Mock OSCE

Midwifery
In your objective structured clinical examination (OSCE), you will be assessed on 10
stations in total:
• four of the stations are linked together around a scenario: this is called the APIE,
with one station for each of Assessment, Planning, Implementation and
Evaluation, delivered in that sequence and with no stations in between. Stations
will last between 16 and 20 minutes.
• Two stations will take the form of a linked pair, testing practical clinical skills.
Each pairing of skills stations will last for approximately 30 minutes in total
(including reading time), with no break between each paired skill.
• Two stations will be separate skills stations, one of which will be an acute
emergency skill. These skills will last 8 minutes each.
• There are also two silent stations, lasting 10 minutes each. In each OSCE, one
station will specifically assess professional issues associated with professional
accountability and related skills around communication (called the professional
values and behaviours, or PV, station). One station will also specifically assess
critical appraisal of research and evidence and associated decision-making
(called the evidence-based practice station, or EBP).

We have developed this mock OSCE to provide an outline of the performance we

expect and the criteria that the test of competence will assess. This mock OSCE
contains an APIE, one clinical skill station (which is part of a linked pair), one PV and
one EBP station.

The Nursing and Midwifery Council’s code (2018) outlines professional standards of
practice and behaviours, setting out the expected performance and standards that are
assessed through the test of competence.

The code is structured around four themes: prioritise people, practise effectively,
preserve safety and promote professionalism and trust. These statements are explained
below as the expected performance and criteria. The criteria must be used to promote
the standards of proficiency in respect of knowledge, skills and attitudes. They have
been designed to be applied across all fields of midwifery practice, irrespective of the
clinical setting, and they should be applied to the care needs of all individuals.

Please note: this is a mock OSCE example for education and training purposes only.

The marking criteria and expected performance apply only to this mock OSCE. They
provide a guide to the level of performance we expect in relation to midwifery care,
knowledge and attitude. Other scenarios will have different assessment criteria
appropriate to the scenario.

Evidence for the expected performance criteria can be found in the reading list and related
publications on the learning platform.

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Theme from the code: Prioritise people

Expected performance Criteria

Treat people as individuals and uphold Introduces self to the person at every
their dignity contact and upholds the person’s
dignity and privacy.

Listen to people and respond to their Actively listens to the person and
preferences and concerns provides clear information, behaving
in a professional manner, respecting
others and adopting non-
discriminatory behaviour.

Make sure that people’s physical, Upholds respect by valuing the

social and psychological needs are person’s opinions and being sensitive
responded to to feelings and/or appreciating any
differences in culture.

Act in the best interest of people at all Treats each person as an individual,
times showing compassion and care during
all interactions.
Respects and upholds people’s
human rights.

Respect people’s right to privacy and Ensures that people are informed
confidentiality about their care and that information
about them is shared appropriately,
maintaining confidentiality.

Theme from the code: Practise effectively

Expected performance Criteria

Always practise in line with the best Provides skills, knowledge and
available evidence attitude that is supported by an
evidence base at all times.

Communicate clearly Communicates clearly and effectively

to people in their care, colleagues
and the public.

Work co-operatively Maintains effective and safe

communication with people in their
care, colleagues and the public.

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 Share your skills, knowledge and Supports others by providing
experience for the benefit of people accurate, honest and constructive
receiving care and your colleagues verbal and written feedback.

Keep clear and accurate records Provides clearly written feedback on

relevant to your practice all care given, and demonstrates
accurate evidence-based verbal
handover of care to others.

Be accountable for your decisions to Accountably delegates to competent

delegate tasks and duties to other others, ensuring person safety at all
people times.

Theme from the code: Preserve safety

Expected performance Criteria

Recognise and work within the limits Accurately identifies, observes and
of their competence assesses signs of normal or
worsening physical and mental health
in the person receiving care,
requesting timely and appropriate
assistance as required.

Be open and candid about potential Documents events formally and takes
mistakes, preventing harm further action (escalates) if
appropriate, so they can be dealt with
quickly.

Provide assistance in an emergency Acts in an emergency within the limits

of their knowledge and competence,
seeking appropriate support as
required.

Act swiftly if there is a danger to Delivers care according to national

others, maintaining safety policies and procedures to prevent
danger to others, and applies
appropriate personal protective
equipment (PPE) as indicated by the
midwifery procedure in accordance
with the guidelines to prevent
healthcare-associated infections.

Raise concerns for those who are Shares information if someone is at

seen to be vulnerable or at risk of risk of harm, in line with the laws
harm relating to the disclosure of
information.

Advise on, prescribe, supply, dispense Checks prescriptions, person’s

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 or administer medicines within the identification and administers
limits of your training and competence, medicines safely, highlighting
the law, our guidance and other appropriately any areas of concern.
relevant policies, guidance and
regulations

Demonstrate awareness of any Takes all reasonable personal

potential harm associated to their precautions necessary to avoid any
practice potential health risks to colleagues,
people receiving care and the public.

Theme from the code: Promote professionalism and trust

Expected performance Criteria

Uphold the reputation of the Demonstrates and upholds the standards

profession at all times and values set out in the code.

Fulfil the registration Demonstrates up-to-date knowledge, skills

requirements and competence to provide safe and
effective care at all times.

Provide leadership to make Identifies priorities, manages time and

sure that people’s wellbeing is resources effectively, and deals with risk to
protected and to improve their make sure that the quality of care or service
experiences of the health and is maintained and improved, putting the
care system needs of those receiving care or services
first.

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Assessment
Vaginal bleed at term
The mock APIE below is made up of four stations: assessment, planning, implementation and
evaluation. Each station will last between 16 and 20 minutes and is scenario-based. The
instructions and available resources are provided for each station, along with the specific
timing.

Scenario

You are working on the antenatal assessment unit and you have been asked to assess a
woman who has just presented unannounced with a vaginal bleed at term. The midwife in
charge informs you that the woman is 38 weeks pregnant with her second pregnancy. The
woman is reporting a small amount of fresh red blood loss vaginally as well as abdominal
pain, and ‘looks in pain’ on admission.

You will be asked to complete the following activities to provide high-quality, individualised
midwifery care. All four of the stages in the process will be continuous and will link with
each other.

Station You will be given the following resources

Assessment – 20 minutes • Assessment overview and documentation
You will collect, organise and (pages 10–14)
document information about the • A blank modified early obstetric warning score
individual. (MEOWS) chart to be completed (page 15-16)

Planning – 16 minutes • A partially completed midwifery care plan

You will complete the planning for the next four hours (pages 17–19)
template to establish how two
aspects of the individual’s care
needs will be met.
Implementation – 15 minutes • An overview and medication administration
You will administer medications record (MAR) (pages 20–25)
while continuously assessing the
individual’s current health status.
Evaluation – 16 minutes • Documents from the previous three stations
You will document the care that has • A blank transfer of care letter, including a
been provided so that you can do a communication tool (pages 26–29)
verbal handover to the midwife on
the next shift (the examiner).

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Assessment
Vaginal bleed at term
On the following pages, we have outlined the expected standard of clinical performance and criteria. These
marking matrices are there to guide you on the level of knowledge, skills and attitude we expect you to
demonstrate at each station.

Assessment criteria

Cleans hands with alcohol hand rub, or washes with soap and water and dries with
paper towels following WHO guidelines.
Introduces self and explains the assessment procedure to the woman.
Obtains consent.
Checks environment is safe and maintains privacy.
Accurately assesses, interprets and records the full medical and obstetric history of
the woman (postnatal depression/unexplained infertility/in-vitro fertilisation (IVF)/
gravida 2 para 1 (G2P1)/previous normal delivery at term).
Accurately assesses, interprets and records the health and wellbeing of the woman
antenatally (midwifery-led care/second pregnancy/38 weeks pregnant/low-lying
placenta (LLP) at 20 weeks/34-week ultrasound scan (USS) placental position and
fetal growth no abnormality detected (NAD)/small fresh red vaginal
bleed/abdominal pain/rhesus negative).
Demonstrates the ability to measure and record vital signs for the woman, using
technological aids where appropriate, and implements appropriate responses and
decisions.
Recognises normal vaginal loss and any deviations from normal, referring to an
obstetrician as appropriate.
Undertakes abdominal examination and palpation of the woman (assessing any
discomfort/the state of the uterus including uterine contractions/fundal height of the
uterus/lie and presentation of the fetus).
Accurately assesses fetal wellbeing (fetal movements/undertake auscultation of the
fetal heart, using Pinard stethoscope and technical devices as appropriate,
accurately interpreting and recording all findings).
Accurately diagnoses small vaginal bleed provoked by sexual intercourse with a
differential diagnosis of early labour and bloody show.
Accurately identifies investigations required (Kleihauer).
Acts professionally throughout the procedure in accordance with NMC (2018) ‘The
Code: Professional standards of practice and behaviour for nurses, midwives and
nursing associates’.

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Assessment
Vaginal bleed at term
Planning criteria

Utilises the communication tool to successfully verbalise a plan of care to the examiner.
Logically and accurately provides details of the situation (small post-coital bleed, fresh
red blood loss on wiping with no active bleeding, intermittent abdominal pain).
Logically and accurately provides details of the background (sexual intercourse at
7.30am this morning, intermittent abdominal pain since 8.30am, small fresh red blood
loss noted on wiping and staining of underwear at 9.30am).
Logically and accurately provides details of the assessment (small post-coital bleed with
abdominal pain, uterus soft and non-tender, no active bleeding. Differential diagnosis of
early labour with blood-stained show, observations otherwise normal, fetal movements
reassuring).
Logically and accurately provides details of the recommendation (medical review,
Kleihauer, additional mid-stream sample of urine).
Referral for medical review is acknowledged and actioned appropriately.
Ensures recommendations are current/evidence-based/best practice.
Uses professional terminology in care planning.
Ensures that the woman is involved in the care planning process, with consent gained
for medical review and additional tests.
Acts professionally throughout the procedure in accordance with NMC (2018) ‘The
Code: Professional standards of practice and behaviour for nurses, midwives and
nursing associates’.

Implementation criteria

Cleans hands with alcohol hand rub, or washes with soap and water and dries with paper
towels following WHO guidelines.
Seeks consent from woman prior to administering medication.
Checks allergies on chart and confirm with the person in their care, also notes red
identity (ID) wristband (where appropriate).
Before administering any prescribed drug, looks at the woman’s prescription chart and
checks the following are correct: person (checks ID with person: verbally, against
wristband (where appropriate) and paperwork), drug dose, date and time of
administration, route and method of administration, validity of prescription, signature of
prescriber, and that the prescription is legible.
Considers contraindication where relevant and medical information prior to administration
(prompt permitted).
Provides a correct explanation of what each drug being administered is for to the person.
in their care (prompt permitted).

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Assessment
Vaginal bleed at term
Administers drugs due for administration correctly and safely (anti-D immunoglobulin,
paracetamol).
Omits drugs not to be administered and provides verbal rationale (ferrous sulphate – ask
candidate reason for non-administration, if not verbalised).
Accurately records drug administration and non-administration.
Acts professionally throughout the procedure in accordance with NMC (2018) ‘The Code:
Professional standards of practice and behaviour for nurses, midwives and nursing
associates’.

Evaluation criteria

Situation
Introduces self and the clinical setting.
Documents the woman’s name, hospital number and/or date of birth, and location.
Documents the reasons for discharge.
Documents the current situation with the woman and baby.
Background
Documents date of admission/visit/reason for initial admission/referral to obstetric
team and diagnosis.
Notes previous medical history and relevant medication/social history.
Documents current events and details findings from assessments/tests.
Assessment
Documents most recent observations, any results from assessments undertaken
and what changes have occurred.
Documents that medical review completed.
Documents any areas of concerns.
Recommendation
Documents what is required of the person taking the handover and proposes a
realistic plan of action.
Notes main ongoing care needs.
Proposes a realistic plan of care, including future appointment plan.
Overall
Systematic and structured approach taken to completing the transfer of care letter.
Acts professionally throughout the procedure in accordance with NMC (2018) ‘The
Code: Professional standards of practice and behaviour for nurses, midwives and
nursing associates’.

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Assessment
Vaginal bleed at term
Candidate briefing
You are working on the antenatal assessment unit and you have been asked to assess a
woman, Amy Hall, who has just presented unannounced with a vaginal bleed at term.

The midwife in charge informs you that the woman is 38 weeks pregnant with her second
pregnancy. The woman is reporting a small amount of fresh red blood loss vaginally as well as
abdominal pain, and ‘looks in pain’ on admission.

You are required to take a full history, complete a full antenatal assessment and perform
any additional clinical checks, such as assessing maternal vital signs and fetal
wellbeing, according to the findings from her history. Please note that urinalysis and a
Cardiotocograph (CTG) have already been performed, with results below.

This document provides an overview of the situation you are presented with to assess and the
woman’s history.
Depending on Amy’s circumstances and condition, you may wish to focus on some areas of
assessment in more depth than others.

An observation chart is provided and must be completed within the station. This document
must be completed using a GREEN PEN.

You have 20 minutes to complete this station, including the completion of the following
documentation: modified early obstetric warning score (MEOWS) chart.

Assume it is TODAY and it is 10:30 hours.

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Assessment
Vaginal bleed at term
Overview of recent history

Scenario

Name: Amy Hall

Date of birth: 21/01/1995
Address: 17 Ladybrook Lane, Rotherham, Sheffield.
Postcode: S11 3TF
GP: Dr Shaw

Presenting complaint:
• Second pregnancy
• 38 weeks pregnant.
• Small fresh red vaginal bleed
• Abdominal pain.

History of presenting complaint:

• Sexual intercourse at 7.30am this morning
• Intermittent abdominal pain since 8.30am this morning
• Small fresh red blood loss noted on wiping and staining of underwear at 9.30am this
morning.
• Cardiotocograph performed because of fresh vaginal bleed. CTG findings reassuring.
• Urinalysis: 150mls volume +++ blood ++ leucocytes.

Previous obstetric history:

• 2015 – uneventful pregnancy. Spontaneous labour and delivery of live male infant at 40
weeks’ gestation. Child fit and well at birth.

Past medical history:

• Postnatal depression following birth of last child. Managed with counselling and no
medication required.
• Unexplained infertility following birth of first child. Current pregnancy as result of a
successful IVF cycle.

Current pregnancy:
• Consultant care because of IVF
• 20-week anomaly USS identified low-lying placenta covering the internal os
• Follow-up USS at 34 weeks identified the placental edge was now 2cm away from the
internal os. Normal fetal growth. Transferred to midwifery care at 34 weeks’ gestation.
• Otherwise uneventful pregnancy to date – currently 38/40
• Blood group is A rhesus negative, has received prophylactic anti-D administration

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Assessment
Vaginal bleed at term
during pregnancy.

Social history:
• Married and lives with husband.

Drug history:
• Ferrous sulphate – 200mg twice daily for iron-deficiency anaemia.
• Ex-smoker – previously smoked but gave up at booking.

Allergies:
• Codeine phosphate – severe nausea and vomiting.

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Assessment
Vaginal bleed at term
Candidate notes
This documentation is for your use and is not marked by the examiners.

Antenatal assessment

History

Vital signs

Fetal wellbeing

Additional investigations

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Assessment
Vaginal bleed at term
Candidate notes
This documentation is for your use and is not marked by the examiners.

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Assessment
Vaginal bleed at term
PROMPT - MODIFIED OBSTETRIC EARLY WARNING SCORE CHART

FREQUENCY Use identification label or :-

DATE TIME SIGNED PRINT STATUS
(IN HRS)
Name:

DOB:

Hospital No:

Ward:

Date :

Time :

>30 >30
Respirations 21-30 21-30
(write rate in
corresp. box) 11-20 11-20
0-10 0-10

Saturations 95-100% 95-100%

if applicable
(write stats in
corresp. box) <95% <95%

Administered O2 (L/min.) (L/min)

39 39
Temp

38 38
37 37
36 36
35 35

170 170
160 160
150 150
140 140
130 130
120 120
Heart rate

110 110
100 100
90 90
80 80
70 70
60 60
50 50
40 40

200 200
190 190
180 180
170 170
160 160
Systolic blood pressure

150 150
140 140
130 130
120 120
110 110
100 100
90 90
80 80
70 70
60 60
50 50

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Assessment
Vaginal bleed at term
130 130
Diastolic blood pressure

120 120
110 110
100 100
90 90
80 80
70 70
60 60
50 50
40 40

Urine passed (Y/N) passed (Y/N)

protein ++ protein ++
Proteinuria
Protein >++ protein >++
Clear (C) Clear (C) Pink (P)
Amniotic fluid Pink (P)
Green (G) Green (G)

Alert Alert

Neuro response Voice Voice

(√) Pain Pain
Unresponsive Unresponsive

0-1 0-1
Pain Score (no.)
2-3 2-3

Normal (N) Normal (N)

Lochia Heavy (H) Fresh Heavy (H) Fresh (F)
(F) Offensive (O) Offensive (O)

NO (√) NO (√)
Looks unwell
YES (√) YES (√)

Total number of amber boxes

Total number of red boxes

Name:
Signature:

Guidance for using Modified Obstetric Early Warning Score Chart

A – Alert Alert and orientated
V – Voice Drowsy but answers to name or some kind of response when addressed
P – Pain Rousable with difficulty but makes a response when shaken or mild pain is inflicted (eg.
rubbing sternum, pinching ears)
U – Unresponsive No response to voice, shaking or pain

Pain scores: Record pain levels as follows:

0 – No pain
1 – Mild pain
2 – Moderate pain 3 – Severe pain

Scoring and responding: Document all the scores for all parameters at bottom of the chart. Follow the escalation
algorithm.

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Assessment
Vaginal bleed at term

Identify the number of amber

and/or red boxes
Key

Amber
Red

1 Amber Box 2 Amber Boxes or 1 Red 2 Red Boxes

• Repeat Box
observations • Inform midwife in
• Increasing • Inform midwife in charge
frequency of charge • Immediate referral to
observations to • Immediate referral to obstetric registrar/
every 30 minutes obstetric registrar anaesthetist
• • Transfer to high
• Seek advice from Increase frequency of
observations to every level of care
senior
15 minutes • Consider transfer to
midwife/midwife in
HDU
charge • Woman should be
• Consider review by
• Consider obstetric reviewed within 30 obstetric consultant
review within 30 minutes
minutes if not • Consider obstetric
settled anaesthetist review
• Consider review by
obstetric consultant

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Planning care
Vaginal bleed at term
Candidate paperwork and briefing
Candidate name: _______________________________________

This document must be completed using a BLACK PEN.

Scenario
You have conducted the following assessment of Amy Hall.

Full clinical history:

• History of postnatal depression, unexplained infertility and IVF.
• Gravida 2 para 1 – previous uneventful pregnancy and spontaneous vaginal delivery at
term.
• Current pregnancy – Originally consultant care, history of low-lying placenta at 20 weeks,
normal placental position and fetal growth at 24 weeks, transferred to midwife-led care at
34 weeks.
• Currently 38 weeks, small post-coital bleed, fresh red blood loss on wiping with no active
bleeding, intermittent abdominal pain.
o Sexual intercourse at 7.30am this morning.
o Intermittent abdominal pain since 8.30am this morning.
o Small fresh red blood loss noted on wiping and staining of underwear at 9.30am this
morning.

Assessment of maternal wellbeing:

• Temperature: 36.6ºC
• Heart rate: 88 bpm
• Blood pressure: 120/60
• Oxygen saturations: 100%
• Urinalysis: 150mls volume +++ blood ++ leucocytes
• Alert, fit and well
• Pain level 4/10.

Abdominal palpation:
• Abdomen soft and non-tender
• Mild uterine contractions noted 1:3-5 lasting 30 seconds
• Fundal height = 38cms, longitudinal lie, cephalic presentation 3/5 th palpable.

Assessment of fetal wellbeing:

• Normal fetal movements
• Fetal heart auscultated with Pinard – 146 bpm
• Cardiotocograph performed because of fresh vaginal bleed. CTG findings reassuring.

Diagnosis:
• Small post-coital vaginal bleed and irregular uterine contractions.

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Planning care
Vaginal bleed at term
Differential diagnosis:
• Early labour with blood-stained show.

Based on your assessment of Amy Hall, please produce a midwifery care plan for the next
4 hours.

You may wish to use the situation, background, assessment and recommendation (SBAR) tool
provided. Please then use your notes to explain verbally your plan of care to the midwife in
charge of the antenatal assessment unit (the examiner). Your written work will not be marked
but you may take it with you to the next station for reference.

You have 16 minutes to complete this station. You have 10 minutes to make notes on the form
provided (this is not assessed), and up to 6 minutes to verbalise your plan of care to the
examiner.

Complete all sections of the care plan.

Assume it is TODAY and it is 11:30 hours.

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Planning care
Vaginal bleed at term
Candidate notes
This documentation is for your use and is not marked by the examiners.

Patient details:
Name: Amy Hall
Address:17 Ladybrook Lane, Rotherham, Sheffield, S11 3TF
Date of birth: 21/01/1995
Situation:

Background:

Assessment:

Differential diagnosis:

Recommendation:

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Implementing care
Safe administration of medications
Vaginal bleed at term
Candidate paperwork and briefing
Candidate name: _______________________________________

This document must be completed using a BLACK PEN.

Scenario

Amy Hall has now been reviewed by Dr Gupta, following her admission to the antenatal
assessment unit with a post-coital vaginal bleed at 38 weeks’ gestation.
A speculum examination was performed by Dr Gupta where fresh red blood loss was seen
on examination. The cervical os was reported to be short and approximately 1-2cms dilated.
Intermittent abdominal pain continues.
Dr Gupta has requested that Amy Hall be admitted to the antenatal ward for observation of
her vaginal loss and abdominal pain overnight. Medications required for this admission are
prescribed by Dr Gupta. Dr Gupta asks that all required medications due at 14:00 hours are
to be administered prior to transfer to the antenatal ward.

Please administer and document all required 14:00 hours medications for Amy
Hall in a safe and professional manner.

• Talk to the person.

• Please verbalise what you are doing and why to the examiner.
• Read out the chart and explain what you are checking/giving/not giving and why.
• Complete all the required drug administration checks.
• Complete the documentation and use the correct codes.
• The correct codes for non-administration are on the chart.
• Check and complete the last page of the chart.

You have 15 minutes to complete this station, including all the required documentation.

Complete all sections of the document.

Assume it is TODAY and it is 14:00 hours.

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 Prescription chart for: Amy Hall Female Hospital number:
Date of birth: 21/01/1995

Admission date and time Today 10:30

Known allergies or sensitivities Type of reaction

Codeine phosphate Severe nausea and vomiting

Signature: Dr Z Gupta Bleep 505 Date: Today

Information for prescribers: INFORMATION FOR NURSES ADMINISTERING

MEDICATIONS:
USE BLOCK CAPITALS. RECORD TIME, DATE AND SIGN WHEN MEDICATION IS
ADMINISTERED OR OMITTED AND USE THE FOLLOWING
SIGN AND DATE AND INCLUDE BLEEP CODES IF A MEDICATION IS NOT ADMINISTERED.
NUMBER.

SIGN AND DATE ALLERGIES BOX. IF NONE, 1. PATIENT NOT ON 6. ILLEGIBLE/INCOMPLETE

WRITE ‘NONE KNOWN’. WARD PRESCRIPTION OR
WRONGLY PRESCRIBED
MEDICATION
RECORD DETAILS OF ALLERGY. 2. OMITTED FOR A 7. NIL BY MOUTH
CLINICAL REASON
DIFFERENT DOSES OF THE SAME 3. MEDICINE IS NOT 8. NO IV ACCESS
MEDICATION MUST BE PRESCRIBED ON AVAILABLE
SEPARATE LINES.
CANCEL BY PUTTING LINE ACROSS THE 4. PATIENT REFUSED 9. OTHER REASON –
PRESCRIPTION AND SIGN AND DATE. MEDICATION PLEASE DOCUMENT
INDICATE START AND FINISH DATE. 5. NAUSEA OR VOMITING

* IF MEDICATIONS ARE NOT ADMINISTERED, PLEASE DOCUMENT ON THE LAST PAGE OF THE DRUG
CHART.

Does the patient have any YES Please check the chart before administering
documented allergies? NO medications.

WARD CONSULTANT HEIGHT 1.7m (5 foot 6 inches)

MAU Mr R SMITH WEIGHT 70kg (11 stone)
ANY special dietary NO If YES please specify
requirements?
BMI 24

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Prescription chart for: Amy Hall Female Hospital number:
Date of birth: 21/01/1995

Admission date and time Today 10:30

ONCE-ONLY AND STAT DOSES:

Date Time Drug name Dose Route Prescribers’ Prescribers’ Given Checked Time
due signature bleep by: by: given:
Today 14:00 Anti-D 500iu IM Dr Z 505
Gupta

PRESCRIBED OXYGEN THERAPY:

Date Prescribers’ Target Therapy Device Flow Time Time

and signature and oxygen instructions started and discontinued
time bleep saturation signature and signature

PRN (AS-REQUIRED MEDICATIONS):

Date Drug Dose Route Instructions Prescriber Time Given

signature and given by:
bleep
Today PARACETAMOL 1g PO 4-6 hourly Dr Z Gupta
505

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Prescription chart for: Amy Hall Female Hospital number:
Date of birth: 21/01/1995

Admission date and time Today 10:30

ANTIMICROBIALS:
1. DRUG Date and signature of
nurse administering
medications.
Code for non-
administration
DATE DOSE FREQUENCY ROUTE DURATION TIME Today Tomorrow
Today

Start date

Finish
date
Prescriber’s
signature and bleep

2. DRUG Date and signature of

nurse administering
medications.
Code for non-
administration
DATE DOSE FREQUENCY ROUTE DURATION TIME Today Tomorrow
Today
Start date

Finish
date
Prescriber’s
signature and bleep

3. DRUG Date and signature of

nurse administering
medications.
Code for non-
administration
DATE DOSE FREQUENCY ROUTE DURATION TIME Today Tomorrow

Start date

Finish
date
Prescriber’s
signature and bleep

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Prescription chart for: Amy Hall Female Hospital number:
Date of birth: 21/01/1995

Admission date and time Today 10:30

REGULAR MEDICATIONS:

1. DRUG FERROUS SULPHATE Date and signature of

nurse administering
medications.
Code for non-
administration
DATE DOSE FREQUENCY ROUTE DURATION TIME Today Tomorrow
Today 200mg Twice daily Orally 2 WEEKS 08.00

Start Today
date
Finish 18.00
date
Prescriber’s signature Dr Z Gupta 505
and bleep

2. DRUG Date and signature of

nurse administering
medications.
Code for non-
administration
DATE DOSE FREQUENCY ROUTE DURATION TIME Today Tomorrow

Start
date
Finish
date

Prescriber’s signature
and bleep

3. DRUG Date and signature of

nurse administering
medications.
Code for non-
administration
DATE DOSE FREQUENCY ROUTE DURATION TIME Today Tomorrow

Start
date
Finish
date

Prescriber’s signature
and bleep

Midwifery Mock OSCE ToC 2021_V2.1_Updated 13.12.22 Page 25 of 43

Prescription chart for: Amy Hall Female Hospital number:
Date of birth: 21/01/1995

Admission date and time Today 10:30

4. DRUG Date and signature of

nurse administering
medications.
Code for non-
administration
DATE DOSE FREQUENCY ROUTE DURATION TIME Today Tomorrow
Today

Start
date
Finish
date
Prescriber’s signature
and bleep

INTRAVENOUS FLUID THERAPY:

Date Fluid Volume Rate/time Prescriber Batch Commenced Given Checked Finished
number: @ by: by: @

DRUGS NOT ADMINISTERED:

DATE TIME DRUG REASON NAME AND

SIGNATURE

Midwifery Mock OSCE ToC 2021_V2.1_Updated 13.12.22 Page 26 of 43

Evaluating care
Vaginal bleed at term
Candidate paperwork and briefing
Candidate name: _______________________________________

• This document must be completed using a BLUE PEN.

• At this station, you should have access to your assessment, planning
and implementation documentation.
• If not, please alert the examiner.

Scenario

You are now working on the antenatal ward.

Amy Hall has had an uneventful night on the antenatal ward. Amy has not experienced any
further vaginal blood loss overnight and her abdominal pain has now settled. You have carried
out an antenatal assessment of Amy this morning. A CTG was also done to assess fetal
wellbeing, and both assessments are reassuring.

Dr Gupta has also reviewed Amy this morning and has discharged Amy back to midwifery-led
care in the community.

You are required to complete a transfer of care letter to ensure that the community midwife
has a full and accurate account of Amy Hall’s history and ongoing care needs.

Please complete a transfer of care letter to ensure that the community midwife has a full
and accurate account of Amy Hall’s history and ongoing care needs.

You have 16 minutes to complete all sections of the documentation.

Assume it is 1 DAY LATER and it is 10:00 hours.

Midwifery Mock OSCE ToC 2021_V2.1_Updated 13.12.22 Page 27 of 43

Evaluating care
Vaginal bleed at term
Transfer of care letter
Patient details:
Name: Amy Hall
Address: 17 Ladybrook Lane, Rotherham, Sheffield, S11 3TF
Date of birth: 21/01/1995

Date of admission:
Clearly describe the reason for handover, including the initial admission and
subsequent diagnosis:

Situation – Identify who you are, where you work and explain what the current
situation is with the woman and the fetus.

Background – Give the woman’s reason for admission, explain her pregnancy
history, noting any significant medical or obstetric history as well as any tests or
assessments that have taken place.

Assessment – Explain what you think any underlying causes might be for the
woman’s admission, linking them to your clinical findings.

Midwifery Mock OSCE ToC 2021_V2.1_Updated 13.12.22 Page 28 of 43

Evaluating care
Vaginal bleed at term

Recommendations – Identify any ongoing care needs and further follow-up

review with appropriate timelines.

Plan of care and future appointments

Document allergies and associated reactions

Identified/potential areas for parent education

What are the actual or potential problems that may risk or complicate the
current pregnancy?

Other members of the multidisciplinary team who need to be aware of Amy’s

discharge

Midwifery Mock OSCE ToC 2021_V2.1_Updated 13.12.22 Page 29 of 43

Evaluating care
Vaginal bleed at term
PRINT NAME:
Midwife’s signature:
Date/Time:

Midwifery Mock OSCE ToC 2021_V2.1_Updated 13.12.22 Page 30 of 43

Mock clinical skill

The instructions and available resources are provided for the mock clinical skill station,
along with the specific timing.

Station You will be given the following resources

Clinical skill – 30 minutes will be • Overview documentation (pages 31–35)

allotted for two linked skills and you
will use your professional judgement
to allocate time for this one station.
You will carry out the required
actions to undertake a systematic
examination of a newborn infant.

In the table below, we have outlined the expected standard of clinical performance and
criteria. The marking matrix is there to guide you on the level of knowledge, skills and
attitude we expect you to demonstrate.

Marking criteria – Systematic examination of the newborn

Cleans own hands with alcohol hand rub, or washes with soap and water and dries with
paper towels following WHO guidelines.
Conducts ongoing assessments of the health and wellbeing of the newborn infant,
involving the mother and partner as appropriate, and providing a full explanation, which
must include: parental confidence in handling and caring for the newborn infant, including
response to crying and comfort measures.
Holistic assessment of the full systematic physical examination of the newborn infant in
line with local and national evidence-based protocols, and ensuring that screening and
diagnostic tests are carried out appropriately and as required, in line with local and
national evidence-based protocols.
Identifies risk factors, screens maternal records, and carries out record-keeping of
newborn child health record.
Explains the systematic examination of the screening programme's 4 areas, and gains
informed consent.
Ensures the correct environment (warm, light, flat, firm surface, alongside mother),
reviews the case history and identifies any risk factors.
Has a logical process for the examination.
Acts professionally throughout procedures in accordance with NMC (2018) 'The Code:
Professional standards of practice and behaviour for nurses, midwives and nursing
associates'.

Midwifery Mock OSCE ToC 2021_V2.1_Updated 13.12.22 Page 31 of 43

Mock clinical skill

Overview
Systematic examination of the newborn
Scenario

You are working on a labour ward.

You have been asked to assist with the care of Helen, who gave birth to her second
baby 6 hours ago. Helen and her baby are fit and well postnatally, and Helen would like
an early postnatal discharge home.

You have been asked to perform the systematic examination of the newborn prior to
Helen’s discharge home.

The midwife caring for Helen informs you of Helen’s clinical history as follows. Helen
opted to have full antenatal screening for fetal anomaly at 16 weeks, which were
reported to be low risk. At 20 weeks, Helen opted to have a fetal anomaly scan, where
the nuchal fold was reported to be 6mm with no further anomalies noted. Helen
declined further follow-up.

Helen was admitted in spontaneous labour and was in labour for 7 hours. Helen had an
uncomplicated vaginal delivery of a live male infant. No resuscitation was required at
birth. An examination of the infant at birth was performed and no abnormalities were
detected.

Please undertake a systematic examination of the newborn, focusing on the newborn guidance
examination of the (examiner will select only one key area in the live assessment): eyes,
heart, hips or testes.

Please verbalise and demonstrate your actions as you examine the newborn, giving
careful consideration to evidence-based practice and newborn guidance.

The newborn infant physical examination offers an opportunity for parent education and health
promotion. Please include key information and advice as part of your examination and
document your findings, with any relevant referral and ongoing plan of care, on the
documentation proforma.

Please note that you will have 30 minutes in total to perform a pair of linked skills stations. It
will be up to you to plan your time but this station is the longer one of the pair. The examiner
will give you a warning 5 minutes before the end.

Midwifery Mock OSCE ToC 2021_V2.1_Updated 13.12.22 Page 32 of 43

 Mock clinical skill
Proforma Part 1 and 2

Newborn Health Assessment

PART 1 – MATERNAL, FAMILIAL AND FETAL HISTORY

MATERNAL AND FETAL CONSIDERATIONS

Maternal age: 30 Paternal age: 30 Maternal blood group: O positive

Maternal medical Nil of note

Nil of note Family history:
history:

FASP points of
Routine fetal screening – nil of note
note:

Obstetric History: G 2 P 2 Notes:

MLC
Current pregnancy considerations:
CLC

Medication during pregnancy: Nil

LABOUR AND DELIVERY CONSIDERATIONS

ROM (Hrs): Liquor: CLEAR MECONIUM

Labour onset: SPONTANEOUS INDUCTION AUGMENTATION

1st Stage: 6 hours 40 mins 2nd Stage: 20 mins Apgar: 8/1 9/5

Medication during labour: Paracetamol, Entonox

Mode of delivery: Spontaneous vaginal birth

Cord
Cord clamp interval: > 3 mins Not taken Normal Abnormal
gases:

Specific areas of note

regarding delivery:

Midwifery Mock OSCE ToC 2021_V2.1_Updated 13.12.22 Page 33 of 43

 Mock clinical skill
Proforma Part 1 and 2

PART 2 – NEONATAL ASSESSMENT

NEONATAL CONSIDERATIONS:

Gestation at
38 Birth Weight: 2900g Sex: Male
delivery:

ON NEONATAL EXAMINATION:

Age at
6 hours Temp: 36.6 HC: 34cm
examination:
FINDINGS ADDITIONAL NOTES

Appraisal:

Symmetry:

Tone:

Movement:

Posture:

Skin:

HEAD
FINDINGS ADDITIONAL NOTES

Skull:

Hair:

Face:

Eyes:

Ears:

Mouth:

Nose:

Tongue:

Neck:

Midwifery Mock OSCE ToC 2021_V2.1_Updated 13.12.22 Page 34 of 43

 Mock clinical skill
Proforma Part 1 and 2

PELVIC REGION AND LOWER EXTREMITIES

FINDINGS ADDITIONAL NOTES
Genitalia
and Anus:
Spine and
Back:

Hips:

Femoral
Pulses:
Legs and
Feet:
NEUROLOGICAL ASSESSMENT
FINDINGS ADDITIONAL NOTES

Moro Reflex:

Suck Reflex:

Rooting
Reflex:
Babinski
Reflex:
Gallant
Reflex:
Grasp
Reflex:

Head Lag:

Primitive
Walking:
UPPER EXTREMITIES AND THORACIC REGION
FINDINGS ADDITIONAL NOTES
Arms and
hands:
Brachial
Pulses:

Chest:

Heart
Sounds:
Lung
Sounds:

Midwifery Mock OSCE ToC 2021_V2.1_Updated 13.12.22 Page 35 of 43

 Mock clinical skill
Proforma Part 1 and 2

ABDOMINAL REGION
FINDINGS ADDITIONAL NOTES
Abdomen:

Liver:

Spleen:

Kidneys:

Cord:

FEEDING AND ELIMINATION

FINDINGS
Method: BF Assessment of Feeding: Has had first feed

Excretion: PU Stools: Meconium not yet passed

CONCLUSION AT TIME OF EXAMINATION

Conclusions and
recommendations following
examination
(physical, psychological and
wider sociological factors)

Parental participation/
health promotion points

Referral required

At time of examination no Referral to:

apparent need for referral:
Referral date:

Referral completed by:

Midwifery Mock OSCE ToC 2021_V2.1_Updated 13.12.22 Page 36 of 43

Mock silent stations

You will also be required to undertake two new silent stations. In each OSCE, one station
will specifically assess professional issues associated with professional accountability and
related skills around communication (called the professional values and behaviours station,
or the PV station). One station will also specifically assess your critical appraisal of
research and evidence and associated decision-making (called the evidence-based
practice station, or EBP station).

The instructions and available resources are provided for each station, along with the
specific timing.

Station You will be given the following resources

Professional values and • Overview documentation (pages 38–39)
behaviours:
Dignity, respect and choice – 10
minutes
You will read the scenario and
summarise the actions that you
would take, considering the
professional, ethical and legal
implications of this situation.

Evidence-based practice: • Overview documentation (pages 40–41)

Obstetric anal sphincter injury
(OASI) – 10 minutes

You will read the scenario and

summary of the research, then
write up how you would apply the
findings to the scenario.

On the following pages, we have outlined the expected standards of clinical performance
and criteria. These marking matrices are there to guide you on the level of knowledge,
skills and attitude we expect you to demonstrate at each station.

Midwifery Mock OSCE ToC 2021_V2.1_Updated 13.12.22 Page 37 of 43

Mock silent stations

Professional values & behaviours marking criteria – Dignity, respect and choice
Considers Miriam’s situation and is able to summarise the main points of concern in the
scenario.
Is able to communicate fully and clearly with Miriam and her husband.
Demonstrates kindness and compassion when responding to Miriam.
Recognises Miriam’s autonomy and right to choose how her babies are fed.
Works in partnership with the couple including care planning and follow-up support.
Acts as an advocate for Miriam and does not express own personal beliefs
inappropriately.
Ensures that Miriam is supported to make an informed decision.
Recognises the need for reflection on the situation and the opportunity to improve
practice.
Demonstrates an understanding of the need for accurate documentation of the situation.

Evidence-based practice marking criteria – Obstetric anal sphincter injury (OASI)

Summarises the main findings from the article summary and draws conclusion, making
recommendations for practice.
Recognises and makes reference to the importance of woman-centred care and maternal
choice, regardless of national recommendations or available evidence.
Recognises the fact that Hana has had a previous ventouse birth and may feel anxious
about this.
Informs Hana that the results of the study showed a reduction in anal sphincter injury in
both instrumental and spontaneous vaginal births.
Recognises the fact that there were variables across the participating hospitals that could
have impacted on the results of the study.
Acknowledges the date of publication and is aware that newer evidence may have been
published since 2010.

Midwifery Mock OSCE ToC 2021_V2.1_Updated 13.12.22 Page 38 of 43

Professional values and behaviours:
Dignity, respect and choice
Overview

Scenario

You are working on a busy postnatal ward.

One of the women you are caring for is Miriam, who birthed twin boys at 33 weeks
gestation 2 days ago. The babies are doing well in the neonatal intensive care unit.

Miriam calls her bell and, when you arrive, she is very distressed and angry. She tells
you that she feels pressured into expressing breastmilk for her babies and she wants to
stop. Miriam’s husband is with her and he is upset as he is concerned that the babies
need expressed breastmilk due to their early gestational age.

Using your knowledge of NMC (2018) ‘The Code: Professional standards of

practice and behaviour for nurses, midwives and nursing associates’, consider the
professional, ethical and legal implications of this situation.

Please summarise the actions that you would take in a number of bullet points.

This is a silent written station. Please write clearly and legibly.

You have 10 minutes to complete this station.

Midwifery Mock OSCE ToC 2021_V2.1_Updated 13.12.22 Page 39 of 43

Professional values and behaviours:
Dignity, respect and choice
Candidate documentation

Candidate name:__________________________

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Midwifery Mock OSCE ToC 2021_V2.1_Updated 13.12.22 Page 40 of 43

Evidence-based practice:
Obstetric anal sphincter injury (OASI)
Overview
Read the scenario and the summary of the research below.
Please identify the main points from the summary and apply the findings to the scenario
below.
This is a silent written station. Please write clearly and legibly.
You have 10 minutes to complete this task.

Scenario
You are working in the community and have an appointment with Hana, who is 36 weeks
pregnant with her second baby. She had a ventouse delivery last time and has been
reading about how to prevent perineal trauma during birth. She wants to talk to you about
whether the midwife or obstetrician can manually protect her perineum at the end of the
second stage of labour to prevent trauma.

Article summary

An interventional cohort study published in 2010 was used as evidence to support the
Royal College of Obstetricians and Gynaecologists’ (RCOG) OASI care bundle, which is
supported in UK practice by the Royal College of Midwives. The study involved the
application of an intervention in 40,152 vaginal deliveries in Norway between 2003 and
2009. The intervention was manual support of the perineum at the end of the second
stage of labour.
The study found that the incidence of anal sphincter injury reduced from 4–5% to 1–2%
during the study.
The study also found that:
• the incidence of perineal trauma reduced in both instrumental deliveries and
spontaneous vaginal deliveries
• reduction in fourth-degree tears was the most significant finding of the study
• intervention had no harmful effects on the newborn.

There were variables regarding episiotomy rates, mode of delivery and parity in different
participating hospitals during the study.

Midwifery Mock OSCE ToC 2021_V2.1_Updated 13.12.22 Page 41 of 43

Evidence-based practice:
Obstetric anal sphincter injury (OASI)
Candidate documentation
Candidate name:

What is the relevance of the findings from this research? What advice will you give
to Hana?
Give your responses here as bullet points:
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Midwifery Mock OSCE ToC 2021_V2.1_Updated 13.12.22 Page 42 of 43

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