How to succeed at OSCEs
Succeed at OSCEs
when you've finished this page you will be able to...
- prepare more effectively for an OSCE
OSCEs are the most feared of all medical examinations. The process of examining patients under the pressure of close scrutiny can prove to be the breaking point for many candidates. You'll be expected to examine four or five cases in 30 minutes, giving you no more than five minutes for each station. You're not allowed to ask the patients questions, and your assessment of the case will be based entirely on your clinical findings and how you interpret them.
There's intense pressure, mostly from the unusual format of the short cases, but the examiners will also be pushing you hard to get through the cases within the time limit. Many candidates don't finish their complete examination routine, and there may be frequent interruptions from the examiners. They may even attempt to throw you off guard, and this will probably be successful if you're not prepared for it.
If this sounds scary, it's because it is, but remember, the key to OSCE success is practice - there's no replacement for it. Reading is not enough, you need to take every opportunity to practice your clinical skills.
Top tip
When you practice for the OSCEs, practice being harassed. Take turns in playing the role of examiner and examinee and pile on the pressure. Ask difficult questions, be hyper-critical of each other's performance - and try not to be friendly!
How are OSCEs marked?
You'll be scored at each station by the an examiner who'll have a check list and/or a rating scale. This makes OSCEs a reasonably fair and consistent way to examine students. Obviously you'll be expected to demonstrate different skills at each station, but there are some 'generic' skills that you'll need to display at all the stations:
At each station you'll be expected to show that you can...
- approach patients in a professional, caring manner
- carry out physical examinations smoothly and systematically
- present your findings systematically, eloquently and accurately
What skills do I need to do well in OSCEs?
To do well in the OSCEs, you need to have good communication skills,good physical examination skills and good case presentation skills. There are some tips on all these things below, but don't forget that you'll also need to look the part too. First impressions count, so follow our tips to make sure you make an impact on both patient and examiner for the right reasons:
- look like a future doctor and not like a medical student,by dressing smartly and conservatively. No jeans, t-shirts, low-cut tops or short skirts.
- don't smell. The odour of strong perfume, aftershave, cigarettes, alcohol, garlic and curry will not endear you to the examiners.
- don't bring any unnecessary equipment into the exam - no handbags etc. If you must take a bag, put it down BEFORE you examine the patient; you don't want to hit the patient in the face with a swinging bag.
Before the OSCE, check with a friend, whose opinion you trust, that you look professional - and smell nice.
Recommended Further Reading
Communication Skills
- OSCES are about good communication: you need to show that you can communicate with both the examiner and the patient succinctly, accurately, logically and professionally.
- listen carefully to the examiner's question, as there might be a clue to the diagnosis.
- be polite to the patients and the examiners.
- this cannot be over-emphasised: the first part of any physical examination must always be to introduce yourself to the patient.
- always ask for the patient's consent before you begin the examination.
- always say "please" and thank the patient when you've finished the examination. Refer to the patient as "sir" or "madam", or "gentleman" or "lady" if speaking of the patient to the examiner.
- be confident, but not arrogant - the days when doctors were expected to be supercilious are long gone. Ask your blunt friend to give an honest appraisal of your attitude.
- don't be flippant: the OSCE station is not the place for jokes.
- do not be put off by the examiner's attitudes; they are human and will display the full range of personalities: some will be friendly and approachable, some will be inscrutable and others down right bad tempered - be prepared for this.
- at the end of each station, say "thank you" in a sincere manner.
Physical examination skills
- after you've introduced yourself to the patient, sit the them in the optimum position and expose the area to be examined.
- DO NOT expose areas that may be embarrassing until you reach that area in your examination.
- ask the patient if they have any pain anywhere - especially in the area you're about to examine.
- NEVER hurt the patient; special care should be taken during an abdominal examination. Always look at the patient's face during the palpitation, and remind the patient to tell you if they experience any discomfort.
- act up. Be theatrical for the examiner. Show them that you're doing the correct things by over emphasising particular manoeuvres.
- think carefully about the diagnosis during the examination. Time is very limited,and the examiners will be pressing hard for you to complete the case and move on.
Recommended Further Reading
Case presentation skills
- think before you speak. Before you start to present, take a deep breath, look at the examiner rather than the floor and speak as clearly and as fluently as possible. Pauses, mumbling and goldfish impressions invite the examiner to ask questions, and the worse the offence, the worse the ensuing question.
- remember that common things are common. DO NOT give the rarest cause or most controversial cause of your findings; you're unlikely to be right, and you won't impress anyone.
- if you say something that you didn't mean, or that you know is wrong - take it back as quickly as possible, apologise and offer the correct answer. Mistakes happen and the candidates that realise their mistakes will still pass - those that don't, will not.
- NEVER, under any circumstances, argue with the examiner. Be prepared to withdraw your statement rather than confront the examiner - even if you're sure you're right. There is a predictable loser from a confrontation with an examiner: you.
- don't try to fool the examiner - they might be old, but they're not stupid. If you treat the examiner as a fool, you may as well ask him or her for the resit forms at the same time.
- DO NOT guess or waffle. Be honest in the face of ignorance. The examiners will not mark you down if you admit you don't know a fact - unless you don't know anything.
- avoid strange or annoying mannerisms. Ask a blunt (rude?) friend to tell you honestly if you have any irritating speaking habits. Don't wave your hands around excessively, don't use verbal ticks ("you know", "OK", "like" etc.), don't "ummm" a lot. Don't stand with your hands in your pockets.
- DO NOT be casual in your speech. Say "left ventricular failure" NOT "LVF". Avoid using words like AIDS, cancer, MS or syphilis. They may panic the patient and annoy the examiner. Try terms like neoplastic disorder, retroviral disease, demylinating disease and treponemal disease - it's more tactful.
- don't mention 'slight' physical signs or early changes. OSCE patients will have obvious signs and symptoms. The examiner will quiz you further and probe your lack of confidence about the physical sign that you incorrectly identified.
All these skills can be practiced and will improve with practice, so you need to make sure you practice until you are perfect.
Activity: practice your OSCE skills
For this activity, you'll need at least two friends or colleagues.
1. Visit the OSCE Skills site: www.osceskills.com
2. With your friends or colleagues, take it in turn to play the role of student, patient and examiner.
3. Print out the instructions for each OSCE station from the OSCE Skills site. The 'examiner' can use these to make sure the 'student' is carrying out the examination properly.
4. For the stations that can't be acted (urethral catheterisation!), the student should talk through the procedure.
5. Keep practising each station until each of you has had a chance to be the 'student'. You'll probably need to take a few weeks to do this - it's too much to fit into one day!
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