OSCE — Enhanced Recovery After Surgery (ERAS)

Brief (to candidate)

You will assess a patient with a presentation consistent with Enhanced Recovery After Surgery (ERAS).
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.

Clinical context

ERAS (Enhanced Recovery After Surgery) is a multimodal, evidence-based, protocolised perioperative care pathway that attenuates the surgical stress response, preserves organ function, and accelerates functional recovery. Pioneered by Henrik Kehlet in 1990s colorectal surgery, it reduces length of stay by 2-3 days and complications by approximately 50% without increasing readmission or mortality. The four pillars are: attenuation of the stress response (no fasting, carb loading, regional anaesthesia), maintenance of organ function (goal-directed fluids, normothermia, no tubes), early return of gut function (early feeding, opioid-sparing), and early mobilisation (day 0).

Candidate tasks

1. Clarify onset, severity, associated features, and red-flag symptoms.
2. State focused examination priorities.
3. List first-line investigations and any named score/criteria.
4. Give immediate resuscitation steps.
5. Outline definitive management with doses/routes where standard.
6. Name complications and disposition (ward / HDU / theatre / discharge safety-net).
7. Mention one special-population modifier (pregnancy, child, elderly, CKD).

Examiner checklist

Model outline

Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.