Objective Structured Clinical Examinations, or short OSCEs, started out as part of the curriculum at medical schools and universities but have since found popularity in all branches and areas of clinical assessment. If you are looking to relocate your medical career and seek to join a health board in a different country, there is a fair chance you will be required to undergo OSCEs to demonstrate you are fit for the job.
Being a relatively new clinical assessment, you might not have encountered OSCEs before. Any sort of examination can cause nervousness and even more so if you are not familiar with the process. Our guide is here to help you get an idea of what to expect and how to prepare for your OSCEs.
What are OSCEs?
OSCEs are universally-accepted standard exams in health sciences to assess clinical skills and competencies. These exams present a candidate with a range of standardised medical scenarios that allow them the opportunity to demonstrate competency in communication, history taking, physical examination, clinical reasoning and decision making, medical knowledge, interpretation of clinical outcome results, and integration of these skills.
The method was first mentioned in the British Medical Journal in 1975 and has since been widely adopted and continues to evolve to reflect developments in medicine and education study.
OSCEs are deemed to be an extremely fair and accurate method of assessment due to the wide range of scenarios and skill tests as well as due to a candidate’s score being based on evaluations from multiple examiners rather than a single one. Unlike more traditional medical exams, OSCEs allow for assessments of the areas most critical to performance of healthcare practitioners such as communication skills and the ability to handle unpredictable patient behaviour.
Top Tip: Medi Students provides information on OSCEs in different specialist areas and is a great place to find details on the assessment in your field of practice. [https://www.medistudents.com/osce-skills]
How are OSCEs implemented?
A candidate undertaking the exam rotates through a series of stations in sequential order. The number of stations can vary, but as a standard, between 10 to 18 is considered an appropriate number to ensure both objectivity and an accurate assessment. At each of these stations, the candidate is presented with a distinct clinical scenario they will have to respond so.
The scenarios are acted out in roleplay with mock patients (these are usually actors, but mannequins can also be used) to better assess a candidate’s practical skills, including communication and interaction with a patient. The candidate is assessed by a different examiner at each station and receives a score based on performance and the examiner’s professional evaluation.
Each station routinely assesses multiple aspects of a candidate’s clinical competence across communication, clinical examination, medical procedures/prescription, exercise prescription, joint mobilisation/manipulation techniques and interpretation of results. For example, a scenario might be: ‘A 44-year-old man presents himself with a complaint of headaches. Obtain a complete history of this complaint.’ Stations can stand entirely on their own, but individual stations can also be linked together around a scenario, known as APIE (a station each for assessment, planning, implementation, and evaluation).
Prior to entering a station, the candidate is given information about the upcoming scenario and is allowed two minutes to prepare. The information provided will usually outline the age and gender of the patient they are about to meet in the station as well as the medical complaint presented.
A station can vary in length, commonly lasting anywhere between five and 15 minutes. A longer time may be given if a scenario is particularly complex or requires a demonstration of skill that simply cannot be completed within the usual timeframe.
Top Tip: IELTS Medical UK [https://www.youtube.com/c/IELTSMedicalLTD/featured] offers a range of information videos that give you a feel for what to expect on exam day. We particularly recommend this one [https://www.youtube.com/watch?v=Z3yMhNhbic8] of an OSCE actress speaking about how she presents different patients, how candidates frequently act, and what is usually expected from a candidate in a specific scenario.
Preparing for OSCEs
As with pretty much any exam, your best way to prepare is to practise and to study. Friends or family may be willing to help you out and can act as a mock patients in different medical scenarios – you can easily find example cases (see top tip below) to either work through on your own and theoretically consider how you would handle the situation or to actually act out and practise with a volunteer. Not only does this help you familiarise with what you will be facing in the actual exam, it will also establish your strengths and weaknesses. If you come across a scenario or even just an aspect of a scenario that you don’t feel particularly confident with, this is where you perhaps want to get the textbook out again.
There are some skills that you cannot polish quite so easily though, such as taking blood or mobilising patients. A lot of hospitals and universities have clinical skills labs where it is possible to practise these and similar treatments in a safe and controlled environment. It is always worth enquiring if such a possibility is available at your current place of work or at a medical education partner institution.
If preparing within the confines of your everyday environments does not give you the confidence you need to tackle your exam, you can even book a ‘Mock OSCE’. [https://mock-osce.com/] This practice assessment replicates the OSCE format – time-constraint and station-based – and is staged online with candidates, actors/mock patients, and examiners logging onto a web-based platform using a webcam and microphone. Participants receive instant results and personalised feedback.
Most importantly, try to not get too stressed about the exam. If you are relocating and undertaking OSCEs to register for a health board in a different country, chances are that you have already been practising as a medic for a while. You will encounter nothing in the exam that you wouldn’t also encounter during your everyday practice, and you will have the skills and experience to handle these situations – in a way, your day-to-day practice as a medic is the best preparation for OSCEs you can possibly get. All you have to do on the day is demonstrate how you do your job.
Top Tip: A number of online resources provide OSCE stations example cases, many even including candidate, patient, and examiner instructions. This is an ideal way to familiarise yourself with the type of scenarios you might encounter and to get an idea of what examiners are looking for. A possible place for you to start with example cases is the dedicated website OSCE Stop [https://oscestop.education/] or the medical education page Geeky Medics. [https://geekyquiz.com/osce-stations/]
How are OSCEs graded?
Candidates are scored against various specific or more generic criteria at each station based on a structured marking scheme. The examiners will mark a candidate’s score as the scenario plays out at the station, either on paper or digitally depending on the institution holding the OSCE.
The approach to calculating an OSCE grade can differ from institution to institution. A Borderline Regression Analysis (BRA) is prominently used to better incorporate the different degrees of difficulty of the individual stations, as well as the professional opinion of the examiners into the score. Many institutions allocate each station an individual pass mark with the sum of the pass marks off all the stations determining the overall pass mark for the OSCE. It is also common practice to impose a minimum number of passed stations as a requirement.
Top Tip: Since grading and scoring approaches can differ between institutions, make sure to check with the host of your OSCEs what the requirements are prior to undertaking the assessment. You will of course want to do your best regardless, but it is always useful to know what the threshold is.