Captain! Change Tack! Port of OSCE Due North!

Captain! Change Tack! Port of OSCE Due North!
Six months ago, or hopefully more, you set sail for ‘Destination Fellowship’ – a sometimes difficult journey fraught with unforeseen challenges interspersed with interesting facts and unfamiliar places. The end reward of this journey is the freedom to embark confidently on your General Practice career.

I’m sure when you set sail to reach the first port of ‘AKT and KFP’ you had a good map and perspective on how to reach those locations. Some of you experienced smooth sailing but for some the seas were a little treacherous.  Still, you made it!  Now that you’re heading for the Port of OSCE, however, you need to change your tack if you want to sail through.

What do we mean by ‘tack’?   In sailing, ‘tacking’ is manoeuvring your bough in accordance with the prevailing winds to attain the desired direction. Savvy captains will have studied the winds and already be planning their approach to the next leg of the trip.

So, how do you avoid choppy waters as you embark upon the OSCE leg of your voyage?

The first thing to consider is post-study fatigue and self-care.  Many of you have been studying for these exams for six to twelve months, giving up time for yourself, family and friends.   IT IS OK TO HAVE A BREAK!   If you are fatigued you will not synthesize knowledge well, and the OSCE requires a different approach – it’s about synthesis, contextualisation and communication of knowledge as opposed to knowledge regurgitation or decision-making.   Build self-care and time-out into the next leg of your preparation and give yourself permission to get the wind back in your sails.

I know that it’s trotted out frequently at exam workshops, but that’s because it’s important – good old Miller’s pyramid (and it does look a bit like a sail).

To examine the ‘Does’ of Miller’s pyramid would require many of episodes of direct observation of practice each year, which is not feasible or cost effective but would be ideal in assessing competence.   As an alternative we assess how ‘Shows How’ in the OSCE.     That’s the key – we want you to show us how you do it – in real life, in practice, based on guidelines and evidence-based knowledge.   

That’s the difference between studying for the OSCE and the written exams – you need to go to work, see patients, think about your approach and how you are going to show off your knowledge by consulting.

In the AKT we are asking you express that you ‘know’ your clinical knowledge, and in the KFP that you ‘know how’ to use your knowledge by demonstrating clinical decision-making steps, but in the OSCE we want to see how you actually combine the skills displayed in the written exams in a clinical situation – so the only way to learn that skill is to practice!

Here are some key tips for OSCE preparation:

  1. Recharge your batteries:  Have a break after the written exams and spend time with loved ones and re-address self-care in readiness for the next leg of the journey.
  2. When it’s time to study:
    1. Think about those cases you most fear walking through that OSCE door – why do they trouble you?   Is it applied knowledge or the other domains?   Study those first.
    2. Practice, Practice, Practice – find a study pal or group and practice cases – ideally find a partner who sees a different patient demographic to yourself, so you can learn from each other.
    3. Polish up – shortcuts in physical examination get no marks in the exam – go back and look at how to do all examinations properly so that you can make appropriate decisions combing your clinical knowledge and decision-making to perform a ‘focused examination’.
    4. Develop a proforma for reading time:
      1. What could they be asking about?  Which domains?
      2. What are the things I always miss?
      3. What are my tasks and how am I going to manage my time?
    5. Practice looking slick and confident – you need to look like you have done the consultation (including examination) millions of times – and indeed you should have done it at least hundreds of times!
    6. In the weeks prior to the exam, review Guidelines to make sure you are up to date.
    7. Remember that your performance is measured over the station, not in individual parts – be professional, courteous, WASH your HANDS!

For most doctors, the written exams are the hurdles, the OSCE is the opportunity to ‘show off your skills’.  Remember that there is never a time in your life as a clinician that you will be so professionally polished and know so much, so now it’s time to find a sextant, put on your Captain’s cap and plot a course for OSCE success!  

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.

Dr Rebecca Stewart author image
Dr Rebecca Stewart

Rebecca is a GP, GP Supervisor and Medical Education Consultant working in Townsville, North Queensland. She delivers exam preparation education for the RACGP, Medcast and Mededexperts.