OSCE Thoughts - Introductory Blog Part 1

Welcome to Teach Train Go - our insightful OSCE Tips.

Knowing how to navigate an OSCE is a must-have skill for any medical student to have under their belt. As medical undergraduates, they must see it and approach it as a necessary skill that they will need for much of their medical career.

Medical undergraduates will need to demonstrate their OSCE skills:

1. Throughout their undergraduate training.

2. When they move on to more advanced specialist training.

Junior doctors will be required to undertake a practical OSCE-style exam known as PACES to advance in their careers.

This will be for their MRCP PACES and all specialisms that require a Royal College membership exam.

When a junior doctor gets to this further stage, the stakes will be higher, and what is expected and demanded of them in the exam will be more robust.

But there is something else to consider - once a junior doctor leaves medical school, any structured communication skills lessons and learning ends. Yes, they can attend outside courses, but these courses primarily focus on the ability to apply clinical skills - and there is nothing wrong with that.

However, without the application of robust communication alongside clinical skills, a candidate will be stuck.

In addition, by the time a junior doctor needs to revisit their structured communication style that is required explicitly for their practical exam, medical school ended years ago. Most junior doctors are likely to remember bits and pieces. Yet, it's also like riding a bike; if they have truly understood the mechanics the first time around, they’ll always remember. But only if they truly have that skill under their belt.

For 23 years, I have been working in medical education. For most of that, I have been a simulated patient for all types of undergraduate OSCE exams, PACES, Royal College membership exams, and even GMC competency tests. I have seen it all.

I am also fortunate enough to teach OSCE-related communications skills. And I know what is needed at each stage. Because of my experience, my primary advice will always be: Be sure to start OSCE prep before exam season. Do not leave it to the last minute. And not just for that year’s exam. Start as early as possible in your medical training.

When talking to medical students while teaching, I often hear -

“It’s too early. I won't start thinking about OSCE until nearer the time.”

Or

“I’ll have three weeks before the OSCE exam. That will be plenty of time!”

The issue with this type of approach and the attitude towards it is that the undergraduate only focuses on that particular year’s exam. It is an inconvenience to get over and done with, so they can forget about it until next year.

What is wrong with this approach?

Let me give you an analogy (Note - I will do much of that in OSCE Thoughts.)

Let's take the example of when learning to drive.

Stage 1 - When you first start taking lessons.

You need to juggle loads of balls at the same time. Mirror, signal, manoeuvre. Find the biting point. When you're about to drive off, the car makes juddering movements, and you are likely to stall. You’ll probably stall at many junctions. And that's normal for when you begin.

Stage 2 - After a number of lessons.

You start getting a feel for it. But it's all still a bit shaky, still very cautious. You are going through the motions, but you haven’t got it in your bones, so to speak.

Stage 3 - Test Day.

There is no room for jerkiness, stalling or an inefficient emergency stop. You have to show you are safe to go on the road with your P-plate.

Stage 4 - You've passed your test.

Motorway driving, night driving, going a long distance - that's the next step of learning to be a driver. Getting real-life experience.

Stage 5 - You've been driving for years.

It's as if you're on autopilot, you don’t need to think about the everyday basics.

But you’ll find yourself saying, “If I had to take the test now, I would fail.” Whether that's theory or practical.

The above 5 stages are similar to your medical career. That is how you have to see the exam.

For every exam, a student should be performing at stage 3. You cannot stall. You cannot be unsafe.

As an experienced simulated patient, I regularly see stages 1 and 2 in the exams, time and time again.

When it is a practice OSCE (MOSCE - Mock OSCE, or FOSCE - Formative OSCE), the one thing that comes up routinely during the feedback session is that the students tell the examiner and me that they only started looking at OSCE prep a few weeks earlier.

By leaving it to the end, students may learn it at face value. But this shows in front of the examiner and patient and will, without a doubt, affect your marks.

By approaching OSCE Prep earlier, there is time for it to sink in. When with patients, communication skills can be applied and developed throughout the year. It gets practiced and developed overtime, making it a natural part of patient-focused practice.

Good luck with your OSCE development!

Please share our blog and newsletters with your friends and fellow students!

If you haven't already, subscribe on our homepage to receive more OCSE Tips and Tricks.