ORE Part 2 Exam Coaching in India

. DIAGNOSIS AND TREATMENT PLANNING

1. History taking and contemporaneous note making – 10 minutes

You will meet your patient, who will be a role player who has been briefed on the clinical scenario and should in all respects be treated as the “patient”. You will not be able to examine the patient or their mouth.
You will have ten minutes to take the necessary history for this patient. During this time you will be expected to make contemporaneous notes, which will be marked.
An examiner, who will remain mainly silent during this part, will observe you and complete a structured mark sheet. The examiner will make sure that the role player’s responses are accurate and may ask for clarification if they do not understand any of your responses. The contemporaneous notes will not be collected until the end of the examination and then will be assessed by another examiner. You will therefore be able to keep these notes with you during the other stages of the examination.
Available at this chair will be (artefacts) the clinical results from the routine examination you would normally undertake. Examples of the results are:
• Study casts or photos of study casts to give you information such as
◦ the occlusion
◦ number and position of teeth
• Details of obvious pathology with unaided vision such as caries
• BPE
• Photographsto show you such things as
◦ lip line
◦ gingival colour
It is advised that you do not spend time looking at these until you have completed your history taking. This information will then help to inform you to complete the forms in the next section.

2. Complete provisional (possible) diagnosis, special investigations & radiographic prescription forms – 11 Minutes

At the end of the first 10 minutes the “patient” and examiners will leave the surgery and you will have 11 minutes to complete your contemporaneous notes, examine the artefacts and prepare the following:
Please Note it is your responsibility to check that all the artefacts are present. There is a list on the top of the artefacts stating what is present. (A cast is a single upper or lower so upper and lower will be 2 casts.) If you believe the artefacts do not agree with the list please contact the helper immediately and inform them of the issue.
a. Written provisional (possible) diagnosis.
b. Radiographic prescription including clear justification for this request. If no radiographs are required please indicate this on the request form.
c. Written list of any special investigations you would make if you were examining this patient.
The provisional (possible) diagnosis should be formulated from the complaint, history, and routine investigations (artefacts). It will guide you in prescribing any necessary special investigations. You should only request information you need to acquire for this patient during a clinical examination, including radiographs, etc. to allow treatment planning.
Examples of Special investigations other than radiographs(this is not an inclusive list)
• Vitality tests
• Full mouth periodontal charting
• Body temperature
• Condition of muscles of mastication
• Cracked tooth tests
At the end of this time a helper will collect the
a. Written provisional diagnosis. (sheet 3)
b. Radiographic prescription including the clear justification for this request (sheet 4).
c. Written list of special investigations you would make if you were examining this patient. (sheet 5) and bring you a further folder with other artefacts giving the results of any special investigations and the necessary radiographs. Do not worry if they do not contain all the requests you made. There will be enough for you to make your treatment plan.

3. Written Treatment Plan – 23 minutes

You will now have all the necessary artefacts and information required to plan your treatment for your “patient”. You will have twenty-three minutes to consider these artefacts and formulate a treatment plan and write down the treatment options and their advantages and disadvantages. You will also have to complete a written radiographic report for one radiograph, which will be clearly identified. You should use the real radiograph and not the one illustrated on the sheet. Your treatment plan should also consider the potential risks of treatment, the long term stability, your patient’s wishes and the suitability for your patient. If you consider it necessary to refer your patient you should give some justification and reasons for the referral, and be able to inform your patient of the possible outcomes of such a referral.

4. Presentation of Treatment Plan to the patient – 10 minutes

At the end of the treatment planning time your “patient” will return with the examiner. The examiner will ask you to present your treatment plan to your “patient”. This treatment plan should be presented to the “patient” in lay terms explaining your essential findings in such a way that the “patient” has sufficient information to understand the advantages and disadvantages of the possible options that you consider are available, and to give valid consent for your proposed preferred option. (In view of the difficulty of understanding costs of treatment in a foreign country you will not be expected to give indication of costs other than the relative difference of any treatment recommended e.g. implants high-cost relative to denture). It is expected that the treatment plan will include not only active treatment but also any necessary care and prevention and the possible influence of any medical problems.
While you are explaining the advantages and disadvantages of any treatment you consider and finally giving your preferred choice, the patient or examiner may seek further clarification of your suggested treatment options.
This oral treatment plan will be assessed by the examiner. At the completion of your treatment plan you must hand in all your written sheets of your contemporaneous notes and treatment plan for marking. If you do not hand these sheets in you will be unable to attain full marks.
You must not make copies of these sheets or remove any information from the examination area. Removing such information would be seen as infringing the regulations.
All examiners will mark independently and also asses your professionalism. You should refer to the GDC web site for further information on professionalism.

5. Advice on completing the written forms

5.1 Patient History Form

You should record in legible handwriting:
a. the “patient’s” demographic details
b. the “patient’s” main complaint and any other concerns they may have listing their symptoms and when they started and any modifying factors.
c. a structured record of the medical (including any medications), social & past dental history
d. any other relevant information such as dental care routines, diet and any other factors which influence dental health
e. “Patient’s” wishes

5.2 Provisional or possible Diagnosis Form

This form will be pre-populated with the patient’s demographic data and requires you to enter what are the most likely reasons for the “patient’s” complaint(s) from the evidence youhave received from your history taking and the artefacts supplied in relation to the examination. Where possible you should indicate the reasons for your conclusions.

5.3 Radiographic Prescription Form

This form will be pre-populated with the “patient’s” demographic data but you should enter which radiographic film(s) you require clearly indicating when necessary the site and tooth. You should also indicate the justification for the request. If no radiographs are required write this clearly on the form. Remember it is unethical to prescribe more radiographs than are required to make a diagnosis.

5.4 Special Investigations Form

This form will be pre-populated with the “patient’s” demographic data and you should enter any special investigations that you would wish to carry out. This should not be a list of all possible examinations and investigations but carefully considered and only those which are justified from the history.

5.5 Written Treatment Plan Form

This form of two sheets will be pre-populated with the “patient’s” demographic data and you should enter the treatment and care options for the “patient”. This should include any urgent, immediate and planned treatment as well as long term care plans together with your preferred treatment. You should then complete the other questions on the second sheet.
You should also indicate any risks of the proposed treatment. You will be expected to explain if you would treat the “patient” yourself or would refer them for all or part of the treatment explaining your reasons. You should also give the “patient” some information about the possible outcomes from such a referral.

5.6 Radiographic Report Form

This form will be pre-populated with the “patient’s” demographic data and a copy of the radiograph or section of radiograph on which you should report. It will only be necessary to report on the one view shown on the report form. You should use the real radiograph to make the report and not the one illustrated on the sheet. Your report should be the standard expected by the GDC and should include which film view it is, details of the side, bone quality, bone level, teeth present, restorations or caries present, and any other relevant details. Finally you should comment on the quality, and any issues related to the film itself.