EXAM Formats EXPLAINED

What is it?

If you had to go through Multiple Mini Interviews (MMIs) during your medical school application days, you’ll find the Objective Structured Clinical Examination (OSCE) to be of a very similar concept. While schools like UCL also terms it the Objective Structured Clinical and Practical Examination (OCaPE) for pre-clinical students, it all means the same thing. The OSCE is used to assess the student’s competency in clinical practice settings. Most stations function like written exams and involve the application of scientific knowledge, but in a full circuit, a few stations are usually set aside to specifically test Ethics and Law, Statistics, or clinical procedures such as Basic Life Support. Some stations may involve interacting with an actor under the watch of the examiner. Each station has a fixed structure and every student will receive the same questions/tasks. Students are marked against an objective mark scheme, with marks awarded for correct answers and some marks allocated for communications skills, hand washing, and professionalism.  

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How to prepare

When preparing for your OSCEs, the most important thing is to practice doing and explaining things out loud. If you are preparing for clinical procedure stations, try to practice on friends, medical mannequins from your university Clinical Skills Centre, or even your pillows if you are practicing at home. Look for a reliable group of friends who will practice with you. Get used to explaining what you are doing out loud because this is what you’ll be doing in your exam. If you can find a mark scheme or checklist of the things you need to do, have it at hand to make sure you don’t miss important points.  There is little variation in how clinical procedure stations will be presented in your exam, so know these like the back of your hand. For good demonstrations on how each procedure should be performed in the exam setting, GeekyMedics has a YouTube channel that provides OSCE guides.

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These books have been tried and tested by many students over the years:

1. For OSCE practice with your friends: OSCE Cases with Mark Schemes: A Revision Aid for Medical Finals

2. For learning Clinical Examinations: Macleod's Clinical Examination

3. For free crash course style online notes on every possible topic: OSCEstop

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When preparing for knowledge or interpretation-based stations, try going over your lecture notes and coming up with a list of testable diseases, syndromes, or abnormalities. Go through these systematically. Here are seven things you should consider when going through each disease: 

1. Disease/Syndrome/Abnormality 

2. What symptoms would you see in an affected patient?

3. (If genetic disease) What is the inheritance pattern of this disease?
   (If transmissible disease) What is the mode of transmission of this disease?

4. Which tests would you perform to confirm the diagnosis?

5. What test results would you expect in an affected patient?

6. Explain the pathophysiology of this disease.

7. What is the best course of treatment/recommended medication? 

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Of course, the questions you receive in your OSCE may not always be presented in this order. Often, the scenario will describe a patient with a set of symptoms and you will be asked a series of questions based on this. Sometimes, you may even receive laboratory results, images of histological or microscopic slides, or even videos of abnormal movements. If there is a specific name for a particular symptom, e.g. Chvostek sign in a patient with hypocalcaemia, you usually are required to give this name in order to receive the full mark. In this case, simply describing the symptom as a “twitching of a facial muscle” will not cut it, although saying this aptly demonstrates that you know how to identify this symptom in a patient and link it to the correct disease. If there are two or more diseases with similar symptoms, similar pattern of inheritance, similar pathophysiology, similar mode of transmission, you should know their differentials in order to distinguish one disease from the other. 

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Don't forget Pharmacology! Know: -

1. Drug names and classes (especially gold standards and first line treatments)

2. Mechanisms of action

3. Side effects

4. Drug elimination kinetics e.g. first order elimination

5. Antidotes to use in an overdose (if applicable) 
    

Pronounce drug names out loud when you practice – you’ll be surprised how quickly similar-sounding names start to blend together – do you know the difference between pyridostigmine, pilocarpine, phenoxybenzamine, phentolamine, phenylephrine, phenelzine, and phenobarbitone? Well, you would if you practiced out loud.