Ethics OSCE

[Goyf17]

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In reviewing the content outline for the OSCE, all of the sections make sense except for the ethics one. It just seems like a laundry list of potential ethical issues in no particular order, and I can't imagine what the graders will want me to demonstrate in the standardized patient interaction.

Without violating any confidentiality agreements with the ABA, can anyone help give me some idea of what to expect? I really do not want to fail this, but I've heard the exam is quite arbitrary and have no idea how to prepare for this.

 

[okayplayer]

I can’t help you but the fact this is a thing is hilarious.

 

[DM27]

The ethics OSCE is you and a patient actor where the patient actor is asking for something that is ethically wrong but from my experience and that of others is not overtly nuts. You pass by saying no and explaining why it's wrong in a coherent way. The following are not any of the actual scenarios I am aware of, but are situations I would say are somewhat similar in terms of being overtly against your professional ethics but not outright nuts.

Patient brings in their child for a procedure, but is not allowed to have the day off to care for them afterwards and cant' afford daycare, parent wants a note telling their employer they were ill and had to miss work.

Patient with OSA and COPD has an intense fear of waking up with a breathing tube and his wife who is his health care proxy wants you to guarantee him he won't be awake in any way before extubation even though you and the wife acknowledge to each other it won't be true.

Patient needs an urgent-to-emergent procedure but is refusing because of a past addiction and fear of receiving any form of pain medication, family wants you to convince him procedure won't be painful so he'll go ahead with it.

I made these up so they are fairly weak. But it seems to usually involve some form of reasonable, but fairly obviously wrong, form of deception that violates one or more ethical principles.

 

[drmwvr]

I can’t help you but the fact this is a thing is hilarious.

I'll play...ethics being a thing is hilarious?

 

[okayplayer]

I'll play...ethics being a thing is hilarious?

The entire OSCE strikes me as an absurd waste of money and a blatant cash grab from the ABA.

 

[ZzzPlz]

Reminds me of step 2 cs, where English proficiency and common sense will get you through

 

[drmwvr]

The entire OSCE strikes me as an absurd waste of money and a blatant cash grab from the ABA.

Got it. Fair statement.

 

[DM27]

I agree that the ethics thing is ridiculous, the OSCE feels like another thing where the very existence as a requirement for US ACGME-accredited residency graduates seems to show a strong lack of confidence in the minimum level of skill being graduated.

 

[Goyf17]

I can’t help you but the fact this is a thing is hilarious.

Well, I'm not laughing. My future depends on passing this arbitrary and capricious test. Last I saw the pass rate was around 70%.

 

[Goyf17]

The ethics OSCE is you and a patient actor where the patient actor is asking for something that is ethically wrong but from my experience and that of others is not overtly nuts. You pass by saying no and explaining why it's wrong in a coherent way. The following are not any of the actual scenarios I am aware of, but are situations I would say are somewhat similar in terms of being overtly against your professional ethics but not outright nuts.

Patient brings in their child for a procedure, but is not allowed to have the day off to care for them afterwards and cant' afford daycare, parent wants a note telling their employer they were ill and had to miss work.

Patient with OSA and COPD has an intense fear of waking up with a breathing tube and his wife who is his health care proxy wants you to guarantee him he won't be awake in any way before extubation even though you and the wife acknowledge to each other it won't be true.

Patient needs an urgent-to-emergent procedure but is refusing because of a past addiction and fear of receiving any form of pain medication, family wants you to convince him procedure won't be painful so he'll go ahead with it.

I made these up so they are fairly weak. But it seems to usually involve some form of reasonable, but fairly obviously wrong, form of deception that violates one or more ethical principles.

What about temporary suspension of DNR status for the OR? It's a common ethical question, but doesn't seem to have a clear answer.

 

[DM27]

I will simply say I left that out for a reason...

 

[lizzers729]

What about temporary suspension of DNR status for the OR? It's a common ethical question, but doesn't seem to have a clear answer.

Ethical Guidelines for the Anesthesia Care of Patients with Do-Not ...https://www.asahq.org › files › public › resources › standards-guidelines

 

[navi86]

To put it vaguely, for my ethics question there was a mistake or deviation from standard protocol, and the patient was negatively affected by it. Your task is to explain to the patient what happened, why it happened, blame no one specifically, and what you'll do to prevent it in the future. Think about all the standard protocols you have to follow (getting consent, time outs, etc) and what could happen to a patient if they weren't followed. What would you say to them?

Other things that I came across from my studies: dealing with patients with specific beliefs that can interfere with your care (Jehovah's witnesses for example). Dealing with conflict between minor patients and their decision makers, or unborn babies and their mothers.

 

[anbuitachi]

The ethics OSCE is you and a patient actor where the patient actor is asking for something that is ethically wrong but from my experience and that of others is not overtly nuts. You pass by saying no and explaining why it's wrong in a coherent way. The following are not any of the actual scenarios I am aware of, but are situations I would say are somewhat similar in terms of being overtly against your professional ethics but not outright nuts.

Patient brings in their child for a procedure, but is not allowed to have the day off to care for them afterwards and cant' afford daycare, parent wants a note telling their employer they were ill and had to miss work.

Patient with OSA and COPD has an intense fear of waking up with a breathing tube and his wife who is his health care proxy wants you to guarantee him he won't be awake in any way before extubation even though you and the wife acknowledge to each other it won't be true.

Patient needs an urgent-to-emergent procedure but is refusing because of a past addiction and fear of receiving any form of pain medication, family wants you to convince him procedure won't be painful so he'll go ahead with it.

I made these up so they are fairly weak. But it seems to usually involve some form of reasonable, but fairly obviously wrong, form of deception that violates one or more ethical principles.

so you just tell the patient no, I cant write you a note, and figure it out yourself? that sounds like the best answer to me but who knows how examiners think

 

[DM27]

so you just tell the patient no, I cant write you a note, and figure it out yourself? that sounds like the best answer to me but who knows how examiners think

Yeah that's basically it. It just needs to be fairly comprehensive but definitive. One thing you may encounter when taking the OSCEs is that the time allotted is standardized and some scenarios simply do not require anywhere near the time given. So it ends up being a battle between just talking until time runs out and going "ok I am going to leave now...".