Are you prepared for the OSCE? Ten tips to triumph.

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With the Royal Australian College of General Practitioners (RACGP) Objective Structured Clinical Exams (OSCEs) just around the corner, there are many general practice registrars working hard and feeling a little (or a lot) nervous. You have come so far, worked so hard and this is one of the final hurdles to jump before gaining fellowship.

As a medical educator who sat her OSCE exam only a few years ago, I can still remember those nerves. I was provided with some tips, but there were a few extra that I wish I had received. I’ve compiled all of these suggestions and have created for you a top 10 tips list for when you’re ready to sit the OSCE.

1. Just another day at the office (well, practice).
Treat the OSCE like any other consultation. The OSCE is like a normal day consulting, except your “patients” are really efficient at providing histories and following exam instructions. Working in your clinic really is some of the best practice you can have.

2. Time is EVERYTHING!
When you perform practice cases, time your reading periods, short cases and long cases so it provides you with comfort of knowing how to fit everything in.

3. Consistency is key.
By designing my own set of logical instructions that I applied during the reading time, it provided me with a “security blanket” and helped me calm down before each station. If I became stuck during the practice consultation, I could then refer to my sheet for assistance. Often I didn’t refer to it during the consult, however, the process kept me focused. My process as a registrar was:

a. Presenting complaint
b. Past medical history
c. Medications
d. Allergies
e. Smoking
f. Alcohol
g. Family history
h. Social history
i. Opportunistic screening

4. Partner up; join a study group.
Study groups for the OSCE are invaluable, if not essential. A group of three to four is ideal; two people practice each case (one doctor, one patient) and the other two are critics. It’s important for the study group to be a safe space so that you can constructively criticise each other without feeling hurt. In between face-to-face study groups, use your phone/Skype/FaceTime to call someone from your study group and run through a few history-based cases.

5. Courtesy costs nothing but buys you everything.
Be polite, call the “patient” by their name, introduce yourself (unless the reading material states that they are a regular patient), ask permission to examine and thank the “patient”.

6. Question everything, assume nothing, learn the truth.
Start your history with open questions as the “patient” will give you important information in those opening statements. Closed questions will eventually follow, just like a normal consultation. Listen to the “patient”; they want you to pass and if you ask the right questions they will give you the answers needed to pass the station. Although cases may not be text book presentations, they usually have some classic symptoms to guide you to the diagnosis. Make sure you remember to ask the “Red Flag” questions.

7. We’re all human.
Try not to feel embarrassed for doing appropriate things. If you need to take a sexual history or partially undress a patient for examination, politely ask them but don’t continuously apologise for having to do so.

8. Look around, you will find me.
For examination stations, have a look around the room. What tools are available? If tools are there it is likely that the examiner wants you to use them. Don’t forget to wash your hands before and after touching the patient.

9. You don’t always have to get to a diagnosis.
Some cases, in the OSCE and real life, are idiopathic and registrars’ often struggle not getting to a clear answer. Even if there is a diagnosis that you haven’t managed to reach, this is not the be all and end all. If you have taken a good history, performed a good physical examination and investigated appropriately (depending on what is requested), you can still pass even without a diagnosis.

10. Never-never (OSCE) land.
When it comes to management plans, remember that this is make believe OSCE land. You can have all the resources you can imagine – a super qualified practice nurse, diabetes educator, asthma clinic, dietician, physiotherapist, and so on; use them as you like. If you can’t recall specifics of management plans, explain where you would go to get your answers e.g. therapeutic guidelines.

I will be honest, the OSCE is a draining exam, but it’s really just an assessment of your daily consults. You’ll be fine if you have practiced cases while studying and doing well with your clinic work.

Good Luck!

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