Effective Time Management in the OSCE

And your time starts... Now!

Completing the OSCE is a race against the clock.  With eight minutes to complete a short case, and nineteen minutes to complete a long, you need to think clearly and quickly - the last thing you want is to hear the bell ring when you’re just getting started!

An organised and structured approach will make all the difference.  Between cases, take time to reset.  It doesn’t matter how the previous station went, the next one is a fresh start and your slate is clean.

Short Cases

Your approach needs to be focussed - short cases cover only certain components of a consultation. My tips:

• Read carefully.  Reading time is invaluable.  Read the question. Read it again.
• What is the question asking you to do?  Underline the key words.  Are you being asked to take a focussed history from the patient?  Start straight up by performing an examination? Or have you been asked to request examination findings from the examiner?
• Think, plan & jot.  How should you divide your eight minutes to cover all parts of this question?  Consider dividing your notes page into sections headed with the requested tasks.  What information has been given to you already?  Jot down ideas, what system/s to examine, relevant special tests or investigations that come to mind, key things not to forget, components of management to consider e.g: immediate, short-term, long-term, pharmacological, non-pharmacological.  
• Look.  What equipment can you see in the room?  It’s there to help you.
• Safety net every case. Don’t forget to say when you would like to see the patient for follow up review, and to safety net.
• Practice.  Often.  Try to get used to how fast that eight minutes passes and develop a sense for the pace you need.  Polish your examination skills. Do regular timed practice cases in a study group setting, both as the candidate and the observer.  Try Skype to practice if you’re in remote place or can’t get babysitters.

Long Cases

The long case generally represents an entire consultation from history taking, through to management and follow up.  My tips:

• Read carefully and plan.  Again, use your reading time carefully to prepare.
• Create a template.  Consider creating a template page in the reading time to keep you on track, with headings such as HPI, PMHx, Meds/Allergies, FHx, SHx, Exam, DDx/Problem Definition, Ix, Mx.  
• Make notes.  Jot down your key ideas and things not to forget before you head in.  What have you been told already? Don’t forget things like immunisations, ADLs, SNAP, vital signs and office tests.
• Listen.  Start with open questions and let the patient tell you as much as they can before you jump in.  Follow the cues given to you.
• Take a cue from the bell.  By the first bell you should be near half way through your template.  Keep moving through and allow enough time to cover the components of management (e.g: emergency / immediate, short-term, long-term, pharmacological, non-pharmacological, prevention).  
• Arrange follow up and safety net.
• Practice.  Regular timed practice cases will help make this process a smooth one.

And for every case, do sweat the small stuff.  You are being assessed on your communication skills and rapport as well as your clinical decision making – introduce yourself to every patient.  And remember to wash your hands – look out for the hand gel!

Now, practice! Every patient at work is a short or long case...  just keep an eye on the time.

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.