Anesthesiology APPLIED Exam › OSCE: communication and professionalism

Disclosing a peri-procedural complication or error

OSCE: communication and professionalism·~5 min read· Physician-reviewed✓ Sourced · 5

Stem

Mr. Haddad, a 58-year-old man, 96 kg, had a five-hour robotic prostatectomy yesterday under general anesthesia, in steep head-down position with both arms tucked at his sides. This morning he reports numbness in the ring and little fingers of his right hand. The surgeon has told him the anesthesiologist will come to explain. Your task: evaluate the patient and discuss the problem with him.

Question

My hand's been numb since I woke up, and the nurse says it's from the surgery. What happened to me?

Ideal answer

Headline"I'm sorry this happened. Let me hear what you've noticed and examine your hand, then I'll explain what I think happened and what we'll do."

Concern, then history. "Good morning, Mr. Haddad. I'm Dr. Reyes, one of the anesthesiologists who cared for you yesterday. I'm sorry this happened, and I want to understand it with you. When did you first notice it? Just these two fingers, or more? Better, worse or the same? Any weakness, like dropping things?"
Focused exam, narrated. "May I examine your hand? I'm touching your little finger; does that feel normal compared with the other side? Now squeeze my fingers. Now spread them apart against my hand. I'm also checking your elbow."
Cause in plain words. "A nerve called the ulnar nerve runs past the elbow, right under the skin. During a long surgery with your arms tucked it can get pressed or stretched, even with careful padding. That's the most likely cause."
Outcome and plan. "When it's only numbness, many people recover within days, and most within six months.¹ We'll keep pressure off your elbow, a neurologist will see you, and if it isn't improving in three or four weeks, a nerve test will tell us more."
Questions and follow-up. "I'll see you again this afternoon. What questions do you have?"

Breaking down the answer

Seven behaviors, half about how the patient feels — from eliciting the history to showing concern.² ABA sample: a disclosed error, glycopyrrolate 0.4 mg instead of rocuronium from the wrong syringe, tachycardia to 128 that resolved, a patient ready for discharge expecting my explanation.³
Elicit the history, examine — onset relative to surgery, distribution, motor versus sensory, progression; light touch in the ulnar distribution, grip, finger abduction, the elbow. Disclosure without assessment is reassurance without basis.
Narrate the exam — it shows the grader what I am doing and tells him I take it seriously.
When it was an error — I state the fact without hedging: "The tooth was chipped when I placed the breathing tube."
Honest numbers — about 40% of sensory-only ulnar neuropathies resolve within 5 days and 80% within 6 months; sensory plus motor does worse, about 20% resolved at 6 months.¹ False reassurance is not scored, so the motor exam comes before numbers.
Plan in lay terms — protect the elbow, neurology, nerve studies at 3–4 weeks if not improving, when they can grade severity, and a follow-up visit.¹ "Will I be able to play guitar?" deserves a direct answer and the plan to find out.
Concern is scored explicitly — "I am sorry this happened" is concern, not an admission of negligence.

Follow-up question

He pulls his hand away: "Somebody screwed up. I want to know who, and I'm calling a lawyer." What do you say?

Follow-up answer

HeadlineReasonable anger: I do not defend, deflect or blame the surgeon or a nurse, and I keep my voice level.

"You have every right to be upset. If I woke up with a numb hand, I would be too." I restate what I know and do not yet know, and that we are reviewing what happened, true because I have reported it through our safety system. He has every right to seek advice, and I and our patient-relations office will answer his questions meanwhile. Then back to his hand and when I see him next. "Was it your fault?" before I know: I don't know yet, I will find out, and I will tell him.

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."

Rapid-fire

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	7²
Sensory-only ulnar neuropathy	~40% resolve in 5 days, ~80% by 6 months¹
Nerve conduction studies if not improving	3–4 weeks after injury¹
Dental injury needing repair or extraction	~1 in 4,500 anesthetics, half at laryngoscopy⁵

Sources

1.Peripheral nerve injuries from positioning · OpenAnesthesia · openanesthesia.org
2.APPLIED Examination OSCE Content Outline · ABA · theaba.org
3.OSCE Example Scenarios · ABA, 2023 · theaba.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.