On the 11th of March last year, a mass email was sent out from the registrar’s office, informing 5th and final year students of the possibility of taking an OSCE. This was supposed to be a no-stakes clinical exam for research purposes.
The email called for 20 students from the English programme in the 5th and 6th years who were willing to take this no-stakes clinical exam. I constantly try to test myself and push myself out of my comfort zone, especially in academic settings, so signing up was a no-brainer. My next Google search? What is an OSCE? I had always heard of it. I knew my friends in medical schools in the UK took it, for example but I really did not know much about what it entailed and the process.
OSCE stands for objective structural clinical examination. It is an exam format that aims to implement theoretical knowledge in simulated clinical settings. It helps to test not just clinical knowledge, but reasoning skills, resource management skills and more.
Shortly after signing up, I received an email with all our instructions. We were asked to bring a lab coat, name tag, stethoscope, reflex hammer and notebook & pen (for note-taking). We showed up on the 4th floor of the main building in front of the MediSkills lab.
There was a small delay, just by a few minutes and we were briefed in person on what would happen. We signed consent forms because recordings were to be taken for research purposes. We were directed to our starting stations and asked to stand in front of the door. Taped to each door was a clinical case that gave us our positions and the most general information about the patients. It went something like this:
You are a first-year resident spending an over-night shift in the ER. A middle-aged woman, BMI 30 comes in complaining of severe abdominal pain which started after her dinner. She has no known medical conditions and has taken 2 painkiller tablets. Conduct a physical examination.
We were giving 2 minutes to read this and take our notes and once we received the signal, we went into the room. There was a timer counting down from when you stepped in. Some rooms had actors who did a fantastic job simulating sick patients. We also had a nurse in one or two rooms to assist. In other rooms, we encountered dummies or phantoms. During this time, the examiners sat in the corner and observed, only interrupting to give a 1 or 2-minute warning on the clock. They watched our hygiene practice, interview skills, bedside manner, etc. One thing to note is that we had specific instructions. Some stations required only a physical exam, while some required just the anamnesis.
This is where my details are hazy. If I remember correctly, we had 7 minutes to deal with the patient and 2 minutes to speak with our examiners and receive feedback from them. The examiners did not necessarily need you to make a full diagnosis but if you were able to make logical decisions and come to a reasonable conclusion, this was enough for most.
We did 5 stations at a time with a 20-minute break and refreshments at the half-way point. Internal medicine, neurology, surgical techniques, general medicine practice all featured and we had a station where we had to break bad news to the family member of deceased patient. Altogether, it must have lasted about 2 hours.
We had a short session where we gave in-person feedback. One of the more common sentiments was that we did not have enough time to complete our tasks. I do think this is moreso tied to the fact that we were unfamiliar with the OSCE format. In theory, we are taught this long list of questions during the interviewing process with a patient. In practice, as I am sure you know, there is barely ever enough time for that and that was really reflected in this OSCE. I had a hard time isolating just the questions relevant to the patient’s condition in such a short time.
Another problem I personally had was that I did not really understand to what extent we had to be thorough. We had actors who played their role but ultimately were not actually patients and even dummies in some rooms, so in my first few stations I was unaware that I had to also wash my hands and glove as I would in real life. A few stations had imaging that I did not know was an option I could request. All in all, it was a rather fun and educational experience. I was nervous despite it being essentially no-stakes. I can say with a certain amount of certainty that this was the first time most of us were exposed to the OSCE; it definitely was for me. On my first station, I was rather confused on what to do and scrambled a lot, but by the 5th station, I was a lot more confident.
Two weeks after the OSCE, we received our evaluation forms. Did I pass? No. If I am correct, passing can be confirmed when you meet the requirements for all stations and unfortunately I did not meet the requirements in my first station. I remember freezing for a good 10 seconds because the simulated patient was moaning and groaning in mock pain, and the nurse was just staring at me waiting for my instructions. A bit of a chaotic situation to be thrown into for the first time, so I didn’t expect much there.
I believe in the long run, the plan is to implement the OSCE into our examining system and I believe this will be an excellent idea. I did some research and found that a medical school in France conducted a study that made some interesting findings regarding the OSCE. 6th year students were examined via the traditional testing methods and also with the OSCE. The study reported lower scores at OSCE exams compared to other evaluation formats, suggesting that the OSCE is able to test in a way that traditional testing formats do not. It also showed that students who had a single OSCE training session prior to the OSCE saw an improvement in their OSCE scores. So if you are unsuccessful based on these OSCE standards, try not to feel bad about it. A new testing method will always take some adjusting to. Another study from a sample group of final year medical students across a variety of UK medical schools found a positive connection between mock OSCEs and an improvement in student confidence and anxiety in future high-stake exams. The OSCE tests your clinical and theoretical knowledge, as well as your technical skills and medical competency. It is able to test a large group of students in a short period of time and because with a variety of examiners, it reduces the possibility of examiner prejudice or bias. Complementary to other forms of testing and provided that it is well administered, it will significantly improve our university experiences as students.
So I encourage students to register for this opportunity and attend it. And if you missed it this year, it might come around again next year so keep your eyes peeled for that. It’s a great way to know how you reason in a clinical setting. And to those who have registered: At this point in the 5th or 6th year, you have all the knowledge to do well in the OSCE. Brush up on a few concepts if you need to prior to the exam. The Youtube Channel Geeky Medics has an OSCE guides series that can be helpful for you. Also remember to go through the SPIKES model for delivering bad news. Aside that, it won’t be anything crazy.
In the spirit of sharing, I have attached my assessment sheets here. I encourage you to check them to see what is expected of you. Just an FYI: I have 11 sheets because 2 examiners separately assessed me in my first station. I also received assessments from the simulated patients and have attached them here as well. Why did simulated patients also give their assessments, you may ask… Their experience with you also gives you feedback on a patient’s experience with you as a potential healthcare provider, so this definitely matters.
EDIT: I just remembered that we were able to get a certificate for this!
Next up is an interview with a good friend that some of you are waiting on. Won’t be long now. Cheers!
