Treat it like a big day at work. Become comfortable with role play, and just behave us you would at work.
Reading time. The Candidate Instructions provided outside the station will clearly indicate what is expected of you in the stations. Read them carefully and plan your approach before entering the room. Every word and phrase in the clinical stem has been workshopped many times. It is there for a reason and it is important. For example, consider the time of day, local resources etc. You will usually be able to predict what will happen once inside the room. Where is the station likely to go? What is the consultant level knowledge I can demonstrate? When you enter the room, make sure you pick up on all cues – there may be results, ECGs, x-rays or other props that may be important. Be prepared for normal x-rays and path as this may be the whole point of the station.
Read the TASKS given and make sure you achieve those in the OSCE. Try to form a structure for each OSCE in the 4 minutes that you have outside the room. Think of the task/s you need to perform and break them down into sections to provide a structure. You will lose marks if you do not perform all of the tasks that were required. If you can, verbally outline that structure at the beginning of the OSCE so if you run out of time at least the examiners will know what you intended to cover.
Look at the domains being tested and think about how you can concentrate on those, especially the main ones. If it says you are being tested on scholarship and teaching, you need to teach! The examiners will be assessing you on every domain that is listed on the OSCE stem separately. It is no good performing excellently in one domain while failing at another. E.g. There is no point spending 3 minutes counselling a patient to stop smoking if Health Advocacy is not being tested.
Be the consultant! This is your chance to show the examiners you are ready to be a FACEM. You need to “own” the OSCE and give the impression that you are in control at all times and are unflappable. Take your time when talking, pause to think and make sure you phrase things as if they are YOUR practice/plan etc. i.e.” MY practice is to ....; MY management plan in this patient is....; I think we should....” If the problem is difficult/controversial, say so - acknowledge some may do things other ways, but “my choice is…” Examiners want to see a colleague consultant who is sensible and safe, not a registrar who has read a lot.
Prioritise appropriately when listing differentials or management. This is particularly important for treatment of critical illness and ordering investigations. Always complete the most important things first. Remember, this is a consultant level exam. E.g. if a patient has chest pain, you would prioritise an ECG over an FBE.
Stay calm and confident. No matter what the role player does or what happens in the scenario keep going and remain calm. Never get angry at the role player or exhibit frustration at the process.
Actively listen to the confederates/role players. The examination is an INTERACTIVE process with the confederates/role players and candidates exchanging information during the encounter. Candidates are advised to listen carefully to the role players’ responses and questions and respond accordingly. In their feedback to unsuccessful candidates, examiners frequently note that the candidate did not answer the role player’s question or ignored a prompt. Role players are provided with instructions, including set questions or prompts, to assist you to demonstrate your knowledge and to help you achieve the requirements of the station .Listen carefully to these prompts and ensure you answer any questions asked by role players as fully as you can. Should a role player repeat a question, you should take this as a cue that you have not yet answered some key element of the question. If a role player or examiner interrupts you, you should assume, you have covered that point and they are moving you on to cover additional criteria.
Be empathetic with the patients. Always show that you care and be considerate.
Speak clearly and do not talk too fast. The examiners need to be able to hear and understand you to give the marks. Consider going to a performance psychologist or speech coach if necessary. They may be able to help you with tips on controlling your nerves, slowing speech, speaking more clearly etc.
Summarise. Summarising allows the examiners to pick up on things they may have missed and gives you a way to make sure you have covered all your tasks that you needed to achieve in that OSCE.
Let it go! When you walk out of the OSCE, forget about it completely and focus on the next one. If you didn’t do as well as you’d hoped, don’t let it negatively impact on your next station.
Examiner Feedback (from ACEM OSCE Report 2021.1)
Over multiple examinations, several themes are observed by examiners:
Candidates who perform well in their OSCE, more often demonstrate they:
• have read the Candidate Instructions carefully, including the tasks required and the domains that are to be examined
• present a clear and structured approach to the required tasks
• demonstrate sound medical expertise (knowledge) and relate this directly to the specific scenario and the tasks at hand
• demonstrate their ability to conduct a comprehensive assessment: history and examination
• undertake appropriate patient management and safe disposition plans
• communicate effectively with role players in the context of the scenario.
Candidates who do not perform as well, more often:
• lack the clinical knowledge required to successfully complete the station
• have an inadequate history taking technique and miss key aspects of the station
• have a tendency to make generic statements such as ‘get bloods’ but do not indicate the samples required, or they suggest medication without the correct dosages
• neglect to justify their decisions about investigations, management, or disposition
• do not really listen to what the role player is asking and neglect to answer their specific questions.
Trainees are reminded that if a role player asks a question, this may represent a prompt for the candidate to refocus on an essential area or to cover a required aspect of the case. The examiners will be waiting to hear the answer the candidate provides, so that marks can be allocated to that section.