Welcome to the Viva Video Page
Our VIVA Videos will be available here following each VIVA live webinar.
MODULE 1: Introduction
1: Introduction
MODULE 2: CLIniCAL EXAMINATION
2. Clinical Examination
6.30-6.40 Q&A
6.40-6.55 Clinical Examination: In general
6.55-7.20 VIVA 1 + debrief
7.20-7.45 VIVA 2 + debrief
7.45-8.00 OSCE Exam: Things to remember not to forget
8.00-8.25 VIVA 3 + debrief
8.25-8.50 VIVA 4 + debrief
8.50-9.00 Summary and Questions
6.40-6.55 Clinical Examination: In general
6.55-7.20 VIVA 1 + debrief
7.20-7.45 VIVA 2 + debrief
7.45-8.00 OSCE Exam: Things to remember not to forget
8.00-8.25 VIVA 3 + debrief
8.25-8.50 VIVA 4 + debrief
8.50-9.00 Summary and Questions
Due to technical difficulties encountered, zoom did not record videos. I have recorded the lectures for you below and have given you the VIVA topics discussed with an idea of the answers, so you can over them again.
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Here are the 5 OSCEs we covered. Go over them and write a model answer. Use the lectures on the website.
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MODULE 3: ECG AND THE OSCE
3. ECG and the OSCE
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What types of OSCEs will you get?
The ECG in the OSCE may be a quick interpretation of a STEMI in a cardiac arrest scenario, or it can take the form of a teaching station. In the teaching session you will be required to go over an ECG with a junior doctor.
The Key points in Teaching are:
The Key points in Teaching are:
- Determine the knowledge level of the participant
- Take them over the reading of the ECG
- During this step it is critical to continue communication with the person you are teaching
- Look at the person occasionally
- This is a communication and teaching station and you will lose marks if you just immerse yourself in the ECG and don't pay attention to the person you are teaching ( it happens often
- Ask for feedback ie., determine that they have understood what you have taught
- Always finish by asking if there is something else they would like you to cover
OSCE to try; there are strict instructions
- Do this OSCE to time: Take 4 minutes to read and plan and set a 7 minute time to answer
- You MUST videotape yourself on your phone(or other device) for this
- Watch it back when reading the answers and pay attention to the things you need to find to give marks
- One of the reasons for doing this is to put you in the shoes of the examiner and see what they have to look for.
- Many delegates tell me that they hate looking at themselves in the video, so they won't do it. CRAZY TALK!!!!!- Think about this... If you hate the way you are presenting, will the examiner like you? Remember that the mark you get is a qualitative mark. If you are borderline, a few tweaks may change everything! The examiner must like your presentation. Try it. You will only make your presentation better.
OSCE
Take 4 minutes to read and plan and then 7 minutes(video yourself) to answer
CANDIDATE INSTRUCTIONS
DOCTOR JONES IS A PGY3 JUNIOR DOCTOR. HE WISHES TO DISCUSS A PATIENT’S ECG AND THEIR CLINICAL PRESENTATION. THE HISTORY IS AS FOLLOWS, BUT DR JONES IS UNAWARE OF THE EXAMINATION FINDINGS.
AT YOUR TERTIARY REFERRAL CENTRE, IT IS 11 AM ON A WEDNESDAY.
THE PATIENT, JOHN, IS A 40 YEAR OLD MAN WHO IS CURRENTLY IN RESUS HAVING COME IN FOLLOWING A SYNCOPAL EPISODE WITHOUT HEAD INJURY. HE HAS NO OTHER PAST MEDICAL HISTORY AND IS ON NO MEDICATIONS. JOHN DESCRIBES HAVING HAD A PREVIOUS EPISODE OF SYNCOPE, FOR WHICH HE DID NOT SEEK MEDICAL ATTENTION.
THE PATIENT IS CURRENTLY STABLE IN THE RESUSCITATION ROOM UNDER THE CARE OF A SENIOR REGISTRAR AND THEREFORE YOU HAVE TIME AND/OR SEVERAL MINUTES TO DISCUSS THIS WITH DR JONES.
YOUR TASKS ARE TO:
THIS OSCE WILL ASSESS THE FOLLOWING DOMAINS:
DOCTOR JONES IS A PGY3 JUNIOR DOCTOR. HE WISHES TO DISCUSS A PATIENT’S ECG AND THEIR CLINICAL PRESENTATION. THE HISTORY IS AS FOLLOWS, BUT DR JONES IS UNAWARE OF THE EXAMINATION FINDINGS.
AT YOUR TERTIARY REFERRAL CENTRE, IT IS 11 AM ON A WEDNESDAY.
THE PATIENT, JOHN, IS A 40 YEAR OLD MAN WHO IS CURRENTLY IN RESUS HAVING COME IN FOLLOWING A SYNCOPAL EPISODE WITHOUT HEAD INJURY. HE HAS NO OTHER PAST MEDICAL HISTORY AND IS ON NO MEDICATIONS. JOHN DESCRIBES HAVING HAD A PREVIOUS EPISODE OF SYNCOPE, FOR WHICH HE DID NOT SEEK MEDICAL ATTENTION.
THE PATIENT IS CURRENTLY STABLE IN THE RESUSCITATION ROOM UNDER THE CARE OF A SENIOR REGISTRAR AND THEREFORE YOU HAVE TIME AND/OR SEVERAL MINUTES TO DISCUSS THIS WITH DR JONES.
YOUR TASKS ARE TO:
- INTERPRET THE ECG
- DISCUSS THE POTENTIAL CAUSES FOR THE PATIENT’S PRESENTATION
- EXPLAIN WHAT INVESTIGATIONS WOULD BE REQUIRED
THIS OSCE WILL ASSESS THE FOLLOWING DOMAINS:
- MEDICAL EXPERTISE
- SCHOLARSHIP & TEACHING
LOOK at the ECG when the 7 minutes start- REMEMBER YOU MUST video yourself for maximum benefit
ANSWER: Now look at the marking sheet, whilst watching the video and give yourself an honest mark
OTHER THINGS TO LOOK FOR IN THE VIDEO
Are you sitting up straight and looking confident?
Go over the video and see what you might change.
- Do you look the part of the consultant?
- Are you using a lot of filler words such as 'Ummm' and 'Ahh' or 'You know' or anything that is a filler
- Are you fidgeting?
Go over the video and see what you might change.
MODULE 4: WHAT THE EXAMINERS WANT.......STRATEGY
This is a communication OSCE. Take 4 minutes to read the candidate instructions. Then record your approach for a full 7 minutes. This is more difficult than you think, because I want you to speak for a full 7 minutes on the topic.
Please video tape yourself doing this and watch how you perform.
Please video tape yourself doing this and watch how you perform.
Candidate instructions.
You are a junior consultant working in a rural emergency department. The resident has just seen a 2 yo child who has been brought in by the parents, following what appeared to be a seizure. There is no previous medical history and the child was born at term, is immunised and is meeting all milestones.
The history of the presenting complaint, is that the child was playing on the floor, when she heard him crying. He then became stiff and then his arms 'jerked' for a few seconds and the child's mother states, his lips turned blue. He then regained consciousness within 30 seconds but was tired and sleepy for a short time. This occurred about an hour prior to arrival. The parents tried to call the ambulance, but there was an issue with their phone, so decided to bring the child into the emergency department themselves.
The parents are concerned that the child has epilepsy.
When the resident examined the child, his conscious state was normal. The child was playing happily.
His vitals were all normal. He had no fever and heart rate, respiratory rate and saturations were within normal limits. A BSL was done and was normal.
Physical examination demonstrated that the child was interacting and moving all limbs normally. Chest was clear, heart sounds dual, abdomen soft and non tender. EENT examination was also normal.
Please discuss with the resident, the differentials of this presentation and potential sequelae, as well as the chances of the child having epilepsy. Also cover how you would approach this child if the episode recurred whilst in the emergency department.
This station examines Communication, Medical Expertise, Scholarship and Teaching
You are a junior consultant working in a rural emergency department. The resident has just seen a 2 yo child who has been brought in by the parents, following what appeared to be a seizure. There is no previous medical history and the child was born at term, is immunised and is meeting all milestones.
The history of the presenting complaint, is that the child was playing on the floor, when she heard him crying. He then became stiff and then his arms 'jerked' for a few seconds and the child's mother states, his lips turned blue. He then regained consciousness within 30 seconds but was tired and sleepy for a short time. This occurred about an hour prior to arrival. The parents tried to call the ambulance, but there was an issue with their phone, so decided to bring the child into the emergency department themselves.
The parents are concerned that the child has epilepsy.
When the resident examined the child, his conscious state was normal. The child was playing happily.
His vitals were all normal. He had no fever and heart rate, respiratory rate and saturations were within normal limits. A BSL was done and was normal.
Physical examination demonstrated that the child was interacting and moving all limbs normally. Chest was clear, heart sounds dual, abdomen soft and non tender. EENT examination was also normal.
Please discuss with the resident, the differentials of this presentation and potential sequelae, as well as the chances of the child having epilepsy. Also cover how you would approach this child if the episode recurred whilst in the emergency department.
This station examines Communication, Medical Expertise, Scholarship and Teaching
Candidate instructions.
You are a junior consultant working in a rural emergency department. The resident has just seen a 2 yo child who has been brought in by the parents, following what appeared to be a seizure. There is no previous medical history and the child was born at term, is immunised and is meeting all milestones.
The history of the presenting complaint, is that the child was playing on the floor, when she heard him crying. He then became stiff and then his arms 'jerked' for a few seconds and the child's mother states, his lips turned blue. He then regained consciousness within 30 seconds but was tired and sleepy for a short time. This occurred about an hour prior to arrival. The parents tried to call the ambulance, but there was an issue with their phone, so decided to bring the child into the emergency department themselves.
The parents are concerned that the child has epilepsy.
When the resident examined the child, his conscious state was normal. The child was playing happily.
His vitals were all normal. He had no fever and heart rate, respiratory rate and saturations were within normal limits. A BSL was done and was normal.
Physical examination demonstrated that the child was interacting and moving all limbs normally. Chest was clear, heart sounds dual, abdomen soft and non tender. EENT examination was also normal.
The resident has asked you to assist by discussing with the case with the parents and dealing with their concerns about this being epilepsy.
This station examines Communication, Medical Expertise, Scholarship and Teaching
You are a junior consultant working in a rural emergency department. The resident has just seen a 2 yo child who has been brought in by the parents, following what appeared to be a seizure. There is no previous medical history and the child was born at term, is immunised and is meeting all milestones.
The history of the presenting complaint, is that the child was playing on the floor, when she heard him crying. He then became stiff and then his arms 'jerked' for a few seconds and the child's mother states, his lips turned blue. He then regained consciousness within 30 seconds but was tired and sleepy for a short time. This occurred about an hour prior to arrival. The parents tried to call the ambulance, but there was an issue with their phone, so decided to bring the child into the emergency department themselves.
The parents are concerned that the child has epilepsy.
When the resident examined the child, his conscious state was normal. The child was playing happily.
His vitals were all normal. He had no fever and heart rate, respiratory rate and saturations were within normal limits. A BSL was done and was normal.
Physical examination demonstrated that the child was interacting and moving all limbs normally. Chest was clear, heart sounds dual, abdomen soft and non tender. EENT examination was also normal.
The resident has asked you to assist by discussing with the case with the parents and dealing with their concerns about this being epilepsy.
This station examines Communication, Medical Expertise, Scholarship and Teaching
KEY WORDS IN THE INSTRUCTIONS
THIS IS A COMMUNICATION AND MEDICAL EXPERTISE OSCE. ITS A TEACHING OSCE.
KEY WORDS IN THE INSTRUCTIONS ARE:
You are a junior consultant working in a rural emergency department. The resident has just seen a 2 yo child who has been brought in by the parents, following what appeared to be a seizure. There is no previous medical history and the child was born at term, is immunised and is meeting all milestones.
The history of the presenting complaint, is that the child was playing on the floor, when she heard him crying. He then became stiff and then his arms 'jerked' for a few seconds and the child's mother states, his lips turned blue. He then regained consciousness within 30 seconds but was tired and sleepy for a short time. This occurred about an hour prior to arrival. The parents tried to call the ambulance, but there was an issue with their phone, so decided to bring the child into the emergency department themselves.
The parents are concerned that the child has epilepsy.
When the resident examined the child, his conscious state was normal. The child was playing happily.
His vitals were all normal. He had no fever and heart rate, respiratory rate and saturations were within normal limits. A BSL was done and was normal.
Physical examination demonstrated that the child was interacting and moving all limbs normally. Chest was clear, heart sounds dual, abdomen soft and non tender. EENT examination was also normal.
Please discuss with the resident, the differentials of this presentation and potential sequelae, as well as the chances of the child having epilepsy. Also cover how you would approach this child if the episode recurred whilst in the emergency department.
KEY WORDS IN THE INSTRUCTIONS ARE:
You are a junior consultant working in a rural emergency department. The resident has just seen a 2 yo child who has been brought in by the parents, following what appeared to be a seizure. There is no previous medical history and the child was born at term, is immunised and is meeting all milestones.
The history of the presenting complaint, is that the child was playing on the floor, when she heard him crying. He then became stiff and then his arms 'jerked' for a few seconds and the child's mother states, his lips turned blue. He then regained consciousness within 30 seconds but was tired and sleepy for a short time. This occurred about an hour prior to arrival. The parents tried to call the ambulance, but there was an issue with their phone, so decided to bring the child into the emergency department themselves.
The parents are concerned that the child has epilepsy.
When the resident examined the child, his conscious state was normal. The child was playing happily.
His vitals were all normal. He had no fever and heart rate, respiratory rate and saturations were within normal limits. A BSL was done and was normal.
Physical examination demonstrated that the child was interacting and moving all limbs normally. Chest was clear, heart sounds dual, abdomen soft and non tender. EENT examination was also normal.
Please discuss with the resident, the differentials of this presentation and potential sequelae, as well as the chances of the child having epilepsy. Also cover how you would approach this child if the episode recurred whilst in the emergency department.
DIFFERENTIALS?
This certainly appears to be a breath holding spell.
The child is too young for a BRUE
Other causes of afebrile 'seizure' include:
The child is too young for a BRUE
Other causes of afebrile 'seizure' include:
- Arrhythmia
- Vasovagal
- Anoxic
- Trauma with head injury
- Always think of NON Accidental Injury
The teaching process
- Ensure you have understood everything that has been said, so repeat the findings, with emphasis on the normal exam and vitals
- Give the differentials
- Go over the differentials with the most likely on top of the list and explain them
- Ensure the resident has understood, by asking for frequent feedback
- Ask if there is anything else he would like to know
When dealing with parents, it's really an adapted teaching process. Keep the language as non-medical as possible.
There are some basic steps:
There are some basic steps:
- Introduce yourself. Tell them who you are and find out who they are: Hello I'm Dr Peter. If the parents don't introduce themselves, you do need to know who you are dealing with and to ensure they are the parents. How you ask this is important.
- Summarise what has happened to ensure you have the facts right. There may be an addition to the facts at this time, which might be important
- Summarise why you think it has happened, basically giving them your most likely diagnosis, which is a breath holding spell. You can discuss potential alternatives. You can also give your opinion on it being epilepsy. Reassure that it is not
- Ensure that the parents have understood
- Repeat and reword as necessary.
- Always offer admission if concerned or if parents concerned
- Finish by asking if there are any other questions
MODULE 5: EQUIPMENT
MODULE 6: PAEDIATRICS
Unfortunately, due to technical difficulties the video was not able to be recorded. However here are the main points made.
TOPICS: POPULAR BUT RECENTLY ASKED:
•Neonatal resus
•Limping child/limb injury
•Head injury
•Headache/LP
POPULAR TOPICS DUE TO RETURN
•Seizure/febrile fit
•BRUE
•Neonatal/infant sepsis
•Paeds SOB
•Paeds resus
•Neonatal resus
•Limping child/limb injury
•Head injury
•Headache/LP
POPULAR TOPICS DUE TO RETURN
•Seizure/febrile fit
•BRUE
•Neonatal/infant sepsis
•Paeds SOB
•Paeds resus
CANDIDATE INFORMATION
•A 2 ½ year old boy, Jaxxon Thimble, has been brought by ambulance from home having had a seizure. He was accompanied by a his gran who provided the history:
•He has been unwell for a couple of days with a running nose but was otherwise well. He had shaking episode whilst unresponsive that lasted about 1 minute and resolved and was back to normal by the time he arrived in ED.
•Gran thinks he is otherwise well, is unsure of vaccinations status of sick contacts as she only looks after him on Wednesdays.
•Assessment in ED found; URTI signs, temp 38.6C. Observations were otherwise normal. Chest was clear, UA NAD and basic bloods normal.
•Temperature has been controlled with paracetamol.
•You feel that this is an uncomplicated febrile convulsion and are happy to discharge him home. Gran has called his mother/father to come in from work. You will be asked to discuss Jaxxon’s condition with his parent and advise them on further management/home care.
•He has been unwell for a couple of days with a running nose but was otherwise well. He had shaking episode whilst unresponsive that lasted about 1 minute and resolved and was back to normal by the time he arrived in ED.
•Gran thinks he is otherwise well, is unsure of vaccinations status of sick contacts as she only looks after him on Wednesdays.
•Assessment in ED found; URTI signs, temp 38.6C. Observations were otherwise normal. Chest was clear, UA NAD and basic bloods normal.
•Temperature has been controlled with paracetamol.
•You feel that this is an uncomplicated febrile convulsion and are happy to discharge him home. Gran has called his mother/father to come in from work. You will be asked to discuss Jaxxon’s condition with his parent and advise them on further management/home care.
MARKING CRITERIA
CANDIDATE
•Structured Case Based Discussion
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You are the duty consultant at a small rural ED.
An unwell 11 month old child has been brought into the ED
The child has been transferred by ambulance from a GP clinic with dyspnoea and hypoxia, starting suddenly 2 days previously and worsening.
The child is stable after initial application of supplemental oxygen
•Please discuss the further assessment, management and disposition of this child
•A chest xray has been taken and is shown below
Domains being examined
·Medical Expertise 50%
·Prioritisation And Decision Making 50%
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You are the duty consultant at a small rural ED.
An unwell 11 month old child has been brought into the ED
The child has been transferred by ambulance from a GP clinic with dyspnoea and hypoxia, starting suddenly 2 days previously and worsening.
The child is stable after initial application of supplemental oxygen
•Please discuss the further assessment, management and disposition of this child
•A chest xray has been taken and is shown below
Domains being examined
·Medical Expertise 50%
·Prioritisation And Decision Making 50%
Xray- Can be viewed during reading time.
responses
•Onset time, prodrome, activities at time
•PMHx incl meds and imms
•Developmental and Fhx
•Treatment prior to arrival and effects
•Differential diagnoses-
•Pneumonia
•Inhaled FB
•Tumour
•Congenital
•Treatment_ oxygen, abx, fluids NBM,
•Early recognition of higher level fo care and planned peads TF for bronch
•PMHx incl meds and imms
•Developmental and Fhx
•Treatment prior to arrival and effects
•Differential diagnoses-
•Pneumonia
•Inhaled FB
•Tumour
•Congenital
•Treatment_ oxygen, abx, fluids NBM,
•Early recognition of higher level fo care and planned peads TF for bronch
CANDIDATE INSTRUCTIONS
Doctor Jones is a PGY3 junior doctor. He has asked you as the consultant on the shift to assist him with a parent who is insisting a CT Brain be done on her child. The history is as follows.
At your tertiary referral centre, it is 11 am on a Wednesday.
The patient, Johnny, is a 4 year old who is currently in a cubicle having been sent in by the local doctor after he hit his head on the corner of the coffee table. The injury occurred 2 hours ago. His GP had advised the parent that he requires a CT Brain as he was a little subdued for a minute or two after the accident and now has a bruise on the forehead measuring 3cm in diameter. There is nothing to find on examination. He has no other past medical history and is on no medications. He is currently happily playing on his parent’s mobile phone.
The patient is currently stable and under the care of a senior registrar and therefore you have time and/or several minutes to discuss this case with Dr Jones. Also Dr Jones has asked that you discuss this with the father who is insisting he gets a CT Brain and insisting he speaks with a senior consultant.
Your tasks are to assist the junior doctor to understand:
The risk stratification of head injury in children
Explain the various methods/scores to rule out severe head injury
To explain the relative risks to the parent
This OSCE will assess:
Medical Expertise
Scholarship and Teaching
Communication
At your tertiary referral centre, it is 11 am on a Wednesday.
The patient, Johnny, is a 4 year old who is currently in a cubicle having been sent in by the local doctor after he hit his head on the corner of the coffee table. The injury occurred 2 hours ago. His GP had advised the parent that he requires a CT Brain as he was a little subdued for a minute or two after the accident and now has a bruise on the forehead measuring 3cm in diameter. There is nothing to find on examination. He has no other past medical history and is on no medications. He is currently happily playing on his parent’s mobile phone.
The patient is currently stable and under the care of a senior registrar and therefore you have time and/or several minutes to discuss this case with Dr Jones. Also Dr Jones has asked that you discuss this with the father who is insisting he gets a CT Brain and insisting he speaks with a senior consultant.
Your tasks are to assist the junior doctor to understand:
The risk stratification of head injury in children
Explain the various methods/scores to rule out severe head injury
To explain the relative risks to the parent
This OSCE will assess:
Medical Expertise
Scholarship and Teaching
Communication
MARKING SHEET
CANDIDATE INSTRUCTIONS
This station is a Standardised Case-Based Discussion. You will be interacting directly with an Examiner. You will be asked to outline your assessment and management to the following clinical situation. Further information will be provided as the case evolves. The examiner will be assessing your medical knowledge as well as your reasoning and rationale to your approach and decisions.
Please be as specific as possible when answering. For example, when discussing drugs, describe your dosage regimen and the reasons why you chose that regimen, as opposed to other regimens.
Case Information:
You are the duty consultant of a Regional Base Hospital Emergency Department. A 3 yo child is brought to the emergency department as mother complains that hasn’t been walking properly for the past week and today refuses to put weight on the right leg.
On examination the patient is alert and in no distress. She is seated on the floor playing.
Examination demonstrates some minor tenderness in her foot but nothing else. The patient’s vitals are as follows:
HR 110 bpm
BP 110/40 mmHg
Sats 99% on RA
RR 26
The child has no past history, is fully immunised for her age.
This SCBD will assess the following domains:
·Medical Expertise (60%)
oInitial Management(20%)
oSpecific/further Management (40%)
·Prioritisation and Decision-making (40%)
Please be as specific as possible when answering. For example, when discussing drugs, describe your dosage regimen and the reasons why you chose that regimen, as opposed to other regimens.
Case Information:
You are the duty consultant of a Regional Base Hospital Emergency Department. A 3 yo child is brought to the emergency department as mother complains that hasn’t been walking properly for the past week and today refuses to put weight on the right leg.
On examination the patient is alert and in no distress. She is seated on the floor playing.
Examination demonstrates some minor tenderness in her foot but nothing else. The patient’s vitals are as follows:
HR 110 bpm
BP 110/40 mmHg
Sats 99% on RA
RR 26
The child has no past history, is fully immunised for her age.
This SCBD will assess the following domains:
·Medical Expertise (60%)
oInitial Management(20%)
oSpecific/further Management (40%)
·Prioritisation and Decision-making (40%)
RESPONSE
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MODULE 7: TOXICOLOGY
MODULE 8 SIMULATION
Links
Abstract of the PEAPETT Study
The TROICA Trial
| troica_trial.pdf |
COVID AIRWAY GUIDELINES
| anzics-covid-19-guidelines-version-1.pdf |
MODULE 9: ADMINISTRATION
MODULE 10: SCHolarship and teaching
| pocket_guide_to_teaching.pdf |
MODULE 11: THE COMMUNICATION OSCE
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Below is an OSCE you can try.
Record this on your phone- reduce it's size and email to me at [email protected]
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MODULE 12: PREDICTIONS
Over the next 2 weeks, we will upload information that will assist you in your final preparations for the exam.
Below is Will's synopsis of the predictions. More material to come in the coming week.
Below is Will's synopsis of the predictions. More material to come in the coming week.
MODULE 12.5
This link is to Safe Airway Society Paper that we are all using: https://www.safeairwaysociety.org/covid19/
his is the ACEM Document https://acem.org.au/Content-Sources/Advancing-Emergency-Medicine/COVID-19/Resources/Clinical-Guidelines
his is the ACEM Document https://acem.org.au/Content-Sources/Advancing-Emergency-Medicine/COVID-19/Resources/Clinical-Guidelines