NDEB Virtual OSCE cheat sheet

Open-to-closed funnel: begin with open-ended prompts, narrow to closed/direct questions only after the chief complaint and its natural history are fully explored.

Standard history sequence: chief complaint, HPI (onset, location, duration, character, aggravating/relieving, timing, severity), PMH, medications, allergies, family, social, review of systems.

Use a pain scale (0-10) plus function impact; record the patient's own words for the chief complaint verbatim in quotes.

SOCRATES or OLDCARTS frameworks ensure all HPI dimensions are captured for pain and non-pain symptoms alike.

Screen for red flags systematically: unintentional weight loss, night pain, fever, bleeding, dysphagia, neurologic deficit, and suicidal ideation.

Ask about bleeding risk before any invasive procedure: anticoagulants, antiplatelets, bleeding disorders, liver disease, and prior transfusion reactions.

Document non-adherence and barriers (cost, transport, health literacy, beliefs) as part of the medication history, not as a compliance judgment.

Use teach-back and chunk-and-check to confirm comprehension; avoid jargon, and confirm the patient's preferred language and need for an interpreter.

Generate a broad differential first (hypothetico-deductive), then prioritize by prevalence, severity, and treatability; rule out worst-case diagnoses before common ones.

Use pattern recognition only when the presentation is classic; atypical features mandate re-opening the differential rather than forcing a fit.

Sensitivity rules out (SnNout): a highly sensitive test with a negative result makes the diagnosis unlikely; specificity rules in (SpPin).

Likelihood ratios: LR+ >10 or LR- <0.1 meaningfully shift post-test probability; LR near 1 adds little.

Diagnostic test ordering follows a decision threshold: test only if the result would change management or cross a treatment threshold.

Anchor bias is countered by explicitly listing features that do not fit the leading diagnosis and seeking disconfirming evidence.

Correlate symptoms anatomically and temporally; a single unifying diagnosis is preferred, but two common conditions can coexist.

Document the differential with the reasoning for inclusion/exclusion, not just the final diagnosis.

Sequence care by urgency: stabilize acute/urgent problems, then address definitive and elective needs; obtain informed consent at each stage.

Treatment options should be presented as at least two alternatives (including no treatment), each with risks, benefits, costs, and prognosis.

Prognosis depends on host factors (systemic disease, smoking, oral hygiene, compliance) as much as on the procedure itself.

Case management requires defined review intervals and objective outcome measures; set measurable goals before starting.

Coordinate multidisciplinary care when the plan is limited by medical, psychosocial, or financial factors; document the rationale for modified plans.

Consider staging and restorability before committing to complex reconstruction; an unrestorable tooth is an indication for extraction, not heroic treatment.

Informed refusal must be documented when a patient declines recommended care, including alternatives discussed and risks of non-treatment.

Reassess the plan when new findings emerge; a treatment plan is a living document, not a one-time decision.

Valid informed consent requires capacity, adequate disclosure, comprehension, voluntariness, and a documented decision; all five elements must be present.

Disclose material risks: those a reasonable patient would consider significant, plus any risk the specific patient has flagged as important.

Shared decision-making uses a two-way exchange; the clinician provides evidence, the patient provides values and preferences, and both agree on a plan.

Breaking bad news uses a structured approach (setting, perception, invitation, knowledge, empathy, strategy/summary) with pauses for response.

Empathy statements name the emotion and validate it before offering information; premature reassurance blocks disclosure.

Motivational interviewing uses open questions, affirmation, reflection, and summarization; avoid persuasion and confrontation, which raise resistance.

Cultural humility includes asking about beliefs, decision-making roles, and preferences for family involvement rather than assuming them.

Confirm understanding with teach-back; a signature alone is not evidence of informed consent.

Four core principles: autonomy (respect patient choice), beneficence (act in patient's interest), non-maleficence (avoid harm), and justice (fair allocation).

Confidentiality is the default; disclosure without consent is limited to legal mandates (reportable diseases, imminent serious harm, court order) and is documented.

Competence and capacity are decision-specific and time-specific; a diagnosis of cognitive impairment does not automatically negate capacity.

Boundaries: dual relationships and treating family members can impair objectivity; disclose and manage conflicts of interest.

Mandatory reporting duties vary by jurisdiction but commonly include suspected child abuse, elder abuse, and certain communicable diseases.

Documentation is a legal record: contemporaneous, factual, dated, signed, and free of speculation or derogatory language.

Scope of practice is defined by licensure and training; refer rather than practice beyond competence.

Truthfulness about errors (open disclosure) is an ethical and often legal obligation; disclose harm promptly and document the disclosure.

A complete clinical record includes identifying data, consent, history, examination findings, diagnosis, plan, and follow-up instructions.

Records should be contemporaneous; late entries are labeled as such with the actual date/time of entry and the date/time of the event.

Never alter a prior record; corrections are made by a dated addendum that preserves the original entry.

Privacy and security obligations (e.g., HIPAA-type frameworks) require minimum-necessary disclosure and secure storage of identifiable data.

Scheduling efficiency depends on appointment type, procedure duration, and buffer capacity; overbooking trades access for quality.

Financial records must separate clinical and billing documentation; fee disclosure and treatment cost estimates are provided before care.

Retention periods are jurisdiction-specific; records are retained for the statutory minimum and released only with valid authorization.

Quality improvement uses audit cycles: define an indicator, measure a sample, implement change, and re-measure.

Levels of prevention: primary (prevent onset, e.g., fluoride, vaccination), secondary (early detection, e.g., screening), tertiary (limit disability/recurrence).

Risk-based prevention: interval and intensity of recall are set by caries risk, periodontal risk, smoking, and systemic disease, not by a fixed calendar.

Behavior change counselling uses the 5 A's: assess, advise, agree, assist, arrange follow-up.

Fluoride and dietary sugar-frequency counselling are the highest-yield caries-prevention messages; frequency of sugar exposure matters more than total amount.

Smoking cessation advice is effective when combined with pharmacotherapy referral and follow-up; brief advice alone has a small but real effect.

Health literacy limits comprehension; use plain language, pictures, and teach-back, and target material to reading level.

Patient education is documented: what was taught, materials given, and the patient's response or understanding.

Screening programs require adequate sensitivity and follow-up pathways; a screening test without a defined referral route is incomplete.

A referral must state the reason, the specific question, relevant history, investigations, and what the patient has been told.

Closed-loop referral: the referring clinician confirms the appointment occurred and receives the consultation report; unconfirmed referrals are a care gap.

Role clarity prevents duplication and omission; each team member's responsibilities should be explicit in the shared care plan.

Use structured handover (SBAR: situation, background, assessment, recommendation) to reduce communication error.

Shared decision-making across disciplines requires a common record or interoperable summary; conflicting plans must be reconciled and documented.

Refer when the case exceeds competence, requires equipment or expertise not available, or when the patient requests a second opinion.

Respect the patient's choice of specialist where feasible; document any constraints and the patient's preference.

Interprofessional conflict is resolved through case-based discussion focused on patient outcomes, not hierarchy.