OSCE Tips and Advice
OSCEs are something that needs lots of 'practice makes perfect'. Feel free to share tips and pieces of advice that have helped you get through them below and ask questions 
First of all, what's an OSCE?
Objective Structured Clinical Examination
It can assess your performance in a simulated clinical environment: role, task, setting and clinical situation are all important here. Time management is needed. Confidence is key.
An OSCE exam can include multiple times stations that you go around in a circuit with buzzer/bells there to guide you. You can get 1 minute reading time and ~7-10 minutes for the station depending on where you're being assessed.
Each station has a trained examiner and a real/simulated patient. You're usually expected to ignore the examiner unless you need details from them. Depending on what level you are, you can be expected to tell the patient your top differential, explain it and potential next steps.
Mark schemes can be based on a checklist or domains.
The UKMLA would be assessing this through something called CPSA (clinical and professional skills assessment)
Please feel free to post your tips and advice! No one is perfect and what works for someone else might not work for you, so building these resources would hopefully help the masses
First of all, what's an OSCE?
Objective Structured Clinical Examination
It can assess your performance in a simulated clinical environment: role, task, setting and clinical situation are all important here. Time management is needed. Confidence is key.
An OSCE exam can include multiple times stations that you go around in a circuit with buzzer/bells there to guide you. You can get 1 minute reading time and ~7-10 minutes for the station depending on where you're being assessed.
Each station has a trained examiner and a real/simulated patient. You're usually expected to ignore the examiner unless you need details from them. Depending on what level you are, you can be expected to tell the patient your top differential, explain it and potential next steps.
Mark schemes can be based on a checklist or domains.
The UKMLA would be assessing this through something called CPSA (clinical and professional skills assessment)
Please feel free to post your tips and advice! No one is perfect and what works for someone else might not work for you, so building these resources would hopefully help the masses
Scroll to see replies
Original post
by KA_POSCEs are something that needs lots of 'practice makes perfect'. Feel free to share tips and pieces of advice that have helped you get through them below and ask questions
First of all, what's an OSCE?
Objective Structured Clinical Examination
It can assess your performance in a simulated clinical environment: role, task, setting and clinical situation are all important here. Time management is needed. Confidence is key.
An OSCE exam can include multiple times stations that you go around in a circuit with buzzer/bells there to guide you. You can get 1 minute reading time and ~7-10 minutes for the station depending on where you're being assessed.
Each station has a trained examiner and a real/simulated patient. You're usually expected to ignore the examiner unless you need details from them. Depending on what level you are, you can be expected to tell the patient your top differential, explain it and potential next steps.
Mark schemes can be based on a checklist or domains.
The UKMLA would be assessing this through something called CPSA (clinical and professional skills assessment)
First of all, what's an OSCE?
Objective Structured Clinical Examination
It can assess your performance in a simulated clinical environment: role, task, setting and clinical situation are all important here. Time management is needed. Confidence is key.
An OSCE exam can include multiple times stations that you go around in a circuit with buzzer/bells there to guide you. You can get 1 minute reading time and ~7-10 minutes for the station depending on where you're being assessed.
Each station has a trained examiner and a real/simulated patient. You're usually expected to ignore the examiner unless you need details from them. Depending on what level you are, you can be expected to tell the patient your top differential, explain it and potential next steps.
Mark schemes can be based on a checklist or domains.
The UKMLA would be assessing this through something called CPSA (clinical and professional skills assessment)
Oooh following!!
Fun fact: Year 1 OSCEs used to be a show up and you automatically pass just for showing up but the year above us did so badly its now assesed
Original post
by halfharryOooh following!!
Fun fact: Year 1 OSCEs used to be a show up and you automatically pass just for showing up but the year above us did so badly its now assesed
Fun fact: Year 1 OSCEs used to be a show up and you automatically pass just for showing up but the year above us did so badly its now assesed
No way! That must've been a big jump in year 2 thenUse the 1 minute reading time outside the station to note down a quick structure to give you direction once you're inside. Don't go in without a plan since that will affect how much time you take.
Is there anything you tend to forget a lot when practising? Note that down. Have a mnemonic that helps you? Another one to note down
This is more for earlier years when you have a sheet of paper stuck outside your station telling you the setting, role and what you're supposed to do. This may not be available depending on where you are or what year you're in.
Is there anything you tend to forget a lot when practising? Note that down. Have a mnemonic that helps you? Another one to note down
This is more for earlier years when you have a sheet of paper stuck outside your station telling you the setting, role and what you're supposed to do. This may not be available depending on where you are or what year you're in.
Make sure you're able to summarise findings briefly at the end.
For examinations:
- Name, Age, Presenting Complaint
- Positive findings on inspection
- Positive findings on palpation (+/-auscultation)
- Top differential
- Further investigations/assessments
During the examinations, you can vocalise what you're looking for/can't see to the patient (explain you will be doing so beforehand and say they can ask if unsure at the end) so the examiner is aware you know what to look for.
For when you're on placement, you can use SBAR (Situation, Background, Assessment, Recommendation)
For examinations:
- Name, Age, Presenting Complaint
- Positive findings on inspection
- Positive findings on palpation (+/-auscultation)
- Top differential
- Further investigations/assessments
During the examinations, you can vocalise what you're looking for/can't see to the patient (explain you will be doing so beforehand and say they can ask if unsure at the end) so the examiner is aware you know what to look for.
For when you're on placement, you can use SBAR (Situation, Background, Assessment, Recommendation)
Knowing your conditions well can really help when it comes to OSCEs, focussed histories become an instinct with this as you have direction in terms of what symptoms you're looking for:
- Symptoms of your top differential
- Symptoms that would help you exclude other differentials
- Specific red flags to look out for
Doing a systems review can really help in focussed histories in particular.
Presenting complaint/history of presenting complaint should take most of your time in this type of history taking. If you lose track of your thoughts, summarise what you've discussed so far and ask the patient if they feel you missed something.
I personally like doing ICE (ideas, concerns and expectations) right after presenting complaint and history of presenting complaint as I tend to forget about it if it's left to the end.
- Symptoms of your top differential
- Symptoms that would help you exclude other differentials
- Specific red flags to look out for
Doing a systems review can really help in focussed histories in particular.
Presenting complaint/history of presenting complaint should take most of your time in this type of history taking. If you lose track of your thoughts, summarise what you've discussed so far and ask the patient if they feel you missed something.
I personally like doing ICE (ideas, concerns and expectations) right after presenting complaint and history of presenting complaint as I tend to forget about it if it's left to the end.
Systems review:
"I'm going to run through a couple symptoms, let me know with a yes or no if you're experiencing them"
A head to toe run-through. (The list below is from the top of my head and I need to improve on systems review so will be updated once I feel a bit more confident on this - I did have a good table for this but wasn't the best)
Headache, light-headness.
Numbness, tingling.
Visual changes, hearing changes.
Sore throat, coughing/wheezing, shortness of breath, difficulty swallowing.
Chest pain, abdominal pain.
Bowel changes, urinary changes.
Weakness, stiffness, aching.
Rashes, swelling, bleeding, fever.
"I'm going to run through a couple symptoms, let me know with a yes or no if you're experiencing them"
A head to toe run-through. (The list below is from the top of my head and I need to improve on systems review so will be updated once I feel a bit more confident on this - I did have a good table for this but wasn't the best)
Headache, light-headness.
Numbness, tingling.
Visual changes, hearing changes.
Sore throat, coughing/wheezing, shortness of breath, difficulty swallowing.
Chest pain, abdominal pain.
Bowel changes, urinary changes.
Weakness, stiffness, aching.
Rashes, swelling, bleeding, fever.
Reply 7
Original post
by KA_PSystems review:
"I'm going to run through a couple symptoms, let me know with a yes or no if you're experiencing them"
A head to toe run-through. (The list below is from the top of my head and I need to improve on systems review so will be updated once I feel a bit more confident on this - I did have a good table for this but wasn't the best)
Headache, light-headness.
Numbness, tingling.
Visual changes, hearing changes.
Sore throat, coughing/wheezing, shortness of breath, difficulty swallowing.
Chest pain, abdominal pain.
Bowel changes, urinary changes.
Weakness, stiffness, aching.
Rashes, swelling, bleeding, fever.
"I'm going to run through a couple symptoms, let me know with a yes or no if you're experiencing them"
A head to toe run-through. (The list below is from the top of my head and I need to improve on systems review so will be updated once I feel a bit more confident on this - I did have a good table for this but wasn't the best)
Headache, light-headness.
Numbness, tingling.
Visual changes, hearing changes.
Sore throat, coughing/wheezing, shortness of breath, difficulty swallowing.
Chest pain, abdominal pain.
Bowel changes, urinary changes.
Weakness, stiffness, aching.
Rashes, swelling, bleeding, fever.
This is basically how I do it too. Start at the head and work downward. Joints/muscles skin and bleeding ('tother' end) to finish up.
I feel it is relatively easy to become fixated chasing down every last question to rule in or out differentials to the point that you could run out of time and miss other parts of the station which will muller your score far more readily than missing out a couple of more focused questions.
I always do I.C.E.E early on too. In some situations (thinking of GP in particular) these are more important than social/family history as the consultation basically revolves around the patient's agenda.
Original post
by ErasistratusVThis is basically how I do it too. Start at the head and work downward. Joints/muscles skin and bleeding ('tother' end) to finish up.
I feel it is relatively easy to become fixated chasing down every last question to rule in or out differentials to the point that you could run out of time and miss other parts of the station which will muller your score far more readily than missing out a couple of more focused questions.
I always do I.C.E.E early on too. In some situations (thinking of GP in particular) these are more important than social/family history as the consultation basically revolves around the patient's agenda.
I feel it is relatively easy to become fixated chasing down every last question to rule in or out differentials to the point that you could run out of time and miss other parts of the station which will muller your score far more readily than missing out a couple of more focused questions.
I always do I.C.E.E early on too. In some situations (thinking of GP in particular) these are more important than social/family history as the consultation basically revolves around the patient's agenda.
Yes this is definitely true. With practice and becoming more comfortable with the different conditions, you start to adapt and ask the necessary questions rather than a checklist exercise (time constraints are real and every question needs to have thought and rationale behind it).
Do you have any extra tips? Also, is ICEE different to ICE? What does the extra E stand for?
Reply 9
Original post
by KA_PYes this is definitely true. With practice and becoming more comfortable with the different conditions, you start to adapt and ask the necessary questions rather than a checklist exercise (time constraints are real and every question needs to have thought and rationale behind it).
Do you have any extra tips?
Also, is ICEE different to ICE? What does the extra E stand for?
Do you have any extra tips? Also, is ICEE different to ICE? What does the extra E stand for?
I can't tell you where I got the idea from but the final E in my mind is for 'emotion'- I basically ask how the patient is dealing with their circumstances (I hate the word 'problem' and don't use it) at a pyschological level. You can trim the language up/down to taste and to suit the audience. This is only my limited experience of course but all these questions we ask in consultations in reality I feel lack overall substance because it doesn't give you any idea of how the patient is coping with the situation. As you know some people will absorb even comparatively serious diagnoses without a care in the world. Other people, by contrast might receive a more run of the mill diagnosis/injury etc and demonstrate debilitating changes to their lives.
And whilst I wouldn't do this in an OSCE (ultimately there is a hard time limit in these things), I also tend to speak with any relevant family/etc present at the time and enquire about how they are coping with the situation. I feel it makes the whole thing less impersonal and gives you an overall idea of the support network around a person. Of course including them in any conversation can also be useful for a host of other reasons.
Practice under timed conditions as many times as possible. Little and often is the way to go - cramming is not. You need to simulate a real OSCE scenario - the more you do this, the less nervous and more prepared you'll be on the exam day.
Practice with other people if you are able to. In a group of 3, one can be patient/actor, another the candidate and the third is examiner. There are many free OSCE scenarios available online. Once you've exhausted them, you can utilise AI to create new scenarios for you - ask for a detailed patient script, candidate prompt and examiner's sheet.
For keeping track of time, use a stopwatch or a timer on your phone. This is to help you reflect on and see which areas you can spend more/less time on. Ask your medical school to provide you with crib sheets as Geeky Medics can sometimes be beyond what we are expected to know (this isn't a bad thing, but can be quite overwhelming).
If you're on placement, make the most of your opportunities to examine and take histories from real-life patients and get feedback on areas to improve. It's a chance to think on your feet and think about next steps too in terms of investigations and management.
Practice with other people if you are able to. In a group of 3, one can be patient/actor, another the candidate and the third is examiner. There are many free OSCE scenarios available online. Once you've exhausted them, you can utilise AI to create new scenarios for you - ask for a detailed patient script, candidate prompt and examiner's sheet.
For keeping track of time, use a stopwatch or a timer on your phone. This is to help you reflect on and see which areas you can spend more/less time on. Ask your medical school to provide you with crib sheets as Geeky Medics can sometimes be beyond what we are expected to know (this isn't a bad thing, but can be quite overwhelming).
If you're on placement, make the most of your opportunities to examine and take histories from real-life patients and get feedback on areas to improve. It's a chance to think on your feet and think about next steps too in terms of investigations and management.
Make mnemonics or simple things to help you remember steps - this is something you can quickly jot down during your reading time.
Something I use for neurological sensory examination is LPVP - Light touch, Pain, Vibration and Proprioception. Not exactly a mnemonic but it stuck
Something I use for neurological sensory examination is LPVP - Light touch, Pain, Vibration and Proprioception. Not exactly a mnemonic but it stuck
Just booked the clinical skills room at my school
They've taught us the knowledge but I have no idea how to translate it to OSCE material
What we've learnt so far:
Cardiac exam, resp exam, neuro exam, ummm...cranial nerves testing, manual blood pressure...i think ive forgotten a few
But i don't know where to star🫠
They've taught us the knowledge but I have no idea how to translate it to OSCE material
What we've learnt so far:
Cardiac exam, resp exam, neuro exam, ummm...cranial nerves testing, manual blood pressure...i think ive forgotten a few
But i don't know where to star🫠
Original post
by halfharryJust booked the clinical skills room at my school
They've taught us the knowledge but I have no idea how to translate it to OSCE material
What we've learnt so far:
Cardiac exam, resp exam, neuro exam, ummm...cranial nerves testing, manual blood pressure...i think ive forgotten a few
But i don't know where to star🫠
They've taught us the knowledge but I have no idea how to translate it to OSCE material
What we've learnt so far:
Cardiac exam, resp exam, neuro exam, ummm...cranial nerves testing, manual blood pressure...i think ive forgotten a few
But i don't know where to star🫠
Listing them out really helps - make a brief note of the steps and practice them at random with a couple friends
Cardio and resp is quite similar in the approach: inspect from end of bed, hands, arms, face, neck, chest. Essentially: Look, Palpate, +/- Percuss, Auscultate. Can then check for peripheral oedema/DVT.
Neuro - how is yours structured? We have quite a few exams for neuro: upper limb and lower limb sensory and motor, cerebellar, Parkinson's and speech exam.
Cranial nerves can be tough to remember, we tend to split it in half (1,2,3,4,6 and then 5,7,8,9,10,11,12) - not sure if this helps:
1-6 excluding 5 is change in smell (you can test smell too)/vision, inspect the pupils, vision tests (Snellen, Ishihara), accomodation, blind spot, visual fields and visual neglect (I call these the wiggling finger tests), then light tests (direct, consensual, swinging). This is then followed by assessing for ptosis (eyelid drooping), light reflex then cover test for strabismus (look at the eye you're uncovering).
5,7,8,9,10,11,12 [this one I'll edit in]
Manual blood pressure: I remember it's estimated when palpating the radial pulse then release and increase the pressure to estimate for next try whilst auscultating. On the way down when releasing pressure, the first sound you hear is systolic, then when it stops that's diastolic.
Reply 14
Original post
by halfharryJust booked the clinical skills room at my school
They've taught us the knowledge but I have no idea how to translate it to OSCE material
What we've learnt so far:
Cardiac exam, resp exam, neuro exam, ummm...cranial nerves testing, manual blood pressure...i think ive forgotten a few
But i don't know where to star🫠
They've taught us the knowledge but I have no idea how to translate it to OSCE material
What we've learnt so far:
Cardiac exam, resp exam, neuro exam, ummm...cranial nerves testing, manual blood pressure...i think ive forgotten a few
But i don't know where to star🫠
Just keep practicing them is the only advice I would give.
Make use of society events that do mock OSCE runs. They tend to be run by upper years, so they'll have lots of tips to give you!
Reply 16
Practising on your friends or colleagues is really helpful as it just makes the process less awkward and all those 'mini-hurdles' you encounter in every day run of the mill consultation or examination will be something you just get used to dealing with.
The skills you should practice several times until you broadly recall the process. On the day it is possible some people may miss subtle findings I found.
The skills you should practice several times until you broadly recall the process. On the day it is possible some people may miss subtle findings I found.
One piece of advice shared on placement. Active listening is key especially when you're coming towards year 4 and year 5. You should be applying it to both clinical placement and OSCEs (remember that you're aiming to be good doctors all-round not just exam robots!)
Listen to what the patient is saying to try to target questions. Why are you asking this question, what differential are you thinking about and is it necessary to ask further closed questions on this? Sometimes it's necessary, but for certain focussed histories it can lead to the patient thinking 'why are they asking me this? It's so irrelevant to what I came in with'
Open questions are really helpful and too many closed questions early on can do the opposite.
Listen to what the patient is saying to try to target questions. Why are you asking this question, what differential are you thinking about and is it necessary to ask further closed questions on this? Sometimes it's necessary, but for certain focussed histories it can lead to the patient thinking 'why are they asking me this? It's so irrelevant to what I came in with'
Open questions are really helpful and too many closed questions early on can do the opposite.
(edited 7 months ago)
I saw online that it can be useful to make ankis on conditions you may be likely to have a counselling session (there's a lot so better to start earlier bit by bit). Essentially, it would be to use the NHS website for that particular condition to counsel a patient in patient-friendly language.
It can be useful for revision as well as putting difficult concepts into a simpler context can help us remember and understand long-term.
It can be useful for revision as well as putting difficult concepts into a simpler context can help us remember and understand long-term.
Reply 19
I'd agree open questions are best, particularly in real consults it's just you can feel pressured in an OSCE and really need to get through things to refine differentials.
At this level no diagnosis should be too difficult to pin down and it's likely to be logical or a common presentation you will know well rather than something more obscure or more tricky to differentiate from.
I feel getting the basics right reliably is very important and will net you a lot of marks. Introductions, explaining the purpose of the consult and the like along with explaining further plans/investigations and safety netting should all be near automatic and easy to spiel out without using up too much brain on the day.
It is worth noting that even an incorrect diagnosis will not fail you a station provided your consult is reasonable and any suggested investigations are logical and reasonable. The main aim is to examine your overall competency and safety. It's not an oblique test of knowledge or at least it never felt that way to me.
Later post-graduate stuff of course is a rather different ball-game.
At this level no diagnosis should be too difficult to pin down and it's likely to be logical or a common presentation you will know well rather than something more obscure or more tricky to differentiate from.
I feel getting the basics right reliably is very important and will net you a lot of marks. Introductions, explaining the purpose of the consult and the like along with explaining further plans/investigations and safety netting should all be near automatic and easy to spiel out without using up too much brain on the day.
It is worth noting that even an incorrect diagnosis will not fail you a station provided your consult is reasonable and any suggested investigations are logical and reasonable. The main aim is to examine your overall competency and safety. It's not an oblique test of knowledge or at least it never felt that way to me.
Later post-graduate stuff of course is a rather different ball-game.
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