I’ve recently arrived at my new locum placement in the picturesque Clare Valley in South Australia. Apart from having access to some fantastic wineries, I’m also lucky to be staying with my good friend & GP registrar, Dr Mel Clothier of the Green GP blog. The RACGP OSCE is coming up in a few weeks and so all the local GP registrars have come around for a study group OSCE practice session tonight. Listening to their preparations, I’m so glad that it’s all behind me now! It’s over a year since I went through the exam and I have subsequently become an examiner for the College. So, it seems like a good time to pass on my top tips for OSCE success in the hope it might help others to get to the other side.
Leading up to the exam…
1. Don’t panic!
Think of it like just another session of consulting. This is what you do all day every day & the normal work of general practice is by far the best preparation you can get.
2. Practice time management
A major difficulty that candidates come up against is time management. Short cases are only 8 minutes long which is shorter than the standard 15 minute consultation that you might be used to. Long cases are 19 minutes, and there are 3 minutes reading time in between stations. Get a stop watch and a couple of friends (bottle of wine optional) and go through some practice cases just so you get used to blurting out all the information before the bell goes “ding! ding! ding!”
3. Go through some cases
“Clinical Cases for General Practice Exams” by Susan Wearne is a popular textbook for OSCE practice. Sample cases can also be found on the GPRA website. Or if all else fails, make up some scenarios for each other. Going over physical examinations (eg musculoskeletal, neurological etc) a few times is a good idea too. You want to be able to go through the steps in a slick fashion without having to panic because you’ve forgotten how to do a McMurray’s test or Hallpike maneouvre.
Consider doing an OSCE preparation course. The RTPs will often conduct an OSCE preparation seminar and there are various RACGP pre-exam courses available too.
4. Have a plan for long cases
You’ll generally be expected to cover quite a lot of ground in the long cases and you might find it useful to have an outline in mind that you can scribble down during reading time. See here for an example of a proforma, but obviously, use whatever structure works for you!
You might be able to hear the bells in the background for the short cases that are happening concurrently so by the 8 minute bell you’ll want to finish with history and by the 11 minute bell you’ll want to be finishing up examination and getting onto management plan.
On the big day…Dr Tim from the KI docs blog would tell you that all you need to do is turn up sober. That’s definitely a good start! Here are a few other things you can do:
5. Most importantly, READ THE QUESTION
The written trigger for the short cases will specify what you need to cover, eg focused history & examination, interpret investigations & management plan or whatever. If the question doesn’t ask you to take a history then don’t waste valuable minutes asking about symptoms. It won’t get you any extra points and you’ll run out of time for the relevant matters.
6. Employ your best communication skills
Be friendly, make eye contact, demonstrate empathy, ask open questions. This seems obvious, but there are marks awarded for the basic communication skills.
7. Take the hint
The examiners are generally kind people who are trying to help you if possible. If the the “patient” asks you a question (particularly if they ask it several times) then they are steering you towards an important point. Here’s an interpretation guide:
“What do you think is wrong with me, doctor?” = You need to state a provisional diagnosis.
“What ELSE could it be?” = You’ve missed an important possible diagnosis or you need to list a few more differentials.
“Yes I understand about that disease, I don’t need you to tell me any more about it” = You’ve explained the diagnosis enough, move on now.
“So what can be done about it?” = Talk about management plan.
“Is there anything ELSE I can do?” = More detail required. Think about medications / lifestyle / biopsychosocial management.
“Is this serious? Am I going to die?” = I need more counselling or reassurance.
“Can you tell me more about that?” = I need more explanation.
“You’ve said I have <diagnosis X> but what about <symptoms Y & Z> ?” = Maybe think again, you might be on the wrong track.
8. Don’t dumb it down too much. Show what you know.
Although you are supposedly talking to a “patient”, you still need to show the examiners your knowledge so don’t be too vague. Use medical terms for diagnoses (eg say “atrial fibrillation”, not just “a funny heart beat”), state the class and/or name of the medication you’re intending to prescribe, the dose and how to take it +/- important side effects if relevant.
9. Remember the fluffy stuff
This is GP-land, so don’t forget all that good holistic care stuff like health promotion and lifestyle management, bio-psycho-social factors, opportunistic screening, safety netting and follow up.
10. Don’t get thrown by a tricky station.
You don’t need to get every point to pass the station. Even if you missed the diagnosis, you may very well have still passed that station if you took a good history and had a reasonable management plan. If you have a complete crash and burn, just put it to the back of your mind and move right along…
If anyone else has any hot tips to share, please feel free to comment below or tweet to the #GPexams13 hashtag.