
Things you need to be familiar with are:
Use of the machine
Use of different knobs.
Optimization of the image
Focusing of the image
Diagnosis based on the ultrasound findings and treatment
Ultrasound protocols in shock
The viva where my exam was held consisted of Thesis, Waste Disposal and Recent advances in Emergency Medicine. This again may be subject to the choice of different centers, but the thesis is very likely to be included and it is one of the things you can prepare for. Carry your thesis, obviously. I had carried a completed logbook as well, but it wasn’t asked for, at my center.
Thesis: you are required to be familiar with study population, study methods, main findings, why you chose to do this study, what results the recent studies in your topic have shown (remember your thesis would be a year old before you take the viva )
Waste Disposal: which articles, which colored bags.
Recent Advances: well, any area of EM. You either know it or you don’t and it’s ok if you don’t. The entire viva lasted for about 10 minutes although the bell rang at 5 minutes.
And then, I was done.
Begin your preparation in the first year and take help from well-meaning seniors.
All the best.
Be better every day.