Stanford University Geriatric Education Resource Center  

HB25: Memory Loss and Depression in the Elderly: Assessment and Treatment

Overview of Objective Structured Clinical Examination (OSCE) format

Table of Contents.

Educational Goals and Objectives  4
Summary of 3-Visit Longitudinal OSCE Series  5
OSCE Visit 1, Station 1: OSCE Facilitator Timeline for Administration  6
Simulated patient script  8
Simulated patient's spouse's script  9
Simulated medical record 10
Nurse Intake Information for Progress Note 11
Resident Task Sheet 12
Simulated Patient Checklist (use same for spouse} 13
Scoring Guidelines 14
OSCE Visit 1, Station 2: Simulated patient script 15
Simulated patient's spouse's script 16
Resident Task Sheet 17
Instruction Sheet for Progress Note 18
Simulated Patient Checklist (use same for spouse) 19
Scoring Guidelines 20
OSCE Visit 2: OSCE Facilitator Timeline for Administration 21
Faculty Supervisor Timeline for Participation 22
Simulated patient script 23
Simulated patient's spouse's script 24
Nurse Intake Information for Progress Note 25
Progress Note for Visit 1 (in Chart) 26
Resident Task Sheet 27
Instruction Sheet for Progress Note 28
Simulated Patient Checklist--Resident Performance 29
Simulated Spouse Checklist--Resident Performance 30
Simulated Patient Checklist--Faculty Performance 31
Simulated Spouse Checklist--Faculty Performance 32
Faculty Attending Checklist--Resident Presentation 33
Scoring Guidelines 34
OSCE Visit 3: OSCE Facilitator Timeline for Administration 35
Faculty Supervisor Timeline for Participation 36
Simulated patient script 37
Simulated patient's spouse's script 38
Nurse Intake Information for Progress Note 39
Progress Note for Visit 2 (in Chart) 40
Resident Task Sheet 41
Instruction Sheet for Progress Note 42
Simulated Patient Checklist--Resident Performance 43
Simulated Spouse Checklist--Resident Performance 44
Simulated Patient Checklist--Faculty Performance 45
Simulated Spouse Checklist--Faculty Performance 46
Faculty Attending Checklist--Resident Presentation 47
Scoring Guidelines 48

Overview
Educational Format:
This learning/assessment activity is a series of Objective Structured Clinical Examinations (OSCE's). The activity is largely experiential for the learner, requiring active involvement that closely simulates realistic patient visits. Each learning station requires 2 persons (one female, one male) to role play a female simulated patient and her husband, who accompanies her to each simulated visit.

The longitudinal OSCE series includes 3 simulated visits, including an initial visit for a newly identified problem (memory loss) and an unidentified problem (depression), and 2 followup visits.

The original design involved administering the Visit 1 module during the first year of training, giving the Visit 2 module during the second year of training, and carrying out the Visit 3 module during the third year of training. The modules are designed to be administered in chronological order (1, 2, 3). The modules could be administered at any practical interval, including within a few days or weeks of each other. They could be given sequentially on the same day, with the necessary logistical arrangements.

The Visit 1 module includes 2 stations, one for gathering history, and one for administering the Mini-Mental Status Examination.

The Visit 2 and Visit 3 modules each include one station, during which the learner is required to gather interval history, elicit and respond to questions from the patient and spouse, order cost-effective laboratory tests, explain test results and their implications, formulate a working diagnosis and a differential diagnosis, and formulate treatment plans. None of the modules include any physical examination components.

Visit 2 also requires the participation of one teaching physician for each learner station.
For each simulated visit, the learner is required to handwrite or dictate a progress note for the visit.

Educational Audience:
This OSCE was developed for use with resident physicians in family practice and internal medicine.
It could also be used with allopathic or osteopathic medical students in the clinical years, or with students in physician assistant or nurse practitioner training programs.

Clinical/Educational Skill Focus:

  1. Eliciting memory loss history from patient and spouse
  2. Conducting the Mini Mental Status Exam (MMSE) (Folstein)
  3. Ordering cost-effective tests to evaluate memory loss
  4. Prescribing medication for depressed elderly patient
  5. Prescibing medication for Alzheimer's dementia
  6. Educating spouse and patient with Alzheimer's dementia
  7. Presenting a patient to the attending/supervising teaching physician
  8. Verifying Medicare patients' history, diagnosis, and management (teaching physician hands-on involvement in patient's care)
Clinical Setting: Ambulatory, Office Practice

Memory Loss and Depression in the Elderly:
Assessment and Treatment
Geriatric Experiential Assessment/ Learning Longitudinal Activity Series
Objective Structured Clinical Examination (OSCE)

Goals:

  1. To assess the learner's ability to establish rapport with an elderly patient with memory loss, and with the patient's spouse, with the patient and spouse both present in the examination room.
  2. To assess the learner's application of basic interviewing skills with an elderly female patient with memory loss and her husband.
  3. To give the learner direct live feedback from simulated patients about their demonstrated interviewing skills and rapport building.
  4. To assess the learner's ability to obtain a thorough history from an elderly patient with memory loss, and from the patient's spouse, including pertinent family and social history.
  5. To allow the learner to practice administering the Mini Mental Status Examination (MMSE) in a structured setting, to assess the learner's ability to competently administer and score the MMSE, and to give the learner feedback on their administration and scoring of the MMSE.
  6. To assess the learner's ability to cost-effectively order diagnostic tests to evaluate an elderly patient with memory loss and depression.
  7. To assess the learner's ability to diagnose Alzheimer's dementia and depression.
  8. To assess the learner's ability to appropriately prescribe medication for an elderly patient with Alzheimer's dementia and depression.
  9. To assess the learner's ability to explain the diagnoses of Alzheimer's dementia and depression to an elderly female patient and her husband.
  10. To assess the learner's ability to do a quick verbal presentation to an attending/supervising teaching physician after seeing an elderly patient with Alzheimer's dementia and depression.
  11. To assess the attending/supervising teaching physician's ability to time-effectively verify the key elements of history, diagnosis, and management for an elderly Medicare patient with Alzheimer's dementia and depression, in accordance with federal guidelines for the teaching physician's required involvement so that resident physicians' patient care can be reimbursed by Medicare.
Objectives:
After participating in this educational activity, the learner should be able to:
  1. Elicit a thorough history from an elderly female patient with memory loss, and from her spouse.
  2. Conduct the Mini Mental Status Exam (MMSE) (Folstein) competently and respectfully.
  3. Order cost-effective tests to evaluate memory loss in an elderly patient who is also depressed.
  4. Prescribe medication for a depressed elderly patient who also has Alzheimer's dementia.
  5. Prescribe medication for an elderly patient with Alzheimer's dementia, who is also depressed.
  6. Educate the patient and her spouse about the diagnoses of depression and Alzheimer's dementia.
  7. Quickly present a patient with memory loss and depression to the teaching physician.
  8. Effectively involve the teaching physician in the hands-on care of an elderly Medicare patient.

User Comments

I especially like the idea of use of OSCE's to assess trainees' knowledge, skills, and attitudes. Schedules, checklists for evaluators were very helpful.

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