The Idiots Guide to the OSCE. Part 2: What do registrars need to do?

The OSCE exam

The FRACGP exam comprises three exams, or modules, each aimed at testing different aspects of knowledge. The OSCE is the ‘highest order’ exam, in which a candidate ‘shows’ what they can do.

Currently, candidates must pass the AKT before they can attempt the OSCE. This will be changing, so that both the AKT and KFP will need to be passed before the OSCE is attempted.

The Exam is structured around 14 stations with different cases, through which candidates rotate.  They are divided into:

• 2 Long Cases (19 minutes + 3 minutes reading time)
• 12 Short Cases (8 minutes + 3 minutes reading time)

These will usually include one Viva, one or two Physical Examination stations and one Indigenous Health Case. 

Each station has two examiners. Usually the ‘case’ will be played by one examiner, while the other examiner observes. Both examiners mark the case. There is a standardised marking schedule for each case which helps with the allocation of marks.

What do registrars need to do?

There are a lot of available resources – check with your training provider, course providers and supervisor. Some of these resources are listed at the end of this article. There are many things that are important for registrars, but as space is limited here, I will cover a few key points.

1. This is a tiring exam in an artificial environment which is the ‘best replica’ of clinical practice. Remember to play the part. Try to imagine that you are actually ‘inside’ that case and forget about the examiner watching you - most of all don’t try to involve the examiner unless it is a direct part of the exam question e.g. “request the examination findings”.  Which brings me to:
2. READ THE QUESTION. (Sorry about the capital letters, but this is an idiot’s guide after all!) The instructions will tell you whether the case involves taking a history, doing an examination, obtaining results, managing the condition. It will also tell you who to speak to – the patient or the examiner.
3. Whilst you are trying to imagine that the case is real, also remember that this is an exam in which you need to move through a program at a reasonable speed. So, do be nice and establish rapport (tick, rapport demonstrated), but then make sure to move through the case.
4. Make good eye contact and establish rapport early on, using open-ended questions such as, “How can I help you today?’ and ‘Can you tell me a bit more about that?’.  If you allow the examiner to tell their story and get an appropriate history, you are well on your way. The examiner is NOT trying to trick you, but is not allowed to ‘lead’ you and give away the whole case without being asked. Allow the examiner some time and some room to give their history. Use a structured approach to pain (such as SOCRATES) and a brief systems review where appropriate. Murtagh’s PROMPT strategy is very important.
5. Use the reading time wisely. Use a template to remind you of the things that you want to cover (click to download an example). Remember that sometimes you have guessed incorrectly in your reading time and the case on chest pain that you thought would be a PE may turn out to be anxiety ... be flexible and be prepared to change course during the case if needed.
6. Practice the interpretation of basic tests such as ECGs or Spirometry. Be able to recognise quickly what is normal, and the common disorders. Too long spent on agonizing over a test result in a case wastes valuable time.
7. When taking the history, the background information you have been given is the equivalent of the patient’s file. Don’t ask all the questions again as though they are new – just quickly confirm that the information is correct.  "I see from your record you smoke 15 cigarettes a day, is that correct?”,  “It looks as though you have no allergies?” This can be brief, but is important to demonstrate that you have thought through these historical items - particularly when, for example, assessing risk factors in a cardiovascular case.
8. When requesting physical examination findings start with : “I would wash my hands.” Then:
9. Move to necessary queries/observations: “What is the patient’s General Appearance?”  For observations: ask for vital signs and if you don’t get them all, check – P, BP, T, RR, Sats and BMI.
10. Ask specific questions about the system you are interested in e.g. Is the JVP elevated? Are the heart sounds normal? Is the chest clear? Is the abdomen soft and non-tender? Are there any organomegaly or masses?
11. If you don’t ask the question, you won’t get the answer!

OSCE Preparation Course

Medcast has an OSCE Preparation course that helps registrars prepare for the OSCE Exam.  The course includes live practice webinars, that provide participants the opportunity to practice cases and receive feedback from our experienced Medical Educators. Read more about the course here