BRADYARRHYTHMIA-OSCE

Bradyarrhythmia OSCE Station (Verbal/Role-Play)

Station Title: Management of a Patient with Bradyarrhythmia

Time: 10 minutes

Objectives:

  • Assess the student’s ability to recognize bradyarrhythmias on clinical presentation and ECG.
  • Evaluate the student’s decision-making in initiating appropriate management for bradyarrhythmias.
  • Assess the student’s communication skills when explaining the treatment plan and delegating tasks in a clinical emergency.

Station Overview

Scenario for Students:

You are called to see a 65-year-old male patient in the emergency room who is complaining of dizziness and near-syncope. The nurse has reported a low heart rate of 38 beats per minute. Below is the patient’s ECG:

Instructions:

  • You will verbally walk through the assessment and management of this patient.
  • Explain the steps you would take after reviewing the ECG and identifying the bradyarrhythmia.
  • The examiner will play the role of an assistant/nurse, and you will delegate tasks.

Instructions for Examiner:

  • Act as an assistant or team member following the student’s instructions.
  • Evaluate the student’s performance using the criteria below. Focus on their ability to recognize the bradyarrhythmia and manage the patient appropriately.
  • Ask follow-up questions to test the student’s clinical reasoning (e.g., “What are the next steps if atropine fails to improve the patient’s heart rate?”).

Assessment Criteria and Marking (Out of 10 Marks)

Section Task Max Marks
1. Initial Assessment (2 Marks)
  • Checks patient stability (level of consciousness, vitals, oxygenation).
  • Obtains focused history (dizziness, near-syncope, medications).
 2
2. ECG Interpretation (2 Marks)
  • Identifies bradyarrhythmia on ECG (e.g., sinus bradycardia, heart block).
  • Explains ECG findings clearly to the examiner.
 2
3. Symptom Management (2 Marks)
  • Describes initial management for symptomatic bradycardia (e.g., oxygen, IV access, atropine).
  • Administers appropriate atropine dose (0.5-1 mg IV) if indicated.
 2
4. Definitive Treatment (2 Marks)
  • Describes escalation to transcutaneous pacing if unresponsive to atropine.
  • Mentions temporary pacemaker insertion if needed for further stabilization.
 2
5. Communication & Leadership (2 Marks)
  • Communicates clearly and delegates tasks effectively to the team.
  • Provides leadership in the resuscitation process.
 2
Total 10 Marks

Sample Questions for the Examiner

  • During Initial Assessment: “How would you assess if the patient is hemodynamically stable?”
  • ECG Interpretation: “What type of bradyarrhythmia is shown on this ECG?”
  • Symptom Management: “What would you do if atropine does not improve the patient’s heart rate?”
  • Definitive Treatment: “When would you consider using transcutaneous pacing?”

No-Manikin Approach: Role-Play

In this station, the examiner will simulate the clinical situation. The examiner may say: “The patient is a 65-year-old male with a heart rate of 38 beats per minute, complaining of dizziness and near-syncope.” The student will then describe their actions, guiding the examiner (acting as an assistant) to perform tasks such as reviewing the ECG, administering atropine, or preparing for pacing.

Room Setup

  • Simple setup: A chair and table to simulate the patient room.
  • ECG interpretation: No actual ECG machine needed. The student will interpret the image provided and discuss it verbally with the examiner.

Final Notes

  • Decision-Making Focus: Emphasize students’ ability to make correct clinical decisions.
  • Realistic Role-Play: Ensure the student clearly articulates their clinical reasoning and commands, as if in a real-life emergency.
  • Consistency: Ensure all examiners are calibrated to score uniformly.
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