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STATION TITLE:
ASSESSMENT OF A PREGNANT LADY
1
CASC Linked OSCE
Instructions to Candidate
You are about to see a woman who has been referred by the GP for an assessment of her
current mental state and advice on management. She is 10 weeks pregnant.
Tasks:
2
CASC Linked OSCE
3
CASC Linked OSCE
afraid that you will see the demon looking out at you. You have no wish to harm the baby,
whom you see as innocent. You do not wish to harm yourself or others. You feel hopeless
and unable to change what is happening. Everything in life is an effort and you cannot see
anything positive about the pregnancy. Refer to your child as the ‘baby’, unless asked
specifically for his name.
If the examining doctor interviews you in an empathic manner, you should answer questions
posed freely. If they are cold, mechanical or ask poorly structured questions, display some
hesitancy. Seek clarification where appropriate. Do not give out information unless asked
appropriate questions.
4
CASC Linked OSCE
CONSTRUCT: The station tests the ability of the candidate to take a focused history of
postpartum depression with psychotic features.
A B C D E
Communication
GLOBAL RATING
5
CASC Linked OSCE
Notes to examiners:
The candidate can be expected to take a history and carry out a MSE that is focused, fluent
and demonstrate empathy with the patient’s experience. They should use an appropriate mix
of open and close ended questioning and display advanced listening skills. A ‘check list
approach’ to history taking should not be rewarded. The candidate should be expected to
ask a range of questions to elicit the way in which a patient with postpartum illness may
present. They should focus on the individual’s experience of the disorder. Exploration of
circumstances of both pregnancies should occur including patient’s experience about the
child. They should also ask about how things have been after the birth of the patient’s first
child and her support network.
They should attempt to identify those mood symptoms that the patient is experiencing as
well as screening for other mood symptoms that might occur in such disorders. They should
attempt to identify those delusions that the patient is experiencing, and has experienced, as
well as screening for other abnormal beliefs might be held in such disorders. They should
demonstrate in their questioning that they are seeking to understand whether the patient’s
beliefs may carry risks for the patient and her child/pregnancy. In exploring the patient’s
beliefs, the candidate is expected to demonstrate the desire to understand the patient’s
experience rather than ascertaining whether delusions are present or not. They should also
ascertain whether there are mood congruent delusions at present. As there are no other
psychotic symptoms of note, the candidate should demonstrate an awareness of how to
screen for symptoms and have the insight to move on when such screening is not
productive.
Candidates should stick to the task indicated in the instructions. They cannot obtain extra
marks for straying outside the tasks identified. A very good candidate may not cover all
possible symptoms, but as this is an assessment of skill, they should be appropriately
rewarded for the skills in carrying out the task. Conversely, a poor candidate may cover all
possible symptoms but not in a manner appropriate to the clinical setting enacted, in
particular they may not seek to understand the patient’s perspective. The marks for such a
candidate should reflect this poor performance.