Anesthesiology APPLIED Exam › OSCE: communication and professionalism

Disclosing a peri-procedural complication or error

T1OSCE: communication and professionalism·937 words · ~5 min read·v0.1✓ Sourced · 5DRAFT

Why examiners ask this

Every anesthesiologist will explain a complication to a patient who did not expect one: a numb hand after surgery, a chipped tooth, a headache after a spinal, recall of the operation. The station tests whether I can take a history, examine, explain what likely happened and what comes next, and do it honestly without speculation, blame or defensiveness. The grader scores seven behaviors, from eliciting the history to showing concern,¹ and the clinical reasoning is only half of them; the other half is how the patient feels when I leave. The ABA sample is a disclosed error: glycopyrrolate 0.4 mg given instead of rocuronium from the wrong syringe, tachycardia to 128 that resolved, and a patient ready for discharge whom the surgeon has told to expect my explanation.²

The 60-second answer

I read the stem for the complication, the timeline and whether an error is involved. I enter, introduce myself, sit, and ask the patient how they are feeling and what they have noticed. I let them tell the story, then take a focused history: onset, character, progression, and what makes it better or worse. I do a focused examination appropriate to the complaint and narrate it. I explain in plain words what I think caused it, including my role if there was one, and I say I am sorry this happened. I describe the likely course honestly, then the plan: tests, consultants, treatment, and when I will see them again. I invite questions and answer them in lay terms. I close by restating my concern and giving them a way to reach me.

Decision points and the "why"

Elicit the history — onset relative to surgery, distribution, motor versus sensory, progression. It is scored because disclosure without assessment is reassurance without basis.
Perform a focused exam — for a numb ring and little finger, I test light touch in the ulnar distribution, grip, finger abduction and the elbow. Narrating the exam shows the grader what I am doing and reassures the patient that I take it seriously.
Explain the causes — I give the most likely cause in plain words: pressure or stretch on the nerve at the elbow during surgery, which happens even with careful padding. If an error occurred, I state the fact without hedging: "The tooth was chipped when I placed the breathing tube."
Give the likely outcome — about 40% of sensory-only ulnar neuropathies resolve within 5 days and 80% within 6 months; combined sensory and motor injuries do worse, with only about 20% resolved at 6 months.³ Honest prognosis is scored; false reassurance is not.
State the plan — protect the elbow, a neurology referral, nerve studies at 3–4 weeks if not improving, when they can grade severity, and a follow-up visit.³ A plan answers the patient's real question: what now?
Answer questions in lay terms — "Will I be able to play guitar?" deserves a direct answer and the plan to find out.
Express concern — "I am sorry this happened" is concern, not an admission of negligence, and it is scored explicitly.

The complication they will inject

The patient gets angry: "Somebody screwed up. I want to know who, and I want a lawyer." I do not defend, deflect or blame the surgeon or nurse. I acknowledge the anger as reasonable, keep my voice level, and restate the facts I know. I say what I do not yet know and that we are reviewing what happened, which is true because I have reported it through our safety system. I tell them they have every right to seek advice, and that I and the patient-relations office will answer their questions in the meantime. Then I return to the plan for their hand. The scored behavior is staying honest, present and focused on the patient under hostility. A variant is the patient who asks "Was it your fault?" before I know; I say I do not know yet, I will find out, and I will tell them.

Pitfalls that cost points

Opening with the explanation before hearing what the patient experienced.
Skipping the examination because the station "is about communication."
Speculating about cause or blaming a colleague in front of the patient.
Minimizing: "It's nothing, it'll go away."
Leaving without a concrete follow-up time and contact.

Rapid-why

Q: Does "I'm sorry" admit liability? A: An expression of sympathy is not an admission, and many states protect it; withholding it damages trust far more than saying it.

Q: Do I disclose an error the patient has not noticed? A: Yes. Disclosure of harmful errors is an ethical obligation and the standard of the CANDOR approach, whether or not the patient asks.

Q: Who else should be in the room? A: Ideally the attending surgeon or a nurse; in the station I mention that I will involve them and our risk-management team.

Q: How do I phrase uncertainty? A: "I don't know yet. Here is what we are doing to find out, and I will tell you when I do."

Numbers to know

Item	Value
Station time	8 min, 4-min read, warning at 6 min⁴
Complication checklist behaviors	7¹
Sensory-only ulnar neuropathy	~40% resolve in 5 days, ~80% by 6 months³
Nerve conduction studies if not improving	3–4 weeks after injury³
Dental injury needing repair or extraction	~1 in 4,500 anesthetics, half at laryngoscopy⁵

Sources

1.APPLIED Examination OSCE Content Outline · ABA · theaba.org
2.OSCE Example Scenarios · ABA, 2023 · theaba.org
3.Peripheral nerve injuries from positioning · OpenAnesthesia · openanesthesia.org
4.What to Expect for Your APPLIED Exam (APPLIED Exam Manual) · ABA, 2026 · theaba.orgRevised July 2026.
5.Perianesthetic dental injuries: frequency, outcomes, and risk factors · Anesthesiology, 1999 · ebi.ac.ukAbstract via Europe PMC (PMID 10319777); 598,904 anesthetics, Mayo Clinic.

Facts on this page were checked against these sources on Oct 14, 2026. Guidelines change; confirm doses against current institutional protocols.