PREFACE TO THE FIRST EDITION
The fundamental goal of a medical school is preparation of a competent medical doctor (MD). Besides implementation of knowledge and cognitive capabilities, instillation of moral attitudes and professional skills is of paramount importance for future doctors. Along with data acquisition and productive reasoning maturation, the students must master a series of dexterities in their curriculum. Those skills may be divided into examinations (primarily diagnostic and noninvasive, e.g., otoscopy) and procedures (mostly therapeutic, often invasive, e.g., decompression of tension pneumothorax). Distinction between those skills is neither simple nor unambiguous; invasiveness is generally equated to the breach of skin continuity. According to such divisions, cardiopulmonary resuscitation would be a noninvasive intervention, although prone to significant injuries, while pricking the fingertip for blood sampling would be invasive, although its complications are very unlikely indeed.
During the Family Medicine Course (the last clinical subject in the final year of Medicine), students’ technical skills are mastered through exercises and practical work in the family physician’s office. Students enter the course with a lot of prior knowledge, mostly based on preclinical and theoretical data, and hospital experience; they are accustomed to a selected, narrow spectrum of specific, generally severely ill patients, which cannot be extrapolated to the wide range of ailments, conditions, and social problems seen in primary care.
Besides the wide range and diversity of those they care for, family doctors differ from hospital clinicians in their particular biopsychosocial (holistic, integrative) approach to the patient, which is peculiar to this very level of health care. While the hospital clinician’s skills are limited to the domain of his/her specialization, a family doctor must be equally capable in resuscitation, irrigating the ear, or placing an infusion system or indwelling urinary catheter. Additional cognizance, attitudes and skills are therefore needed in order to approach the field of family medicine in a successful and efficient way.
The acquired information, understanding and dexterity are assessed not only at the end of the family medicine course, i.e., in the final examination (cumulative evaluation of professional competence), but continuously as well, throughout the curriculum (formative professional evaluation, i.e., assessing achievements, completing tasks, encouraging additional and permanent improvement).
Accordingly, the final family medicine examination consists of three parts: written (multiple-choice questions, MCQ), objective structured clinical examination (OSCE), and oral (assessment of cognition embedded in critical thinking, decision making, and communication skills).
OSCE is the practical part of the cumulative exam, with at least three levels of evaluation: the first one assesses the student’s theoretical knowledge of some relevant procedures and their components, the second evaluates the capacity to incorporate these notions in the appropriate context (e.g., solving a specific diagnostic or therapeutic problem), and the third, crucial part estimates the performer’s ability (i.e., execution of a given intervention in front of the examiners). Full competency is nevertheless achieved only once the student can act independently in the real world of medical practice.
OSCE has many advantages; it is objective (the same tasks for all examinees under identical conditions; equal number of stations and examiners whose subjectivity is mutually compensated), and structured (at least four, usually 5-7 assessment stations). However, it has its drawbacks as well; such an exam is complex to set up, it includes a number of examiners, patients, actors, devices and rooms, while moral attitudes, empathy and productive communication with patients cannot be tested appropriately (such issues are mostly included in the oral part of the exam).
How is OSCE conducted in practice? For example, if there are 6 stations (with models, devices, patients, actors, etc.) in separate premises (rooms or boxes), six consecutive students are distributed in those 6 stations, in each of which there is the test subject/object and one of the 6 examiners. After a predetermined time, e.g., 3 minutes, during which each student must complete a given task, his/her achievement is evaluated on the spot by the respective examiner, according to the predefined criteria. Then the candidate moves to the next station, circulating this way until all 6 tasks are completed by 6 students. Total duration of this exam is up to 24 minutes (6×3=18, +6 minutes for rotation). Of course, final evaluation of acquired medical skills should be done on patients rather than on models or actors. Since it is difficult or nearly impossible to perform consistent assessments using real subjects for many ethical and organizational reasons, models and appropriate devices, which only partially represent the real clinical setting, are often used. Despite this, OSCE is currently the best method of skill evaluation, probably the most trustworthy part of the cumulative exam, and accepted worldwide.
This Practicum is designed to facilitate mastering of some skills important in daily family practice, which are then measured and assessed in an OSCE, the practical part of the family medicine examination. The purposes of the procedures described are intuitively clear. However, in order to avoid possible unclarity, the background or goal of a procedure is occasionally explained.

PREFACE TO THE SECOND EDITION
The need of a new edition of this handbook, after almost an entire decade, arose for several executive reasons, i.e., the observed misprints had to be corrected, the text refreshed with new information, and all former editions were sold out. Moreover, advancement of medical science and technology in the light of untoward circumstances (COVID-19 pandemic, inclement climate, incredible wars) has resulted in modifications in some interventions (e.g., resuscitation), and introduction of new skills (e.g., donning personal protective equipment). Other skills have been added (e.g., communication skills) instead of a few rarely conducted in family practice (e.g., fundus eye examination). Some clinical skills have been skipped (e.g., assessment of body temperature and heart rate), since they are mastered in other subjects, and the number of anthropometric measurements has been reduced (e.g., measuring skinfold thickness) because they are mostly used for research purposes, not in clinical practice.

Mirjana Rumboldt

Naslov: A Practicum of Skills for Students, Family Medicine Residents and Specialists, OSCE 2
Urednice: Mirjana Rumboldt, Marion Tomičić, Irena Zakarija-Grković
Broj stranica: 190
Nakladnik: REDAK
Godina izdanja: 2025.
ISBN: 978-953-395-120-1
Tisak: digitalni tisak knjiga – print na zahtjev