SCBD

The purpose of the SCBD station is to allow enhanced depth of assessment within the domains of Medical Expertise and Prioritisation and Decision Making. There may be up to three of these stations in each exam. In the SCBD stations, the candidate will be asked to outline their approach to assessment and/or management of the clinical situation presented and to outline their reasoning or rationale behind their decision making. The candidate will be asked to respond to further questions as additional information is provided. The candidates will be discussing and answering standardised questions directly to an examiner rather than a role player. The reading material outside the station will clearly indicate what is expected.

Further information about the SCBD stations can be found in the Standardised Case-Based Discussion (SCBD) General Instructions available on the Fellowship Examination Resources site.


SCBD stations from recent ACEM OSCEs:

  • Assessment and management of an elderly female patient who has presented with sepsis and respiratory failure in the setting of other comorbidities.

  • Assessment and management of an unstable patient with significant lower limb trauma who has arrived via primary retrieval (helicopter) following a high-speed motor bike collision.

  • Management of a paediatric patient presenting with a post-tonsillectomy haemorrhage.

  • Assessment and management of an adult male patient with a history of metastatic melanoma who has presented unwell to the ED.

  • Management of a geriatric patient who has fallen from a step ladder onto concrete.

  • Demonstrate skills in team leadership and in managing an agitated patient.


Typical tasks

  • Outline your approach to the clinical situation, with rationale.

or

  • Outline your priorities in the investigation and management of the patient.

  • Answer the examiner’s further questions as the case evolves.

Domains that have been tested in recent OSCEs

  • Medical Expertise: Assessment and Diagnosis

- Identifies elements on initial assessment to formulate an initial management plan

- Performs a focused physical assessment relevant to detect serious, limb or life threatening injury

- Generates a relevant list of differential diagnoses with an inherent focus on conditions requiring time critical management

- Formulates a provisional diagnosis to match the immediate issues

- Creates a focused investigation plan with rationale

- Analyses the results of an ECG to identify relevant findings or patterns


  • Medical Expertise: Management

- Initiates treatments specific to identified abnormalities in … (e.g. airway and/or ventilation, or circulation)

- Acts on time critical investigations results as they arise

- Recognises and expedites any specific intervention essential to resuscitation

- Adapts and initiates standard therapies to that patient, including drugs, fluids, gases, and monitoring

- Formulates a further management plan following initial assessment and investigations

- Formulates an appropriate disposition plan

- Summarises and prioritises the key issues that must be addressed during and following the emergency encounter


  • Prioritisation and Decision Making

- Summarises and prioritises the key issues that must be addressed during and following the emergency encounter

- Provides a rationale to explain and justify decisions about ongoing assessment, management and disposition

- Highlights high-risk features identified during initial patient assessment

- Highlights which of a number of selected investigations has higher priority

- Prioritises essential components of ongoing assessment

- Prioritises chosen treatment options to create an appropriate escalating treatment plan

- Incorporates input from the patient/care givers to ensure shared decision-making for a complex critical patient where there is no clear course of action


ACEM OSCE report feedback

Examiners reported that candidates who performed well in the station:

  • had a structured approach to the station and expressed themselves clearly.

  • were able to synthesise the clinical information and consider the patient’s medical history and medications and how these would impact the patient's current presentation.

  • were able to outline priorities in their initial assessment and resuscitation and to then modify and justify their approach to ongoing resuscitation based on further case information.

  • recognised the critical nature of the presentation and the urgency to act with a need for resuscitation and potential airway management

  • gave specific details of the actions they would take in assessment and management of the patient as opposed to generic resuscitation responses.

  • correctly identified the ECG findings, escalated their management without prompting.


Examiners reported that candidates who did not perform as well in the station:

  • did not appreciate the factors contributing to the risk of a procedure and did not address these factors in their management.

  • were less structured in their approach and their preparation (e.g. for a potentially difficult intubation) was not done well.

  • did not focus on the initial priorities as asked to but commenced a full trauma assessment.

  • did not respond to prompts that attempted to guide them back to the focus of the OSCE.

  • did not appropriately address the 'assessment' section

  • failed to describe an adequate stepwise approach to management in specific detail

  • did not adequately justify their choice of respiratory support

  • gave a generic major trauma approach or made a decision to palliate without justifying

  • gave an inappropriate prognosis and/or did not proportionately address prognosis with the relative

  • had knowledge gaps e.g. ECG interpretation.