It’s coming up to that time again, the RACGP OSCE. To help you prepare and ace the OSCE, here are some vital tips on how you might improve your short stations from Dr. Ashley Ng – an OSCE passer, GP supervisor and RACGP OSCE examiner.
If you’re about to sit the OSCE, that means you’ve passed the written exams – congratulations!
To get to this point I’m going to assume your clinical knowledge base is sufficient and you have basic history and examination skills to get through medical school, a few hospital years and have survived general practice for at least 12 months.
The OSCE is supposed to reflect a typical session of general practice in Australia. That said, there are a few things you can do to optimise your performance to get the most out of each 8-minute station:
1. Read the question.
I think this is the most important one, and the one that you’ve probably heard over and over in any sort of exam. It’s the mistake I hate to see, because it’s such a simple thing that can unravel the whole station. If the question asks you to explain the diagnosis to the examiner, turn to the examiner and explain the diagnosis in medical terms. If the station says that investigation results won’t be available at this consult, please don’t keep bugging me for a haemoglobin.
Use your 3 minutes reading time wisely, you should know what you need to do before you enter that station and how to roughly manage your time. If you need to get through history, examination, investigation and management, then you know you need to move pretty quickly through those sections.
The station instructions typically don’t give you a lot of clinical information, but you can at least determine the age of the patient and past medical/family/social history and get an idea of what else you might need to cover.
2. Be familiar with the OSCE format.
Let’s take a look at how the OSCE is run. Like all the RACGP exams, it’s standardised across Australia, which means each candidate will have exactly the same OSCE station, same history given and same marking scheme. When you walk into that door for your first station, simultaneously around Australia other candidates are walking into that exact same station. There will be different examiners obviously, but that should technically be the only difference.
- The person you take the history from is a GP acting as a role player.
- The person examining you is also a GP.
- If you see a 3rd person in the room, don’t freak out, it’s usually another GP examining the examiner. It’s quality control.
3. Efficiency is key to a concise, relevant history.
To make the most of your time, ensure you have a system that can gather as much of this information as possible in any station. I would suggest starting each station in exactly the same way, if a history is required. For example, once the timer sounds at the end of reading time, walk into the room, flash the examiner your badge and sit down. Introduce yourself and ask “how can I help you?”
- The role player will give you the presenting complaint, to which you will respond – “tell me more about that” (or something to that effect).
- The role player will then give you a bunch of useful information (let them talk!) and from here you will have to use your clinical reasoning to ask further questions to rule in and out red flags and figure out the problem.
- Even if the instructions say the patient has presented with a cough, don’t be that doctor who comes in straight away with: So you have a cough? Is there sputum? Always start off with “how can I help you?” I know I’ve been caught out in regular consulting when you think a patient has returned to discuss results, but they have a completely different agenda to discuss, and you don’t find out until after 10 minutes of discussing their test results. Same thing applies here.
4. Know your system for examination.
A lot of the time you will be asking the examiner for examination findings. Work through it methodically like you would any examination. Rattle off vital signs, general appearance, height, weight, BMI, BP, HR, temperature. It can be a good idea to state the system of examination, then go through that particular examination in more detail. It at least shows you know how to do those examinations methodically. It’s also useful to do this as some stations might only need you, for example, to suggest respiratory exam and you’ll be given the findings, whereas others you will have to specifically ask for things like auscultation, percussion for the examiner to release that information to you.
- When you’re asked to request examination findings, I think it’s rare to be penalised for asking for too many findings. Ask too much though and you might lose time asking for things that are irrelevant.
- In terms of performing examinations, it might be part of an examination or a modified one, because it’s rare that the station will be an examination only. It will likely include a brief history, investigation and discussing management, which will need to fit into 8 minutes.
- Remember, you’re performing examination on well people. The signs have to be reproducible, or acted easily. Hint: know your MSK examinations.
- Be a bit more judicious with investigations. It’s not a good look if you’re ordering CTs and MRIs for everyone. You want to demonstrate that you investigate appropriately and cost-effectively.
5. Practice, practice, practice.
Finally – the other most important point is practice. The more that comes naturally to you, the less you’re going to miss when you’re under pressure. Practice in study groups, to your partner, on your dog. A lot of people suggest practicing while you consult in real life, and I think this is a great idea. Pretend you’re in an OSCE situation and go through the motions properly.
There are OSCE preparation courses and mock OSCEs available by a number of providers now. I found the support and resources from my RTP at the time was great and sufficient in addition to practising in a study group. If you’re not part of a RTP or feel you need more feedback and direction, then consider enrolling in one of these courses.
So that’s it, 5 tips to boost your OSCE preparation. There are loads of other great resources online, through your RTPs and Facebook groups. Good luck!