Kwame Nkrumah University of Science and

Technology

Faculty of Pharmacy and Pharmaceutical Sciences

Department of Pharmacy Practice

PHARM 392/491/492: Pathophysiology and

Therapeutics
Practice Module
 PRACTICAL OSCE PERFORMANCE GUIDE

Medication History-Taking | Prescriber Interaction | Medicines Information | Responding

to Symptoms | Patient Counselling

Purpose: This guide provides a repeatable method for performing common

pharmacy OSCE stations in a practical therapeutics laboratory. Students should use
it before simulated stations, during group practice, and after feedback to improve
performance.

Apply a structured approach to five common pharmacy OSCE station types.

Open consultations professionally, confirm identity, clarify the task, and close safely.
Gather relevant information efficiently within a time-limited station.
Identify medication optimization issues, clinical red flags, referral triggers, and
counselling priorities.
Communicate recommendations clearly to patients, carers, prescribers, or enquirers.
Use teach-back, safety-netting, and documentation to demonstrate safe professional
practice.
 Universal OSCE process for all stations
Every station should follow a simple professional rhythm. The content changes by
station type, but the structure remains the same.

STEP WHAT TO DO

1. Read the task Identify the station type, the person you are speaking
to, the expected output, and any safety-critical
information already provided.

2. Start professionally Introduce yourself, state your role, confirm the

person’s name and one other identifier where
appropriate, request permission to proceed, and
ensure privacy.

3. Clarify the agenda Explain what you need to do: take a history, answer a
medicine question, counsel on treatment, assess
symptoms, or discuss an optimisation issue with a
prescriber.

4. Gather focused Ask targeted questions using an appropriate

information framework rather than a long unfocused list.

5. Interpret and Decide the main problem, urgency, medicines-related

prioritise issues, red flags, and the safest course of action.

6. Communicate the Give a clear recommendation using plain language for

plan patients or structured clinical language for prescribers.

7. Check Use teach-back, invite questions, safety-net, thank the

understanding and person, and document or hand over as needed.
close

Core communication behaviours expected in every station

• Introduce yourself by name and position as a pharmacy student/pharmacist,
depending on the station instruction.
• Confirm the client or patient using name plus a second identifier such as age,
date of birth, or address where appropriate.
• Ask about allergies or previous adverse reactions when medicines may be
recommended, supplied, prescribed, or discussed.
• Avoid unexplained medical jargon; translate technical terms into patient-friendly
language.
• Use signposting: “I will ask a few questions first, then I will explain the options.”
• Be empathetic and non-judgemental, especially for alcohol use, sexual health,
pregnancy, mental health, adherence, and weight-related topics.
• Use teach-back: “To make sure I explained it clearly, can you tell me how you
will take it when you get home?”
• Close with safety-netting: “Seek urgent medical help if…” or “Come back if…”
depending on the risk level.
Medication history-taking stations
Aim: To obtain a complete, accurate, and clinically useful medication history that can
support therapeutic decisions.

Step-by-step approach
STEP PERFORMANCE STANDARD

Opening Introduce yourself, confirm identity, explain that

you need to understand all medicines being used.

Presenting issue Ask why the patient came in, recent symptoms,
recent hospital/clinic visits, and medicines started
or stopped.

Prescription medicines Name, strength, dose, frequency, duration,

indication, adherence, recent changes, and source.

Non-prescription OTC medicines, painkillers, cough/cold products,

medicines antacids, laxatives, eye/ear preparations, topical
products.

Traditional/herbal Ask respectfully and specifically; many patients will

products not mention these unless prompted.

Allergies and adverse Drug name, reaction type, timing, severity,

reactions management, and whether rechallenge occurred.

Medication-taking Missed doses, intentional non-adherence, cost

behaviour barriers, beliefs, side effects, forgetfulness, access
problems.

Clinical context Medical history, pregnancy/breastfeeding if

relevant, renal/liver disease, alcohol, smoking,
occupation, monitoring results.

Verification Use medicine containers, prescriptions, patient-held

records, caregiver information, or phone photos
where available.

SUMMARY Summarise back the medicine list and unresolved

issues; identify discrepancies and questions for
follow-up.
 Common performance errors
• Asking only about prescribed medicines and missing OTC/herbal products.
• Recording allergies without reaction details.
• Failing to ask how the patient actually takes the medicine.
• Not linking the history to a medication-related problem.

Expected station outputs

• A reconciled medicine list.
• Identified adherence problems, duplication, contraindications, interactions,
monitoring gaps, or adverse reactions.
• A concise handover or recommendation to the next station.
 Prescriber interaction stations
Aim: To communicate a medicine optimisation issue to a prescriber and agree a safe
plan.

Step-by-step approach
STEP PERFORMANCE STANDARD

Prepare before Identify the issue, clinical risk, evidence/rationale,

speaking patient-specific factors, and your recommended
alternative.

Use sbar Situation, Background, Assessment, Recommendation.

State the concern Examples: unsafe dose, contraindication, allergy, renal

clearly adjustment, interaction, missing indication,
inadequate therapy.

Make a specific Do not only say “please review”; propose an action,

recommendation dose, monitoring plan, or referral.

Negotiate Invite prescriber input, respond to challenge

professionally respectfully, and keep patient safety as the focus.

Confirm the final plan Repeat the agreed change, monitoring, counselling,
and who will inform the patient.

Document Record the issue, prescriber contacted, advice given,

decision made, and follow-up required.

Common performance errors

• Sounding accusatory rather than collaborative.
• Raising a problem without a proposed solution.
• Ignoring patient-specific risk factors such as renal disease, pregnancy, liver
disease, age, or allergy.
• Ending the call without confirming the agreed plan.

Expected station outputs

• Clear identification of optimisation issue.
• Safe, evidence-informed recommendation.
• Agreed therapeutic plan and monitoring/follow-up actions.
SBAR is a standardized communication framework that stands for Situation,
Background, Assessment, and Recommendation.

The SBAR framework helps you organize your thoughts into a clear, predictable flow:

S - Situation: State what is happening right now. (Keep it brief and identify the specific
patient, person, or problem.)

B - Background: Provide relevant context and history. (What circumstances led up to

this point?)

A - Assessment: Give your analysis of the problem. (What do you think is going on
based on the data?)

R - Recommendation: State what action you are requesting or suggesting. (What needs
to happen next to resolve the issue?)

Why Use It?

Efficiency: It prevents rambling by delivering only the most critical, solution-oriented

facts first.

Safety: It minimizes misunderstandings, which is especially critical during medical

emergencies or staff shift handovers.
 Medicines information stations
Aim: To answer a medicine-related question accurately, safely, and in a way the
enquirer can use.

Step-by-step approach
STEP PERFORMANCE STANDARD

Clarify the question Identify exactly what the enquirer wants to know and
how urgently the answer is needed.

Identify the enquirer Patient, caregiver, pharmacist, nurse, doctor, or other

health professional.

Gather background Patient age, sex, pregnancy/breastfeeding, diagnosis,

medicines, allergies, organ function, relevant labs,
timing, and symptoms.

Check the medicine Interaction, adverse effect, dose, contraindication,

problem administration, monitoring, use in special population,
or therapeutic alternative.

Formulate the answer Give the conclusion first, followed by concise

reasoning, practical advice, and safety-netting.

Confirm Ask whether the answer addresses the concern and

understanding whether further information is needed.

Document Record the query, information obtained, sources

consulted if required, advice given, and any referral.

Common performance errors

• Answering too early before clarifying the real question.
• Failing to ask about other medicines or medical history.
• Giving a theoretical answer without a patient-specific recommendation.
• Not explaining uncertainty or when referral is required.

Expected station outputs

• A clear answer to the medicine information question.
• Risk assessment and patient-specific recommendation.
• Appropriate escalation, monitoring, or referral advice.
 Responding-to-symptoms stations

Aim: To assess a patient’s symptoms, identify red flags, and recommend self-care,
treatment, referral, or emergency care.

Step-by-step approach
STEP PERFORMANCE STANDARD

Identify the patient Who has the symptoms? Age, pregnancy status, comorbidities, and
whether the patient is present.

Characterise Onset, duration, location, severity, associated symptoms,

symptoms progression, triggers, and previous episodes.

Assess medicines Current medicines, allergies, medical conditions, previous

and history treatment tried, response, and contraindications.

Screen for red flags Danger symptoms, severe systemic illness, vulnerable groups,
treatment failure, and symptoms needing referral.

Decide care Emergency referral, same-day medical review, routine referral,

pathway pharmacist treatment, or non-drug advice.

Recommend safely Give product choice only when appropriate, including dose,
duration, precautions, interactions, and side effects.

Safety-net Explain when to stop treatment, when to return, and when to seek
urgent help.

Common performance errors

• Recommending a medicine before assessing red flags.
• Failing to ask age, pregnancy status, or comorbidities.
• Treating severe or persistent symptoms as minor ailments.
• Not giving duration of treatment or follow-up advice.

Expected station outputs

• Appropriate triage decision.
• Safe treatment or referral recommendation.
• Clear patient counselling and safety-netting.
ASMETHOD is a common mnemonic used by healthcare professionals and students
for patient symptom assessment and self-care counseling. It helps structure the
questions asked to a patient to determine the safest and most effective
recommendation.

A – Age: Determine or visually estimate the patient's age to ensure medication

suitability and identify red flags (e.g., vaginal or oral thrush can signal underlying
issues).

S – Self (or someone else): Establish if the patient is seeking advice for themselves or
for another person.

M – Medication: Ask about any current prescription or over-the-counter (OTC)

medications they are using.

E – Extra medicines: Find out if they have already tried any other remedies or
supplements specifically for the current problem.

T – Time persisting: Ask how long the symptoms have been going on to rule out
urgent situations.

H – History: Gather context on the problem's onset, progression, and any recurrent
history.

O – Other symptoms: Ask if the patient is experiencing any other accompanying

symptoms that are abnormal for them.

D – Danger symptoms: Check for serious red-flag symptoms that warrant an

immediate doctor referral rather than an OTC treatment.
 Patient counselling stations
Aim: To help a patient use a medicine correctly, safely, and confidently.

Step-by-step approach
STEP PERFORMANCE STANDARD

Open and confirm Introduce yourself, confirm the correct patient, and explain the
identity purpose of counselling.

Assess baseline Ask what the patient already knows and what the prescriber has
knowledge explained.

Explain indication What the medicine is for and what improvement or outcome to
and benefit expect.

Explain regimen Dose, frequency, timing, route, duration, missed-dose advice, and
administration technique.

Discuss safety Common side effects, serious warning symptoms, interactions,

contraindications, and what to avoid.

Monitoring and What to monitor, when to review, when to seek help, and expected
follow-up timeline of benefit.

Practical adherence Storage, routines, reminders, cost/access issues, lifestyle advice,

support and family support where appropriate.

Teach-back and Ask the patient to explain how they will use the medicine; invite
close questions and thank them.

Common performance errors

• Delivering a lecture instead of tailoring counselling to the patient.
• Not checking what the patient already knows.
• Forgetting missed-dose advice, duration, monitoring, or side effects.
• Not using teach-back.
 Expected station outputs
• Patient knows why, how, and when to use the medicine.
• Patient understands major safety issues and monitoring points.
• Patient can repeat the key instructions back accurately.

Quick-reference frameworks

Station Rapid framework

Medication Prescribed medicines; OTC medicines; herbal/traditional products;

history allergies/ADRs; adherence; indication; dose; duration; monitoring;
social and clinical context.

Prescriber SBAR: Situation, Background, Assessment, Recommendation.

interaction Always finish by confirming the agreed plan.

Medicines Clarify query; gather patient-specific background; identify risk;

information answer clearly; safety-net; document.

Responding to Who is it for? What symptoms? How long? Action already taken.
symptoms Medicines/medical history? Red flags? Treat or refer?

Patient What do you know? Why medicine is needed; how to take/use;

counselling what to expect; side effects; interactions; monitoring; missed dose;
teach-back.