10 tips on how to ace your first year OSCEs

by Francesca Rea

OSCE’s. The word alone fills even the most confident of medical students with dread. But don’t worry, below are some easy hints and tips from students who’ve done it all before (and lived to tell the tale). Aside from the obvious – practicing with peers and knowing the theory – these are some simple ways to improve your performance, and ultimately your mark. Who knows, you might even enjoy them...

1. Practice saying “Hello”

It may sound silly but introducing yourself to the patient is the first impression you will make, and it’s worth taking the time to ensure you don’t make a hash of it. Keep it simple: “Hi, my name is ____ (first AND second name – I’ve heard rumours of people who’ve been marked down for not including their surname) and I’m a ____ year medical student” does the trick nicely.

2. Common things are common

When it comes to OSCE’s the basics crop up a lot. In a respiratory station, it’s unlikely that the patient will have a diagnosis of bird fanciers lung, but it COPD and asthma are likely to appear. Make sure you know the common conditions like the back of your hand, including what their investigations and management plans (this isn’t required for 1st year exams, but if you know them it will definitely score you brownie points).

3. Wash your hands as you enter the door

Washing your hands will gain you safety points in every single station. It is such an easy mark to gain, and yet it is really easy to forget it. While you are practicing for OSCE’s, use hand gel or at least pretend to. It makes you associate the start of a station with washing your hands. In the actual OSCE, as soon as you open the door, reach for your hand gel. I promise, it makes life a lot easier.

4. Practice to time

7 mins isn’t a lot of time to meet someone new, make them comfortable and get them to tell you as much as they can about a potentially sensitive health condition. When studying at first, take your time. Make sure to include everything you can and try to take a thorough history or do a complete examination. However, the closer you get to OSCE’s, the more you should be using a stopwatch or timer. By the week before your exams, you should be able to fit a full respiratory/cardiovascular/gastrointestinal examination comfortably into 7 minutes. History taking is a different story and can vary in time depending on the patient and condition, so don’t worry in an OSCE if you haven’t been able to fit in everything you hoped to.

5. Know your red flags

This is one of the best tips I ever received before heading into my first year OSCE. It might sound simple but these can really help when trying to come up with a diagnosis, or just to fill time. These are most relevant in first year, and there are about half a dozen for each system:

- Respiratory: chest pain; shortness of breath; wheeze; cough (non-productive/productive i.e. phlegm/blood); orthopnoea; weight loss; night sweats;

- Cardiovascular: chest pain; shortness of breath; PND (paroxysmal nocturnal dyspnoea – waking up in the middle of the night, feels like drowning); palpitations; dizziness; oedema; intermittent claudication

- Gastrointestinal (I tend to think of this working down the body): trouble swallowing; nausea/vomiting (haematemesis?); dyspepsis/reflux; reduced appetite/weight loss; abdominal pain; tenesmus; changes to stool.

6. Rehearse awkward conversations

Some examinations are going to be more uncomfortable than others. In first year, of course I am referring to the PR exam. Having a pre-written explanation means you can just reel it off to the patient and not have to worry about stumbling over words. If you need some help, this was mine (disclaimer: this is by no means perfect, just an example!!)

“A PR examination involves me inserting a gloved, lubricated finger into your back passage. This examination should last around 20 seconds. It might be uncomfortable but should not be painful and if you like, it can be stopped at any time.”

7. Wear trousers!

This is a tricky one, because I would argue that comfort is the most important requirement of an outfit during an OSCE. I would encourage you to wear something that makes you feel at ease and prevents fidgeting or fiddling with any details (tassels/beads/buttons etc.). However, I offer a word of caution. On numerous occasions, students (usually females) have been deducted marks from a station due to “inappropriate dress”: “short” skirts or “low cut” blouses etc. This is not me agreeing or disagreeing with the marking process, but in order to ensure this doesn’t happen, I would recommend wearing trousers, just to avoid the situation in the first place.

8. Smile

Smiling fakes confidence, in turn relaxing the patient and yourself. Patients (even pretend ones) become more co-operative and makes getting the answers you need easier.

9. Make your second question in a history, “can you tell me any more about this?”.

I learnt this trick after 1st year OSCE’s so it’s definitely not a must, but nowadays my second question in a history taking station is always “can you tell me anymore about that?”. It’s an open-ended question, which is perfect for the start of a consultation (open questions gain you marks and require minimal effort). It means the patient can lead to conversation to the symptoms/problems they find most pressing. These are usually the most important and it keeps the station patient-centred. It also gives you time to think up your next question.

9. Make your second question in a history, “can you tell me anymore about this?”.

I learnt this trick after 1st year OSCE’s so it’s definitely not a must, but nowadays my second question in a history taking station is always “can you tell me anymore about that?”. It’s an open-ended question, which is perfect for the start of a consultation (open questions gain you marks and require minimal effort). It means the patient can lead to conversation to the symptoms/problems they find most pressing. These are usually the most important and it keeps the station patient-centred. It also gives you time to think up your next question.

10. Read the question

The number of times my parents have said this to me before school exams is embarrassing, especially since I missed out a full page of my higher maths because I didn’t turn over the booklet. It really is simple. Read the piece of paper outside the station and if you have time, read it again.

PS: From a personal point of view, I would recommend spending 2-4 hours a week practicing for OSCE’s with your friends and family in the lead up to exam week (snacks are recommended – let’s be honest, this is kind of your social life when it’s coming up to exams so make the most of it). When practicing taking histories, it helps if the person you are studying with has a bit of knowledge around the subject, but when it comes to examinations it doesn’t matter if who you are practicing with: use friends, family, even your dog!

PPS: I know it might sound daft but try to avoid superstition. The number of times I’ve convinced myself that I will fail an exam because of the number of magpies I’ve seen on my walk into the exam is ridiculous. Don’t stress yourself out – it’s do-able.

Good luck!!

#schoolyear #backtoschool