Quizzes & OSCEs > Example OSCE 1

Example OSCE 1 - Alcohol Dependence

Candidate Instructions

You are an F2 doctor working in A and E. This patient has sprained his/ her ankle the night before. You have examined it and reassured the patient that no further action is needed. They admit that they were drunk when they slipped and you notice that they smell of alcohol (it is 10 am).

 

Please take an alcohol history, particularly to establish if they are dependent on alcohol. Briefly assess what harm alcohol may be causing to their life.

 

This is a 5-minute station.

 

 

Simulated Patient Script

(Unisex)

 

You have sprained your ankle last night. It’s very painful and you’ve come to A and E. The student will be told that you smell of alcohol and they will be asked to take an alcohol history to determine if you are dependent on alcohol.

 

You are your own age and sex. You live with your opposite sex partner of 5 years. No children. You work as a sales assistant in the West End.

 

Please give away the following information freely, but in short replies, and only when asked about each point.

 

You have drunk alcohol since you were 16. You used to drink a variety of drinks, depending on occasion, usually only at weekends. In the last three years your intake has increased. You drink a bottle of wine every night, just by yourself. You go out at the weekends and usually drink vodka, up to 14 singles/7 doubles a night. You also tend to meet friends for a few (2-3 large) glasses of wine at weekend lunchtimes.

 

You no longer tend to go to the theatre or cinema, your previous interests, preferring to stay in for a drink, or go to the pub. When asked about any withdrawal effects, you should say that you had a bad cold six months ago, and had no alcohol for a week. You got sweaty, shaky and irritable. If asked, you did not have a fit. When you recommenced drinking, you thought you’d try to drink only at weekends, but were soon (3 weeks) back to the same pattern. You know that you look forward to a drink (crave) during the day.

 

You have had 4 days off sick this year, and deny it was due to hangovers. No other work problems. You do find that you argue with your partner when you’ve had too much, and this has become physical (you hit them) on a couple of occasions. No fractures/serious injury. You have five year driving ban for drink driving, if asked about convictions.

Apart from the sprained ankle you have no other physical symptoms. You feel fine in your mood (not depressed, anxious or suicidal if asked).

 

 

Examiner Instructions

The candidate has been given the following instructions:

 

You are an F2 doctor working in A and E. This patient has sprained his/ her ankle the night before. You have examined it and reassured the patient that no further action is needed. They admit that they were drunk when they slipped and you notice that they smell of alcohol (it is 10 am).

 

Please take an alcohol history, particularly to establish if they are dependent on alcohol. Briefly assess what harm alcohol may be causing to their life. This is a 5-minute station.

 

At the end of the history Examiner to ask Candidate: ”Is this patient dependent on alcohol?” Candidate should answer “Yes”.

 

Assessment

  1. Communication Skills

    • Introduction

    • Interview Skills

  2. Alcohol History

    • Determines when started using alcohol

    • Determines current use (amount/type of alcohol)

  3. Alcohol Dependence Features Elicited

    • Stereotyped pattern of drinking

    • Salience (hobbies/interests replaced by drink)

    • Reinstatement after abstinence

    • Withdrawal phenomena

    • Narrowing of repertoire

    • Continued drinking despite evidence of harm

    • Craving/subjective awareness of compulsion

  4. Effect in Other Areas Elicited

    • Work

    • Home/Family/Relationship

    • Crime/Convictions/Violence

    • Physical Health

    • Mental Health

  5. Examiner to ask candidate: "Is this patient dependent on alcohol?" Yes.

  6. Simulated patient rates as emphatic

Copyright 2012 RevisePsych

Last updated March 2020

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