Osce Obgyn

download Osce Obgyn

of 37

Transcript of Osce Obgyn

  • 8/17/2019 Osce Obgyn

    1/37

      1

    STATION 1. ANAMNESIS: GESTATIONAL AGE & ESTIMATED DELIVERY DATE

    Objectives:1.  To evaluate students ability in determining the appropriate gestational age and estimated

    delivery date

    2.  To evaluate student communication skills in obstetrics interviewing

    Instruction:

     A 24 years lady, house-wife, arrives to your clinic for medical interview due to a positive urinarypregnancy test which was performed yesterday morning

    Please perform a medical interview in determining :1.  the gestational age of her pregnancy2.  the estimated date of delivery (EDD)

    You have 5 minutes

  • 8/17/2019 Osce Obgyn

    2/37

      2

    Student No: ……………… Student Name: …………………………… 

    Check list for Station 1:Anamnesis: Gestational Age & Estimated Date of Delivery

    No Gestational Age & Estimated Date of Delivery 0 1 2 MaxScore

    1 Started with introducing her or himself to the patient 1

    2 Asked on the last menstrual period (LMP)-   Asked the first date of the last menstrual period-   Asked the regularity of the patient menstrual cycle

    2

    3 Explored specifically on the pattern of LMP and comparing to theprevious menstrual pattern-  Total days the bleeding occurred on the mentioned LMP-  The amount of the bleeding (blood loss) on the mentioned LMP

    or how many pads did the patient use during the mentioned

    LMP-  Compared to the previous cycles (length and quantity)-  Confirming the actual the first date of LMP

    2

    4 Mentioning the gestational age of the conceiving patient- On the 19th of December 2005, the gestational age is 10 weeks

    2

    5 Mentioning the estimated date of delivery- The EDD will be on the 17th of July 2006

    2

    6 Given information to the patient for the gestational age and theestimated date of delivery

    1

    Total Score 10PASSING GRADE 7

    0 = inadequate or not performed1 = some points covered2 = satisfactory coverage of all points

    Global ratings (please tick)

     Failed  Pass

    Comments :

    ……………………………………………………………………………………………. ……………………………………………………………………………………………. 

    FINAL MARK

    Examiner :

    ………………………. 

  • 8/17/2019 Osce Obgyn

    3/37

      3

    SCENARIO for Station 1:ANAMNESIS : Gestational Age & Estimated Date of Delivery

    No Question Answer

    1 Asked on the last menstrual period (LMP)-  When did the first date of the lastmenstrual period

    -  What is regularity of the patient menstrualcycle

    - The first date of the LMP was on the9 November 2005- The type and patterns of the patient

    menstrual period were regular cycle of28-30 days, length of bleeding 5-7 days,using 3-5 pads during the first three daysof the cycles, no pain, no blood cloths

    2 Explored specifically on the pattern of LMPand comparing to the previous menstrualpattern-  How many days the bleeding occurred on

    the mentioned LMP-  How much the amount of the bleeding(blood loss) on the mentioned LMP orhow many pads did the patient use duringthe mentioned LMP

    -  Compared to the previous cycles-  If the length of the mentioned LMP similar

    to the normally experienced by the patient-  If the quantity of the blood loss similar to

    the normally experienced by the patient-  Confirming the actual the first date of

    LMP

    -  On the 9th of November 2005 there wasonly a spotting menstrual blood flow, forthree days, and only less than half-full ofblood on the sanitarian pads

    -  On the 10th

     of October 2005, the patternof menstrual cycle was normal as theprevious experienced cycles, 7 daysbleed length in a normal amount of bloodloss by using 3-5 pads during the first 4days

    -  Confirmed the first date of the lastmenstrual period was on the 10th ofOctober 2005

    3 Calculated the gestational age of theconceiving patient

    On the 19th of December 2005, thegestational age is 10 weeks

    4 Calculated the estimated date of deliveryusing the formula of Naegele (D+7, M-3 andY+1)

    The EDD will be on the 17 th of July 2006

  • 8/17/2019 Osce Obgyn

    4/37

      4

    STATION 2: ABDOMINAL PALPATION OF PREGNANT WOMEN

    Objectives:1.  to evaluate students’ ability to conduct abdominal examination (palpation and auscultation)

    of pregnant women and interpret the result

    Instruction: A 29-year-old woman, G1 comes to your clinic to have an antenatal care.

    Please perform abdominal palpation to this patient and report the examination result (fetallie and fetal position).

    You have 5 minutes

  • 8/17/2019 Osce Obgyn

    5/37

      5

    Student No: …………………  Student Name: …………………….. 

    Checklist for Station 2: ABDOMINAL PALPATION OF PREGNANT WOMAN

    NO ABDOMINAL PALPATION OF PREGNANTWOMAN

    0 1 2 MAXSCORE

    1 Greet the patient and ask the patient to lie down 1

    2 Wash hands with warm water and dry with towel 1

    3 Take a position on the right of the patient facing rightlaterally

    1

    4 Advise the patient that the examination will be started 1

    5 Perform Leopold 1 properly 2

    6 Perform Leopold 2 properly 2

    7 Perform Leopold 3 properly 2

    8 Perform Leopold 4 properly 29 Advise the patient that the procedure has been done,

    remove the drape and help the patient tidy up herclothes

    1

    10 Report the result (fetal lie and fetal position) 2

    Total score 15PASSING GRADE 11

    0 = inadequate or not performed1 = some points covered2 = satisfactory coverage of all points

    Global ratings (please tick): Failed  Pass

    Comments:……………………………………………………………………………………………. ……………………………………………………………………………………………. 

    ……………………………………………………………………………………………

    FINAL MARK

    Examiner :

    ………………………. 

  • 8/17/2019 Osce Obgyn

    6/37

      6

    STATION 3: GYNAECOLOGICAL EXAMINATION: Bimanual Palpation

    Objectives

    -  to evaluate students’ competency in performing gynecological procedure and reporting theresult

    Instruction

    Mrs. A, 27 years old has complained of vaginal discharge since 2 months ago. She needs to beundergone gynecological examination. After having the patient’s informed consent to carry out theexamination, you ask the patient to empty the bladder and help the patient to lie on thegynecological bed. You have already washed your hands. 

    Please perform bimanual palpation to this patient and report the result.

    You have 5 minutes.

  • 8/17/2019 Osce Obgyn

    7/37

      7

    Student No: …………….  Student Name: ……………………… 

    Checklist for Station 3: GYNAECOLOGICAL EXAMINATION

    NO GYNAECOLOGICAL EXAMINATION: Bimanualpalpation

    0 1 2 MAXSCORE

    1 Wear the hand gloves properly 1

    2 Moist the antiseptic cotton and wipe the area of vulvaand perineum

    1

    3 Stand up position 1

    4 Do the vaginal touché properly 2

    5 Put the left fingertips on the suprasymphysis, anddetermine and report the height of fundus uteri

    2

    6 With the inside hand, determine and report the size ofthe uterus, its consistency and direction.

    2

    7 Determine and report the consistency of cervix andcondition of parametrium

    2

    8 Hold back the uterus at suprasymphisis region withthe left hand, and withdraw the right thumb and indexfinger

    1

    9 Wipe at the secretion/fluids on the abdominal wall andaround the vulva/perineum

    1

    Total score 13PASSING GRADE 9

    0 = inadequately or not performed1 = some points covered2 = satisfactory coverage of all points

    Global ratings (please tick): Failed  Pass

    Comments:……………………………………………………………………………………………. ……………………………………………………………………………………………. ……………………………………………………………………………………………

    FINAL MARK

    Examiner :

    ………………………. 

  • 8/17/2019 Osce Obgyn

    8/37

      8

    STATION 4: MANAGING 2nd STAGE OF LABOUR

    Objectives-  to evaluate students’ competency in performing assistance in second stage physiologic

    delivery

    Instruction

    You have Mrs. B, 27 years old, G2P1, with 39 weeks gestational age, singleton baby. The mother’sand baby’s condition are within normal limit. Vaginal examination reveals complete cervical dilationand the baby’s head is crowning. The amniotic membrane has already ruptured with clear amnioticfluid. The mother urges to push. You have already introduced yourself, worn the apron and washed

    your both hands, the patient has already been given the procedure’s information.

    Please perform second stage delivery assistance to deliver the baby.

    You have 5 minutes.

  • 8/17/2019 Osce Obgyn

    9/37

      9

    Student No: ……………..  Student Name: ………………………….. 

    Checklist for Station 4: MANAGING STAGE 2 OF LABOUR

    NO MANAGING STAGE 2 OF LABOUR 0 1 2 MAXSCORE

    1 Put on the sterile gloves 1

    2 Put on buttock sheet, leg sheet and drape for lowerabdomen

    1

    3  Ask the ‘mother’ to take a deep breath, close themouth tightly, and strain the abdominal muscles to thefull power.

    1

    4 Deliver infant’s head properly  2

    5 Let the infant’s head perform outward rotation, and ifnecessary assist that rotation

    1

    6 Deliver infant’s shoulder properly  27 Deliver infant’s body properly  2

    Total score 10PASSING GRADE 7

    0 = inadequately or not performed1 = some points covered2 = satisfactory coverage of all points

    Global ratings (please tick): Failed  Pass

    Comments:……………………………………………………………………………………………. ……………………………………………………………………………………………. ……………………………………………………………………………………………

    FINAL MARK

    Examiner :

    ………………………. 

  • 8/17/2019 Osce Obgyn

    10/37

      10

    STATION 5 : ACTIVE MANAGEMENT OF THE 3RD STAGE OF LABOUR

    Objectives

    -  to evaluate students’ competency in performing active management of the third stage oflabour

    Instruction 

    You have Mrs. B, 27-year-old, P2A0 who has delivered a baby boy of 3000 grams. The umbilicalcord has already been cut and clipped. You’ve already worn the gloves and apron.

    Please perform active third stage delivery assistance to deliver the placenta.

    You have 5 minutes.

  • 8/17/2019 Osce Obgyn

    11/37

      11

    Student No.: ……………………  Student Name: …………………….. 

    Checklist for Station 5:

    ACTIVE MANAGEMENT OF THE 3RD STAGE OF LABOUR 

    NO MANAGING THE 3RD STAGE OF LABOUR 0 1 2 MAXSCORE

    1 Administer oxytocin 10 units intramuscularly (reportto the examiner, which drug that the examinee chooseand how it will be administered)

    2

    Controlled cord traction

    2 Clamp the cord close to the perineum using spongeforceps. Hold the clamped cord and the end of theforceps with one hand.

    1

    3 Place the other hand just above the woman’s pubic

    bone and stabilize the uterus by applying countertraction during controlled cord traction.

    1

    4 Keep slight tension on the cord and await a stronguterine contraction

    2

    5 When the uterus becomes rounded or the cordlengthens, very gently pull downward on the cord todeliver the placenta.. Continue to apply countertraction to the uterus with the other hand

    2

    6 Check the placenta to be sure none of it is missing 1

    7 Uterine massage 2

    Subtotal score

    Total score 11PASSING GRADE  8

    0 = inadequately or not performed1 = some points covered2 = satisfactory coverage of all points

    Global ratings (please tick): Failed  Pass

    Comments:……………………………………………………………………………………………. ……………………………………………………………………………………………. ……………………………………………………………………………………………

    FINAL MARK

    Examiner :

    ………………………. 

  • 8/17/2019 Osce Obgyn

    12/37

      12

    STATION 6 : GYNAECOLOGICAL EXAMINATION:

    External Genitalia Inspection and Examination with Speculum

    Objectives-  to evaluate students’ competency in performing gynecological procedure (inspection) and

    reporting the result

    Instruction

    Mrs. A, 27 years old has complained of vaginal discharge since 2 months ago. She needs to beundergone gynaecological examination. After having the patient’s informed consent to carry out theexamination, you ask the patient to empty the bladder and help the patient to lie on thegynaecological bed.  You have already washed your hands. 

    Please perform external genitalia examination and speculum examination to this patient andreport the result.

    You have 5 minutes.

  • 8/17/2019 Osce Obgyn

    13/37

      13

    Student No: …………….  Student Name: ………………………… 

    Checklist for Station 6: GYNAECOLOGICAL EXAMINATION

    NO GYNAECOLOGICAL EXAMINATION: Inspection &Speculum Examination

    0 1 2 MAXSCORE

    1 Wear the hand gloves properly 1

    2 Moist the antiseptic cotton and wipe the area of vulvaand perineum

    1

    3 Observe and report the area of vulva and perineum 1

    4 Open both clefts of labium majus, observe and reportthe urethral orifice and introitus

    1

    5 Pick up speculum with the right hand, and insert theleft index fingertip into introitus (to expose it).

    1

    6 Insert the speculum properly 1

    7 Press the raising button so that vaginal lumen andportio is clearly exposed

    1

    8 Observe and report the color of portio, vaginal walls,and vaginal secretion or fornix

    1

    9 Put the speculum in the designated place 1

    Total score 9PASSING GRADE 6

    0 = inadequately or not performed1 = satisfactory coverage of all points

    Global ratings (please tick): Failed  Pass

    Comment:………………………………………………………………………….. ………………………………………………………………………….. 

    FINAL MARK

    Examiner :

    ………………………. 

  • 8/17/2019 Osce Obgyn

    14/37

      14

    STATION 7: PAP TEST

    Objectives

    -  to evaluate students’ competency in per forming PAP test

    Instruction

     A 25-year-old woman presents to the hospital in order to undergo annual pap smear examination.You have already washed your hands and worn the gloves.  

    Please perform pap smear examination appropriately to the patient.

    You have 5 minutes. 

  • 8/17/2019 Osce Obgyn

    15/37

      15

    Student No: …………………  Student Name: ……………………….. 

    Checklist for Station 7: PAP TEST 

    PAP TEST

    0 1 2 Max score

    1 Insert the speculum 1

    2 Locate the cervix 1

    3 Collect a sample of cells from the cervix. Use eitherwooden spatula, cytobrush, or cervix sampler

    2

    4 Insert the sampling device into the ostium cervix,either rotate 180o if using the cytobrush or  rotate360o if using the wooden spatula

    2

    5 Transfer the sample to the glass slide

    6 Put in the fixative solution immediately, beforeremoving the speculum

    2

    Total score 8PASSING GRADE 6

    0 = inadequately or not performed1 = some points covered2 = satisfactory coverage of all points

    Global ratings (please tick): Failed  Pass

    Comments:……………………………………………………………………………………………. ……………………………………………………………………………………………. ……………………………………………………………………………………………

    FINAL MARKExaminer :

    ………………………. 

  • 8/17/2019 Osce Obgyn

    16/37

      16

    STATION 8: ANAMNESIS: VAGINAL DISCHARGE (STD)

    Objectives:1.  To evaluate students’ ability in performing oriented medical interview of patient with vaginal

    discharge2.  To evaluate students’ communication skills in medical interview. 

    Instruction:

    Ms N, 19-year-old presents with complaint of vaginal discharge since 1 month ago.

    Please perform problem oriented medical interview regarding her problem.

    You have 5 minutes.

  • 8/17/2019 Osce Obgyn

    17/37

      17

    Student No: ……………… Student Name: …………………………. 

    Checklist for Station 8: ANAMNESIS – VAGINAL DISCHARGE (STD)

    No. STD Anamnesis 0 1 2 3 Max Score

    1 Introduction to the patient 1

    2 Demonstrates respect and compassion for patientsand (their families)

    1

    3 Asked about chief compliant and the onset 1

    4 Searching the patient risk factor for STD 3

    5 Asked about patient disease history 2

    6 Asked about characteristic of compliant (itching,burning sensation, pain, characteristic of fluor,color)

    3

    7 Asked about patient therapeutic history (drugs,douching, etc) 2

    8 Asked about history of sexual intercourse 2

    9 Asked about the sexual partner 1

    10 Asked about the sexual partner compliant (Ping-pong Phenomena)

    1

    11 Asked about contraception 2

    12 Suggest to treat the sexual partner 2

    13 Clarified patient statement with specific questions 2

    14 Closing statement and suggestion to the patient 1

    Total score 24

    PASSING GRADE 17

    0 = inadequate or not performed1 /2 = some point covered2/3 = satisfactory all point covered

    Global ratings (please tick) Failed  Pass

    Comments:……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… 

    FINAL MARK

    Examiner :

    ………………………. 

  • 8/17/2019 Osce Obgyn

    18/37

      18

    Scenario for standardized patient Station 8: STD ANAMNESIS

    No. STD Anamnesis Answers

    1 Asked about chief compliant and the onset Vaginal discharge

    2 Searching the patient risk factor for STD - unmarried

    - multi partner- smoking

    3 Asked about patient disease history 1 month, no history of the samedisease before

    4 Asked about characteristic of compliant (itching, burning sensation, pain,characteristic of fluor, color)

    5 Asked about patient therapeutic history (drugs,douching, etc)

    Using vaginal douche

    6 Asked about history of sexual intercourse Yes, she has

    7 Asked about the sexual partner Multi-partner, without any sexualprotection devices

    8 Asked about the sexual partner compliant (Ping-pong Phenomena)

    There is one of her partner thatcomplain of itching in his penis

    9 Asked about contraception She always use morning-after pill

  • 8/17/2019 Osce Obgyn

    19/37

      19

    STATION  9: KONSELING KONTRASEPSI PIL

    Tujuan:1.  Untuk mengevaluasi kemampuan kandidat untuk memberikan konseling mengenai

    penggunaan kontrasepsi pil

    Kasus

    Ny. M, 26 tahun, para 1, dengan bayi berusia 8 bulan, sudah berhenti menyusui eksklusif, datangke klinik Anda dan menginginkan kontrasepsi pil.

    Instruksi 

    Berikanlah konseling pada klien mengenai kontrasepsi pil, sesuai dengan yang ditanyakan olehklien!

    Waktu Anda 5 menit.

  • 8/17/2019 Osce Obgyn

    20/37

      20

    Student No: ………………….. Student Name: …………………………… 

    Checklist  for Station 9: KONSELING KONTRASEPSI PIL

    No. Tanggapan kandidat atas pertanyaan klien 0 1 2 3Skor

    maks.

    1 Menyapa pasien dan memperkenalkan diri 12 Menjawab cara kerja kontrasepsi pil (1 poin untuk setiap

    1 jawaban benar. Skor maksimal 2)2

    3 Menjelaskan keuntungan kontrasepsi pil(1 poin untuk setiap 1 jawaban benar. Benar 3 atau lebihskor 3 [maksimal])

    3

    4 Menjelaskan keterbatasan kontrasepsi pil(1 poin untuk setiap 1 jawaban benar. Benar 3 atau lebihskor 3 [maksimal])

    3

    5 Menjelaskan kontraindikasi penggunaan kontrasepsi pil(1 poin untuk setiap 1 jawaban benar. Benar 3 atau lebih

    skor 3 [maksimal])

    3

    6 Menjelaskan cara penggunaan kontrasepsi pil(1 poin untuk setiap 1 jawaban benar. Benar 3 atau lebihskor 3 [maksimal])

    3

    7 Menjelaskan tindakan apa yang harus dilakukan bila lupaminum pil(1 poin untuk setiap 1 jawaban benar. Benar 3 atau lebihskor 3 [maksimal])

    3

    8 -- -

    Skor Total 18

    BATAS LULUS 12

    Penilaian umum (mohon beri tanda): Gagal  Lulus

    Komentar:……………………………………………………………………………………………. 

    ……………………………………………………………………………………………. ……………………………………………………………………………………………

    NILAI AKHIR

    Penguji: 

    ………………………. 

  • 8/17/2019 Osce Obgyn

    21/37

      21

    Skenario untuk konseling kontrasepsi pil (Station 9)

    No. Klien (resident) Dokter (kandidat)

    1  Selamat pagi, Dok!Selamat pagi, Ibu M. Saya dr. (menyebut namanya)

    (berjabat tangan)2 Bagaimana sih Doksebenarnya cara kerja pilkontrasepsi itu?

    Cara kerja pil kontrasepsi:1.  menekan ovulasi (pelepasan sel telur)2.  mengentalkan lendir leher rahim sehingga sulit

    dilalui oleh sperma

    3 Oh, begitu. Lalu, apakahkeuntungannya bila sayamenggunakan kontrasepsi pil?

    Oh, keuntungannya banyak, di antaranya adalah:1.  efektivitasnya tinggi bila digunakan secara tepat risiko kegagalan kecil (1 kehamilan/1000wanita dalam tahun pertama penggunaan)

    2.  risiko terhadap kesehatan kecil3.  tidak mengganggu hubungan seksual

    4.  siklus haid menjadi teratur, darah haid berkurang5.  mudah dihentikan setiap saat6.  kesuburan segera kembali setelah penggunaan

    pil dihentikan

    4 Wah, banyak sekalimanfaatnya ya, Dok. Kalausaya boleh tahu, adakahkerugiannya bila sayamenggunakan pil?

    Oh, tentu saja setiap metoda ada kelebihan dankekurangannya. Kekurangannya di antara lain seperti:

    1.  harus teratur penggunaannya, jangan sampailupa

    2.  mungkin dapat membosankan karena harusdiminum setiap hari

    3.  dapat terjadi mual, terutama pada 3 bulan

    pertama4.  ada efek samping seperti pusing, nyeripayudara, kenaikan berat badan sedikit (namunefek samping tersebut tidak selalu ada, jadibersifat individual)

    5.  sebaiknya tidak digunakan pada wanita yangmasih menyusui (dapat mengurangi ASI)

    6.  tidak dapat mencegah penyakit menular seksual,hepatitis B, infeksi HIV

    5 Wah, saya masih menyusui,Dok. Tapi sudah tidak eksklusif.

     Apakah saya bolehmenggunakan pil?

    Yang tidak dapat menggunakan pil adalah yang:1.  masih menyusui eksklusif

    2.  hamil atau dicurigai hamil3.  ada perdarahan per vagina yang belum diketahuisebabnya

    4.  perokok berusia > 35 tahun5.  riwayat darah tinggi, penakit jantung6.  punya penyakit hati akut (hepatitis)7.  kepatuhannya diragukan/sering lupa8.  kanker payudara atau yang dicurigai kanker

  • 8/17/2019 Osce Obgyn

    22/37

      22

    payudara

    6 Baiklah Dok. Setelahmempertimbangkan masak-masak dan juga saya telahberdiskusi dengan suami, saya

    memilih menggunakan pil.Bagaimanakah cara yangterbaik untukmenggunakannya?

    Bagus. (sambil menerangkan, dokter menunjukkanpanah-panah pada kemasan)

    1.  Pil sebaiknya diminum pada saat yang samasetiap hari, misalnya setiap pagi atau setiap

    malam (waktunya sama)2.  Jangan sampai lupa / terlewat3.  Dianjurkan diminum saat hari pertama haid4.  Bila paket berisi 28 pil, minum sampai habis dan

    mulai lagi dengan kemasan baru5.  Bila paket berisi 21 pil, setelah paket habis,

    tunggu satu minggu, kemudian baru minum pildari paket yang baru.

    7 Bagaimana bila saya lupaminum pil satu hari, Dok? Atau

    lupa 2 hari atau lebih?Berbahayakah?

    1.  Bila lupa minum1 pil, sebaiknya minum segerasetelah ingat, dan minum sekaligus 2 pada hari

    yang sama.2.  Bila lupa 2 pil atau lebih, minum 2 pil setiap harisampai sesuai jadualnya kembali, dan sebaiknyagunakan metoda kontrasepsi lain (misalnyakondom) atau tidak melakukan hubunganseksual sampai haid kembali.

    3.  Bila tidak haid, segera ke klinik untuk ujikehamilan

    8 Baiklah, terima kasih Dok. Sayapermisi.

    Terima kasih kembali

  • 8/17/2019 Osce Obgyn

    23/37

      23

    STATION 10: PRE-IUCD INSERTION COUNSELING

    Objectives:

    1.  To evaluate students’ ability in conducting specific method (IUCD) and pre -insertioncounseling

    Instruction: A woman of 28 years old comes to your clinic in order to get more information about IUCD. She isP2A0 with children of 3 years old girl and 1 month-old baby boy. She and her husband havealready decided to use IUCD contraceptive method to limit the number of their children. They’vealready sought the information from their relatives and internet.

    Please give information about IUCD insertion procedure to the patient

    You have 5 minutes.

  • 8/17/2019 Osce Obgyn

    24/37

      24

    Student No: …………….. Student Name: …………………………… 

    Checklist for Station 10: PRE-IUCD INSERTION COUNSELING

    NO PRE-IUCD INSERTION COUNSELING 0 1 2 MAXSCORE

    1 Greet the client warmly and introduce her/himself 1

    2 Show the IUCD and explain the mechanism of IUCDand its effectiveness 

    2

    3 Explain the possible side effects and other problemsthat may be encountered

    2

    4 Show the site and explain the process of IUCDinsertion and what the patient may feel during andafter the insertion 

    2

    5 Explain examinations, which are needed prior theIUCD insertion to determine whether the IUCDinsertion procedure could be done or not.

    2

    6 Ask if she needs more information before IUCDinsertion procedure executed

    1

    Total score 10PASSING GRADE : 7

    0 = inadequate or not performed1 = some points covered2 = satisfactory coverage of all points

    Global ratings (please tick): Failed  Pass

    Comments:

    ……………………………………………………………………………………………. ……………………………………………………………………………………………. ……………………………………………………………………………………………

    FINAL MARK

    Examiner :

    ………………………. 

  • 8/17/2019 Osce Obgyn

    25/37

      25

    STATION 11: OPERATIVE VAGINAL DELIVERY – FORCEPS

    Mrs. A, 27 years old, Gravida 1 at 41 weeks of gestational age. Uncomplicated pregnancy.Spontaneous labor onset 16 hours ago, 4 cm to fully dilated in 6 hours. She had spontaneousrupture of membrane 5 hours ago. From obstetrical examination: estimated fetal weight 3000grams, normal average pelvic. Contraction 3 times in 10 minutes, 40”, average with goodrelaxation. FHR 80 bpm during and after contraction.On inspection, there was greenish amniotic fluid came from vagina.

    What would you do now?

    You have 5 minutes

  • 8/17/2019 Osce Obgyn

    26/37

      26

    Student No: …………….  Student Name: ……………………… 

    Checklist for Station 11: OPERATIVE VAGINAL DELIVERY: FORCEPS

    If the candidate choose forceps assisted delivery, tell him/her to perform it on the phantom, anddiscuss the process as they go.

    0 1 2 MaxScore 

    Anesthesia - give local anesthetic (infiltration) to the perineum 2

    Bladder - in/out catheterization or ensure empty bladder 2

    Cervix - fully dilated 1

    Determine position, station and pelvic adequacy(examinee determines position on the model)

    - occiput anterior 1

    - membrane has ruptured 1

    - head on Hodge IV 1

    Equipment - check and articulate forceps 1Forceps - lubricate 1

    - phantom application, consider left forcep first 1- left blade, left hand, maternal left side, pencil gripand vertical insertion, with thumb directiong the blade

    2

    - right blade, right hand, maternal right side, pencilgrip and vertical insertion with left thumb directing theblade

    2

    - lock blades and support 1

    - check application:

      posterior fontanelle 1 cm above plane ofshanks

      fenestration not > fingerbreadth between itand scalp

      sagital suture in perpendicular to plane ofshanks with occipital sutures 1 cm aboverespective blades

    1

    1

    1

  • 8/17/2019 Osce Obgyn

    27/37

      27

    0 1 2 Maxscore 

    Gentletraction

    -  applied gently with contraction/expulsive effort(forearm bent)

    2

    Handleelevated

    -  traction in axis of birth canal-  do not elevate handle too early, wait for occiput

    under pubic arch

    11

    Incision - consider episiotomy if laceration imminent a perineumdistends

    1

    Jaw - remove forceps when jaw is reachable or deliveryassured

    1

    Total score 25

    PASSING GRADE 17

    0 = inadequate or not performed1 = some points covered2 = satisfactory coverage of all points

    Global ratings (please tick): Failed  Pass

    Comments:……………………………………………………………………………………………. ……………………………………………………………………………………………. …………………………………………………………………………………………… 

    FINAL MARK

    Examiner :

    ………………………. 

  • 8/17/2019 Osce Obgyn

    28/37

      28

    STATION 12: KOMPRESI UTERUS BIMANUAL INTERNA

     Anda baru saja melakukan persalinan per vaginam anak pertama pada seorang nyonya, 20tahun, berat badan lahir 3500 gram. Setelah plasenta dilahirkan lengkap dan Anda pastikantidak ada laserasi jalan lahir, Anda mendapatkan uterus tidak berkontraksi, perdarahan pervaginam masih berlangsung.Tindakan apa yang akan Anda lakukan sekarang?

    Waktu Anda 5 menit.

  • 8/17/2019 Osce Obgyn

    29/37

      29

    Student No: …………….  Student Name: ……………………… 

    Checklist for Station 12: KOMPRESI UTERUS BIMANUAL INTERNA

    Jika kandidat memilih kompresi uterus bimanual interna, perintahkan ia untuk memperagakannya

    pada fantom, dan diskusikan proses ini ketika berlangsung.

    0 1 2  SkorMaks.

    Persiapan Pastikan kandung kemih telah kosong / kosongkankandung kemih dengan kateter

    2

    - penolong berdiri di depan vulva dan memberitahukanpada pasien apa yang akan dilakukan (memasukkantangan ke dalam vaginanya)

    2

    - penolong mengenakan sarung tangan danmengoleskan larutan antiseptik pada sarung tangan

    kanan

    2

    - Dengan ibu jari dan telunjuk tangan non dominanmenyisihkan kedua labia minora ke lateral dan tangandominan secara obstetrik dimasukkan melalui introitusvagina

    2

    - Kepalkan tangan dominan dan letakkan dataranpunggung jari telunjuk hingga kelingking pada forniksanterior, dorong uterus ke arah kranio-anterior

    2

    - Tapak tangan non dominan menekan bagian belakangkorpus uteri

    2

    - Lakukan kompresi dengan jalan mendekatkan telapaktangan kiri dengan kepalan tangan kanan pada forniksanterior

    2

    Evaluasi- Perhatikan perdarahan yang terjadi. Bila perdarahanberhenti, pertahankan posisi demikian hingga kontraksiuterus membaik.

    2

    Pascatindakan

    - Keluarkan tangan kanan, bersihkan sarung tangan danrendam dalam larutan klorin 0,5%

    2

    - Cuci tangan dan lengan, keringkan dengan handuk. 2

    Total skor 20PASSING GRADE 14

  • 8/17/2019 Osce Obgyn

    30/37

      30

    0 = inadequate or not performed1 = some points covered2 = satisfactory coverage of all points

    Global ratings (please tick): Failed  Pass

    Comments:……………………………………………………………………………………………. ……………………………………………………………………………………………. …………………………………………………………………………………………… 

    FINAL MARK

    Examiner :

    ………………………. 

  • 8/17/2019 Osce Obgyn

    31/37

      31

    STATION 13: KURETASE PADA ABORTUS INKOMPLIT

    Tujuan:

    1.  Kandidat dapat melakukan kuretase tajam pada kasus abortus inkomplit

    Kasus:

    Ny. S, 19 tahun, mengalami perdarahan per vaginam saat usia kehamilan 8 minggu. Dari hasilpemeriksaan, Anda mendiagnosisnya sebagai abortus inkomplit dan Anda merenanakan kuretasetajam. Pasien telah menandatangani informed consent   dan telah mendapatkan anestesineuroleptik. Anda siap melakukan tindakan kuretase.

    Waktu Anda 5 menit.

  • 8/17/2019 Osce Obgyn

    32/37

      32

    Student No: …………….  Student Name: ……………………… 

    Checklist for Station 13:

    MELAKUKAN KURETASE TAJAM PADA ABORTUS INKOMPLIT

    No.Tindakan 0 1 2  SkorMaks.

    1.Pastikan kandung kemih telah kosong / kosongkan kandungkemih dengan kateter

    1

    2. Kandidat melakukan pemeriksaan dalam ulang dalam narkosisuntuk memastikan besar dan arah uterus

    2

    3. Kandidat melepaskan sarung tangan dan menggantinya denganyang baru dan steril

    1

    4. Kandidat melakukan a- dan antisepsis genitalia eksterna dansekitarnya

    1

    5. Kandidat memasang spekulum Sims (dengan bantuan asisten)

    dan menampakkan porsio, kemudian porsio dibersihkan denganlarutan antiseptik

    2

    6. Kandidat memasang tenakulum pada bibir atas serviks,melepaskan spekulum anterior dan memegang tenakulumdengan tangan non-dominan

    1

    7. Kandidat melakukan sondase dan menyebutkan panjang danarahnya

    2

    8.Kandidat memasukkan sondase ke dalam wadah berisi klorin0,5%

    1

    9. Kandidat mengambil jaringan sisa konsepsi dengan tang abortus 1

    10. Kandidat melakukan kuretase secara sistematik sampai kavumuteri diyakini bersih

    2

    11. Kandidat mengevaluasi apakah masih terdapat perdarahan darikanalis servikalis

    1

    12. Kandidat melepaskan tenakulum dan meyakinkan tidak adaperdarahan dari lubang bekas tusukan tenakulum

    1

    13. Kandidat membersihkan porsio dengan antiseptik 1

    14. Kandidat melepaskan spekulum dan meletakkan semua alat kedalam ember berisi larutan klorin 0,5%

    2

    15. Kandidat mencuci tangan dan lengan, mengeringkannya denganhanduk.

    1

    Total score 20PASSING GRADE 14

  • 8/17/2019 Osce Obgyn

    33/37

      33

    0 = inadequate or not performed1 = some points covered2 = satisfactory coverage of all points

    Global ratings (please tick): Failed  Pass

    Comments:……………………………………………………………………………………………. ……………………………………………………………………………………………. …………………………………………………………………………………………… 

    FINAL MARK

    Examiner :

    ………………………. 

  • 8/17/2019 Osce Obgyn

    34/37

      34

    STATION 14. PEMASANGAN AKDR

    Tujuan 

    1.  Mengevaluasi kemampuan kandidat untuk melakukan pemasangan AKDR (alat

    kontrasepsi dalam rahim)

    Instruksi

    Lakukanlah pemasangan AKDR Copper -T 380 A pada klien ini. Klien sudah mendapatkankonseling dan sudah dalam posisi litotomi.

    Waktu Anda 5 menit

  • 8/17/2019 Osce Obgyn

    35/37

      35

    Student No: …………….  Student Name: ……………………… 

    Checklist for Station 14:

    MELAKUKAN PEMASANGAN AKDR PADA KLIEN

    No.Tindakan 0 1 2  SkorMaks.

    1.Pastikan kandung kemih telah kosong / kosongkan kandungkemih dengan kateter

    1

    2. Kandidat memasukkan lengan AKDR Cu T 380A di dalamkemasan sterilnya

    2

    3. Kandidat memakai sarung tangan baru 1

    4. Kandidat melakukan a- dan antisepsis genitalia eksterna dansekitarnya

    1

    5. Kandidat memasang spekulum cocor bebek dan menampakkanporsio

    1

    Kandidat mengusap vagina dan serviks dengan larutan antiseptik 16. Kandidat memasang tenakulum pada bibir atas serviks,

    melepaskan spekulum anterior dan memegang tenakulumdengan tangan non-dominan

    2

    7. Kandidat melakukan sondase dan menyebutkan panjang danarahnya (teknik tidak menyentuh [no touch technique])

    2

    8.Kandidat menggeser biru pada tabung inserter sesuai dengandalam uterus, kemudian ia membuka seluruh plastik penutupkemasan

    2

    9. Kandidat memasang AKDR dengan teknik withdrawal   210. Kandidat menggunting benang AKDR, melepaskan dan

    mengeluarkan tenakulum dan spekulum2

    14. Kandidat memasukkan semua alat setelah digunakan ke dalamember berisi larutan klorin 0,5%

    2

    15. Kandidat mencuci tangan dan lengan, mengeringkannya denganhanduk.

    1

    Total score 20PASSING GRADE 14

    0 = inadequate or not performed1 = some points covered2 = satisfactory coverage of all points

    Global ratings (please tick): Failed  Pass

    Comments:…………………………………………………………………………………… 

    FINAL MARK

    Examiner :

    ………………………. 

  • 8/17/2019 Osce Obgyn

    36/37

      36

    STATION 15: VAGINAL DELIVERY OF BREECH PRESENTATION

    Objective

    1.  to perform vaginal delivery of breech presentation

    Instruction:

    ………. ……….. 

  • 8/17/2019 Osce Obgyn

    37/37

    Student No: …………………..  Student Name: ………………………….. 

    Checklist for Station 15:

    MELAKUKAN PERSALINAN PER VAGINAM PADA SUNGSANG

    No.Tindakan 0 1 2  Skor

    Maks.

    1.Pastikan kandung kemih telah kosong / kosongkan kandungkemih dengan kateter

    1

    2. 2

    3. 14. 1

    5. 1

    1

    6. 27. 2

    8.2

    9. 2

    10. 2

    14. 2

    15. Kandidat mencuci tangan dan lengan, mengeringkannya denganhanduk.

    1

    Total scorePASSING GRADE

    0 = inadequate or not performed1 = some points covered2 = satisfactory coverage of all points

    Global ratings (please tick): Failed  Pass

    Comments:

    …………………………………………………………………………………… ……………………………………………………………………………………. …………………………………………………………………………………….. 

    FINAL MARK

    Examiner :

    ……………………….