OSCEs are a stressful time, it can feel like you’re entering into a pit of the unknown and you need to know everything about medicine to get through it. Hopefully I can help you to feel a bit more prepared for the upcoming situation. I’ve asked Medics in my own year and years below, as well as Doctors about what they want to know or wished they knew before their OSCEs and these are the top recurring tips they gave to prepare for them. Let’s get straight to them!
Preparing for OSCE
Clinical OSCEs can be daunting and feel overwhelming because of the combination of knowledge you’ve accumulated with being in placement and additional university-provided scenarios/theme case discussions.
Clinical environments are amazing for building confidence, becoming comfortable and applying knowledge. However, many students found that clinical placements can also expose you to uncommon conditions especially if working in a tertiary care centre and make them seem common. This can get overwhelming and feel like you need to cover everything. What everyone says and what you will see is that OSCEs will include only the most common and emergency conditions. So, it’s best to understand them (signs, symptoms, demographics), be able to explain them and know the gold standard investigation and treatment. Often university provided content will highlight the common conditions.
RED FLAGS, RED FLAGS, RED FLAGS. Know your red flags and referral criteria. Remember to cover red flag questions even if you feel like the diagnosis is straightforward. It needs to be done, it shows you haven’t got tunnel vision and will pick up on more serious conditions that could be disguised. Referral criteria is understanding which signs/symptoms require a two-week review. Systems reviews are important but often there isn’t much time to cover it, but it’s amazing if you do. Squeezing in a systems review is super important when a patient presents with red flag symptoms to highlight any metastasis.
OSCEs are best practiced in groups. Unlike other exams such as MCQs, OSCEs are practical, and you need to work with other people. Practicing in groups helps build confidence, allows you to work on time management and work on wording. Also, examinations can be practiced in a group setting. Practice does not have to be with other medics. Non-medics are good practice because they emulate actual patients, and often medics can speed the examination/consultation along. It can be daunting doing scenarios in groups, but the feedback is really helpful but also the good things that you don’t notice are highlighted.
Start practicing examinations early. I know this is something everyone says but cramming examinations in the last days can be stressful. Examinations should look natural, stopping and starting will show that your examinations were learnt last minute. Starting early will help with confidence and flow. This sounds obvious but know what signs you’re looking for and multiple causes (always have 3 causes, rule of 3). Causes of signs are very common OSCE questions. Be natural with the patient and speak to them where possible when examining or on the other hand let them know that you’re going to go quiet i.e., while auscultating. A great website to use for scenarios is Medisense Casebank.
Always ICE (ideas, concerns and expectations of the patient). I know it feels really annoying to fit ICE into your limited time. But it is really important and try to get it out as soon as possible. It shows that you’re addressing what the patient is truly concerned about and taking a holistic approach. We can get caught up in asking questions to come to a diagnosis as that feels like the most important thing to do. However, the most important thing is the patient's concern. It’s the basics, don’t overlook it.
Confidence is almost as important as knowledge. Patients and examiners want to see doctors that are confident. Unsureness invites extra questions and can make the patient lose assurance of your ability. Tips on appearing confident are remembering to smile (when appropriate), controlling facial expressions when confused and maintaining eye contact. Often, we can have mind blanks which can really knock your confidence so having something to fill the blank is helpful. Three very useful blank fillers are: to summarise what you know so far; to ICE the patient or do a Systems review. These three things will inspire new questions or remind you of something missed. I know being confident is easier said than done. This is where practice examinations and consultations will come in handy. We all get nervous, but practicing will show you that you are perfectly capable, and this is just another consultation, something you’ve done multiple times before.
Lastly, not knowing something: Don’t get externally worried/flustered if there’s something you don’t know. You are not expected to know the entirety of medicine. It comes down to how you deal with the situation. For example, with a patient you can tell them that it's something you can look into for them, ask about their concerns around this and continue the consultation. With an examiner, if unsure about the exact diagnosis/answer you can present the main symptoms and present your differentials. This shows your thought process and that you’ve picked up the important things from your consultation and often the condition is in the differentials.
I hope this helps. All I can say is don’t get stuck in the nitty gritty, common things are common. Remember to ICE, red flags and practice, practice, practice.
Written by: Akashaa Rebab