OSCE Advice from an Examiner | Preparing for the Physical Examination

Preparing for the Physical Examination

As an examiner, one of the most disappointing things I find about candidates’ preparation for the OSCE is their inability to do a good physical examination on a patient. Most candidates can sort of do a physical examination, but they are let down by time in the end, as they are not practiced or fluent in the necessary steps. Quite a lot of candidates stand by the bedside, and you can see them thinking about what step comes next. Others get to the end of the examination, sit down, then jump up and go back to do something that they forgot.

Tips for a good physical exam

There will be at least one, maybe two, examination stations in the OSCE, where you have to actually examine a patient. Other stations require you to ask for physical examination findings. You need to know what to ask for.

There are several ways to improve your physical examination skills.

Revise

Firstly, go to the following websites:

1. Geeky Medics YouTube   
2. Geeky Medics OSCE page

These sites have really great videos and/or outlines of physical examinations that commonly occur in OSCE stations. Most do have videos attached, a couple don't. My advice is to watch a video or read one summary every night before you go to bed from now up until you do the OSCE.

Practice

The other way to revise is to commit to doing AT LEAST ONE examination of a complete body system on a patient every day in your surgery.  So if a patient comes in complaining of feeling Short of Breath, if appropriate, do a full Respiratory or Cardiovascular examination. See if you can do it in less than eight minutes. If someone has a sore shoulder, do a proper shoulder examination, with all the necessary tests. Practice doing back, hip, knee, foot, hand, elbow, CVS, Neuro, Cranial nerve examinations on your patients. Check visual acuity and visual fields properly. Make each patient an exam case. Your patients will feel that they have been very well looked after!

Set your timer

Try to get the feeling of what eight minutes feels like. Set your phone to vibrate, and set the alarm for eight minutes. Set the alarm as soon as you call the patient in, and put the phone in your pocket so that it doesn’t disturb the patient. Only you will know when it goes off, but you will start to get a sense of how much you can get done in eight minutes.

Listen

Practice opening each consultation with, “how can I help you today” and then listening! In the exam, the patient has a story to tell you, just as your patient does. If you cut them off and start asking closed questions you will miss important information. When the patient has stopped talking, ask another open question, such as, “can you tell me some more about that?” or, “Is there anything about that that is particularly worrying you?”. It is important in the exam that the first two questions are open questions, so practice this now!

For further detail we recommend considering the following:

• Emergencies in General Practice course
• The ALERT course
• Medcast Plus membership