In these OSCEs you are usually asked to teach a junior doctor some aspect of Emergency Medicine. Medical Expertise is typically the main domain assessed, with the weighting for Scholarship and Teaching around 20-30%. It may involve interpretation of clinical information or investigation results provided, the formulation of a management plan or explanation of a procedure.
Examples from the 2020.2 OSCE:
teach a junior doctor an approach to anaemia in a 70 year old male patient
teach an RMO a suturing technique performed in the ED
interpret blood results and outline an approach to assessment and management of hyponatraemia
advise a registrar on the assessment and management of a patient with an eye injury
The list of topics in EM that would lend itself to this type of question are infinite so a good way to practice for this type OSCE is to try and imagine you are explaining concepts to a junior doctor when you are revising your EM subject material. The best way to do that, when you are revising a subject, is to try to create a structure to it e.g. for explanation of the approach to patients with AF you can divide it into headings - patients compromised by rapid AF, rate control, rhythm control and anticoagulation. You also need to practice your teaching and communication skills for these OSCEs by doing them over and over again to make sure you remember all the elements you need to cover in a teaching session as outlined below.
Guide the junior doctor (role player) through the correct interpretation of the patient’s (ECG/XR/blood test).
Teach an approach to (ECG/XR/blood test) interpretation in the specific clinical setting.
Explain to the junior doctor how they should assess the patient.
Outline an approach to ongoing management of the patient.
Demonstrate / teach a procedure (possibly using equipment provided).
Answer any questions asked by the junior doctor.
Teach the registrar how to resuscitate a …(e.g. newborn).
Domains that have been tested in recent OSCEs
Medical Expertise: Assessment
Identifies the elements that must be sought on initial assessment to formulate an initial management plan.
Elicits a focused, relevant history.
Identifies important historical details (red flags) diagnostic of an important condition.
Describes expected physical signs for a diagnosis.
Recognises signs on physical examination that indicate the patient is or at risk of imminent deterioration.
Utilises appropriate history, examination and relevant investigations to determine cause of clinical presentation.
Seeks evidence of time critical diagnoses when performing assessment.
Generates a differential diagnosis, with an inherent focus on conditions requiring time critical management.
Creates a focused investigation plan that confirms or excludes time critical diagnoses.
Explains the reasons for selecting tests in the investigation plan.
Scholarship and Teaching
Uses a range of adult teaching strategies from the ACEM Curriculum Framework, including:
Establishes rapport and makes the junior doctor feel safe and supported
Uses language appropriate to learner, is clear and concise
Checks for level of prior knowledge/ understanding
Demonstrates a structured approach to the topic
Covers the topic in appropriate detail
Articulates a practical approach to both assessment and management of the patient
Demonstrates the ability to simplify complicated concepts
Checks the junior doctor’s understanding, regularly and at conclusion
ACEM OSCE report feedback
Common themes for candidates who performed well:
Common themes for candidates who did not perform well:
Tips for the Teaching OSCEs (what the examiners are looking for):
• First establish the junior doctor’s baseline knowledge
• Outline a plan for the teaching session/topics to be covered
• Listen and check understanding throughout
• Be patience and tolerant with the learner
• Correct misconceptions, reinforce correct knowledge
• Specific and relevant depth and breadth of knowledge imparted
• Summarise important take home points at the end
• Answer questions throughout
• At the end of the OSCE, the candidate could recommend that the RMO reflect on the case and follow up with further reading (post experiential reflection)