Ethics OSCE Station Blueprint

Station Name: Doctor's Note

Issue:

Presenting Situation:

Activities:

Time Required:

This station was developed by Dr. Peter A. Singer (Centre for Bioethics and Department of Medicine, University of Toronto), and Anja Robb (Department of Family and Community Medicine, University of Toronto. It is part of the Ethics OSCE Project which is funded by Educating Future Physicians for Ontario (EFPO). There is an accompanying videotape. This material can be used for teaching or evaluation. It is not copyrighted and may be freely reproduced for educational purposes.

Instructions to Candidate:

CHECKLIST ITEMS
^^^^^^^^^^^^^^^^


YES     NO     The Candidate:
        
               1.      determines that patient is not
                       physically ill.
----|-----------------------------------------------------------
               2.      determines that patient is not
                       emotionally/mentally ill.
----|-----------------------------------------------------------
               3.      explores why patient is not prepared for
                       the exam.
----|-----------------------------------------------------------
               4.      asks if patient has requested similar
                       notes in the past.
----|-----------------------------------------------------------
               5.      asks if patient has discussed options
                       with professor.
----|-----------------------------------------------------------
               6.      encourages patient to state case
                       truthfully to professor.
----|-----------------------------------------------------------
               7.      states that it is unethical to write a
                       note saying patient is ill. 
----|-----------------------------------------------------------
               8.      provides reason(s) why physician cannot
                       write note, e.g. doctor cannot lie/has
                       to tell truth.
----|-----------------------------------------------------------
               9.      offers to help patient with future
                       medical problems.                   
----|------------------------------------------------------------ 
=================================================================

                              
RATE FROM 1-5:
 +------------------------------------------------------------+
 |        |          |          |    VERY    |                |
 | POOR   |   FAIR   |   GOOD   |    GOOD    |    EXCELLENT   |
 |  1     |    2     |    3     |     4      |       5        |
 +------------------------------------------------------------+

1.      How would you rate the candidate's communication skills?                                 
        1      2       3      4      5

2.      How would you rate the candidate's ability to address the
        ethical issue in this case?                 
        1      2       3      4      5

Instructions to Standardized Patients:

YOUR STORY:
You find yourself unprepared for an exam tomorrow. You would like the doctor to help you by writing a note saying you are too sick to write the exam. You know some classmates have obtained notes in the past for a variety of reasons. Some needed to defer exams, while others needed extensions for essays. You do not really expect any resistance to the request. When you called the clinic and explained your need, the nurse asked you to come to the clinic to see a doctor. You were left with the impression that it was just a formality.

You are not really ill. The truth is, rather than studying, you spent last week with your out-of-town girlfriend. You have been seeing your girlfriend for the past 2 years. This year she started a program at a different university. You have been worried that the relationship wouldn't survive the separation so you wanted to spend a lot of time with her while she was in town. (She had a reading week.)

Your hope is that you can have an extra week to study and write a make-up exam. You have spoken to your professor who informed you that writing the make-up exam depended on producing a doctor's note.

You have a bursary which helps pay your tuition. It depends on your maintaining a B average. If you don't get the bursary renewed, you probably won't be able to return for your final year. You're the first person in your family to go to university and they are very proud of you. You don't want to let them down.

You may admit that you are not really sick, but that you need a favour. You may say things like:
"It isn't that big a deal is it? This happens all the time, doesn't it?"
"I don't want to cause a problem for you, but I want you to know how badly I need this. If I don't get at least a B, I'll lose my bursary. I have to do a good job on this exam. If I don't, I may have to quit school. I was really hoping that I would graduate next year. If I don't get this I may not even be coming back."
"Haven't you ever had to ask for a favour? You went to school once. Don't you remember how it was? Can't you just say I've got the flu or something?"
"I know I made a mistake and should have been studying. But I hadn't seen her for months!" "Because of this I'll lose my bursary, and I won't be able to continue school. That's not right is it? I made a mistake. But this is really too high a price to pay don't you think?"
"I'm sorry. I've never done this before. I swear I'll never do this again."
"You're my only hope."
"Please."
Prompts are used to standardize the scenario and give all candidates an opportunity to address relevant issues.

PROMPT 1 (immediately):
"I need a note to excuse me from an exam I have tomorrow."

PROMPT 2 (by 1-2 minutes):
"Will you write the note?"

PROMPT 3 (by 2-3 minutes):
If candidate refuses to write note say "Why not?"

PROMPT 4 (by 3-4 minutes):
If candidate says it's wrong or unethical say "Why is it wrong?