“You may knock and enter.”
Those five words get my heart racing. The pin-drop silence followed by pens furiously scribbling and then, “Hi, my name is …., the medical student”.
OSCE stands for Objective Structured Clinical Exam. For those who have never done an OSCE, here’s what to expect.
Set up and initial steps
Individual rooms or a large sports hall separated into booths by temporary walls – think like how an MMI would be set up.
On the outside of the room, there would be a sheet with vital signs and a brief summary of the presenting complaint. Something like ‘55-year-old male with two hours of chest pain and shortness of breath’.
At this stage my tip would be to write some key notes about the vital signs: are they hypotensive? Febrile?
In order to perform an organised history and physical exam, I would recommend writing down some differentials, including those key differentials that are ‘not to miss’.
‘Not to miss’ includes differentials that could be potentially life threatening. Things like aortic dissection, pulmonary embolisms or deep venous thrombosis.
Once you have an idea of what diagnosis you’d like to rule out or look for, it will guide your history and physical exam. For example, if one of your differentials is pneumonia, you know that on a physical exam you will prioritise auscultating the chest.
On the clock care
OSCE stations often have time limits that seem very short.
In order to examine the patient thoroughly in a short amount of time, it’s important to prioritise what parts of the exam or history are most relevant to the patient. For example, if the patient is presenting for the first time for symptoms, it may not be relevant to examine for chronic signs of a disease as these would not be present.
Many of the marks for OSCE stations also come from how you speak to the patient. Introduce yourself, confirm patient details, ask for consent and, if the patient is in pain, try to address it by offering analgesia or acknowledging their situation.
Adequate exposure and patient positioning is also key. Many students make the mistake of not listening for breath sounds or heart sounds for long enough. Although there are time constraints, part of the marks come from technique, so take your time to listen during auscultation.
