Recently Fellowed GP and new RACGP examiner, Penny Wilson has written a fantastic blog post with lots of useful OSCE hints. Well worth a read!
Penny has also posted on the foam4gp website regarding some general exam study tips
I agree with all of Penny’s hints and tips, and would like to add a few of my own… (please note that these are personal opinions and not endorsed by the RACGP.)
1) The process (e.g. structure of the consultation, safety-netting, patient explanations, examination skills, formulation of a differential) is just as (and sometimes more) important than knowing the exact diagnosis. Getting the correct “answer” e.g diagnosis, does not mean you’ve passed the station. Conversely, getting the wrong “answer” doesn’t mean you’ve failed the station.
2) Don’t forget your basic communication skills and end up rushing through the doctor/patient interaction, worrying about time. When appropriate, use silence – think and listen, then speak. Remember that the “patient” may be anxious, teary or angry. Be aware of your own emotions. Allow “patients” to express their emotions. Bolster their self-confidence. Involve “patients” in decision making. Make certain your non-verbal cues match your words.
3) READ THE QUESTION!!! I know this has already been mentioned but I can’t emphasise it enough!! Familiarise yourself with various “Instructions for Candidates” – you must follow these instructions to score marks and knowing how many tasks you have to do will help you manage your time. Pay close attention to whether you’re instructed to discuss issues with the “examiner” (this can be done quickly and using medical jargon) or with the “patient” (need to use a patient-centred approach / appropriate language while still showing off your knowledge to the examiner. A useful technique is using the correct medical term then explaining. E.g. “The tests show that you have a condition known as “x”. This means “blah blah”. Have you got any questions about this?”)
4) Learn to ignore certain visual clues during the exam. This can be one of the hardest things to adapt to as we gather a lot of information about our patients from their external appearances. The role player will probably be a different age and body shape to the “patient”. While the role playing examiner will try to give you appropriate non-verbal cues (facial expressions/ body language etc) not all of them are great actors, so it may be hard to gauge (but try your best to work it out). The best way to prepare for this is by doing mock stations with your colleagues, friends and family.
5) Don’t assume that there won’t be any clinical signs if asked to examine a “patient”, thinking it is a healthy “role player”. It might be someone with real signs! On the other hand, don’t invent signs to fit with your presumed diagnosis (this sounds obvious but you’d be surprised how many people do it!)
6) If the “patient” presents with symptoms of anxiety or depression, it is worth requesting the results of a depression/anxiety rating scale as part of the examination component, if applicable. It may not be available, but can be very helpful if it is.
7) You have to say it aloud to score marks, you cannot just imply. Verbalise actual diagnoses, test names, medication names etc. if you know them. Talk through your examinations as you go.
8) If you’re not sure about something, say what you think it is and admit you’re not certain, then follow it up with something like “I will look it up on “x” website” or “I’ll discuss it with “x” specialist”. This shows that you’re practising safely and is far better than guessing the specifics and getting them wrong.
9) When in doubt/ have extra time, talk about: patient education, support and counselling, lifestyle modification, patient information handouts, follow up plans and safety netting.
10) Physical examination – don’t forget: General appearance, BMI, vital signs
11) If you’re not getting anywhere with the history and you’re feeling a bit lost, you may find it useful to do a systems review. One mnemonic that may be of use in the OSCE is SYSTEMS:
S – Sleep
Y – Your weight (loss / gain)
S – Symptoms – constitutional (eg. fever, malaise)
T – Travel history
E – Eating (diet / appetite)
M – Mood
S – Sexual health
12) Once you’ve finished a station, put it out of your mind. Don’t ruminate – you can’t go back and change it. Focus on the next station. Take a deep breath and use your 3 minutes reading time to plan it out.
13) Use the rest stations (11mins each) to clear your mind and relax your body. You may want to find and practise a 10 minute meditation or relaxation exercise for this purpose, especially if you are prone to performance anxiety.
14) Don’t overdose on the lollies or the water provided at the rest stations. Your performance will not be enhanced by a sugar high, and while keeping hydrated is good, you don’t want to be busting to go to the loo!
15) On a similar note, have your usual caffeine intake on the day of the exam – not more, not less. It is not the time to be going through caffeine withdrawal, nor the time to drink a triple espresso for the first time.
16) While it is an artificial and stressful set up, and you need to learn how to play the exam game, remember that the aim is to assess whether you are a safe and competent GP. The best preparation you can do is by being as good and conscientious a doctor as you can every day with your patients. Ask structured histories, examine your patients properly, give good patient education and always make follow-up plans and safety net. Then come into the exam and be your usual GP self!
Remember: ”We are what we repeatedly do. Excellence, then, is not an act, but a habit.” Aristotle
17) “If it looks like a duck and quacks like a duck, treat it like a duck but you still have to mention that it’s not a pig” e.g. Mention to the role playing patient that the benign-looking rash isn’t meningitis, or that the non-suspicious lump is not cancer, or that the costochondritis isn’t an MI.
18) My final tip – try to avoid traumatic brain injuries in the month leading up to the exam. (If you’re interested in reading about how I came to be doing my OSCE with 6 facial fractures and left temporal lobe contusions… click here)
Good luck everyone!
If you have any other hints, please add to the list by writing in the comment box below.
(These views are my own, not those of my employer, North Coast GP Training, or the RACGP. Thanks to Nispa Krongkaew for her contributions to the above list).