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Station Infant with a rash

FOR THE MEDICAL STUDENT Remember the standard expected for this OSCE is of a competent PRHO. For this station you are expected to take the role of a PRHO working in general practice. Background Information

You are working as a PRHO in general practice. You see a parent with an irritable 10month-old boy with an itchy rash.
Task You be asked to take a focused and relevant dermatological history from the parent.

When you are ready, ask the examiner for the examination findings. You will be asked to explain your findings to the parent and agree a management plan with the parent
You do not need to remember these stages as the examiner will prompt you as you proceed through the station

Station Infant with a rash Notes to the patient You arrive with your 6-month-old son who has developed a rash over the last six weeks, mainly on his face and arms. Your son is constantly scratching his skin and in some places it has caused bleeding. This is your first child and you are worried and tired. You also state your childs skin is very dry, rough and the rash on his face makes him physically unattractive. He is irritable, sleeping poorly (as you are). You are worried that your child may be infective to other children and also worry that other friends children may not want to play with your unattractive son. You have not taken him to the weekly infant swimming class for over a month because you are too embarrassed by his skin condition. You wonder if a cream and/or dietary restrictions would help the rash (you would like to know more about eczema). He has never had a rash, lip swelling or any other problems that you can clearly link to foods. You are not sure how much you should bath him. Your child is otherwise well and has no asthma or hay fever. You had eczema as a child but this cleared but you have dry skin mild and hay fever. No-one else at home is itching

Station Infant with a rash


EXAMINER FORM (complete both pages) STUDENT NUMBER: Which Learning Outcomes are being assessed in this OSCE station? Students MUST be able to Take a dermatological history Describe cutaneous physical signs Explore a patients concerns and expectations Students should be able to formulate a differential diagnosis, describe the investigation and discuss the principles of care of patients with:

Itching (child = atopic dermatitis)

Background for Examiner You will briefly introduce the parent of a child with a rash and ask the student to take a focused dermatological history. You will describe the physical signs. You will tell the student that he /she is confident the child has atopic eczema and ask him to explain this diagnosis to the patient and discuss management. At the end of the whole exam session and not before, you will be feeding back to the student about their performance. For most students, you may feel their performance was fine. Do not tell them about pass/fail decisions. This feedback is about technique/approach.

Please start the exam off and indicate the next stages as appropriate as follows Please tell the student: You are working in general practice. This parent is consulting you for
the first time her child. Please take a focused and relevant dermatological history from the parent. After 5 minutes (if not already there) tell the student the clinical findings

The child has a rash as shown mainly on the face with a non-specific distribution elsewhere but sparing the nappy area. The rash appears non-infected. The rash affects the forearms and to a lesser extent his knees. The rest of the clinical examination is normal, and you believe the diagnosis to be atopic eczema.
Then say: Please can you explain the diagnosis to the parent and discuss options for management.

Station Infant with a rash


Assessment COMPETENCE Competence task Student takes dermatological history including symptoms, duration, treatments used/response, exacerbating factors, factors that make it better Shows awareness of need to ask about psychological and lifestyle impact child unattractive. Asks about family history. Elicits parent's ideas, concerns, expectations Completed Comment (only if reqd)

Student addresses patients anxieties-not contagious, can improve appearance, prognosis - may go away. Not a food allergy-no history of lip swelling or hives Explores treatment and how much time parent has for applying treatment Discusses likely outcome of treatment - control not cure, reduce itch, redness and scaling. Explains and negotiates management - emollients frequently, topical steroid x2/day Continue baths Good student should explain how to use treatment emollients liberally, stop soap and use emollient as soap, use topical steroids thinly May discuss side effects skin thinning-but reassure that mild steroids will not do this Good student will offer patient information leaflet, patient support group, website

Station Infant with a rash


Examiners should give a global assessment of each students performance at this station. The standard expected for this OSCE is that of a competent PRHO working in general practice. How do YOU feel the student has performed? You may take into account fluency and confidence of answers given. Please underline the descriptor that best describes the performance of this student: CLEAR FAIL Student does not ask appropriate questions and has no knowledge of treatment BORDERLINE Student takes history, but omits one aspect e.g. psycho-social aspects or symptoms, poor at counselling patient or negotiating treatment. CLEAR PASS Student covers points in history listed, responds appropriately to patients questions and works with the patient to decide on treatment. ABOVE EXPECTED STANDARD Student covers all points listed, shows insight into indications for different treatments and handles discussion confidently and accurately Finally, check the correct student details are at the top of the form. check the correct student details are at the top of the form.