Playing the OSCE GAME

Hello. Beginning to post a bit more now I’m emerging from the FRCEM OSCE bunker. Over the next few weeks I’ll streamline and put up some of the revision materials I’ve made. It’s important to note I am just an ED trainee, I have nothing to do with the exam.

I’ve been thinking about what I did to prepare, maybe what I could have done better. Here are some of my thoughts:

I didn’t think the FRCEM OSCE wasn’t that clinically challenging in terms of knowledge. I knew most of what they were asking me, and the scenarios sort of made sense. I also felt that the exam was fair.

How is it structured?

The FRCEM OSCE is a 16 station OSCE exam, two stations are double stations, and 1 station is a rest station. That means there are 13 stations. The double stations are always ATLS/APLS/ALS. The exam itself takes place over about 7-8 days. The exam is different on different days, but the college do complicated statistical things to make it fair. So for example on one day you might be asked to teach a GI exam to a medical student, on the next day you might be asked to teach RS exam. They may be examining different content, but the skills/attributes/behaviours they test will be the same.

The college isn’t made of money, this means that high fidelity sim, or examination stations where you are going to have to use a lot of single use equipment probably aren’t going to be tested. It’s also impractical to re-set some complex chest drain, or cricothyroidotomy mannequins within the time you have between stations. This means they are more likely to test things that are easier to simulate eg difficult patients, complex toxicology, consent, histories, mental health. This is good, because let’s face it they are much more likely to happen in your day job than boshing in an ECMO system.

Similarly there is nothing stopping the college putting an USS machine in front of you, however given the number of different models and types many would feel that that might be unfair, so you are more likely to get interpretation/governance stuff than ‘image this aorta’ as a station, but USS in some form will feature.

OSCES are improvisation games for doctors whereby you’ve got to hit a number of key words or actions. Now I’m not going to debate their utility or efficacy here, but the best thing to do is to practice playing these games with your colleagues until you feel comfortable. All OSCES have marks for basic or obvious stuff. This is stuff like washing your hands, or asking permission of a patient before you touch them. They are easy marks to hit, and even easier to forget. If you work on creating a mental script for a number of common scenarios you will perform better.

Most of the stations conform to a number of types:

  • A Teaching Station
    • A good way of both checking you know the content of a topic and also can structure your teaching. A weakness of this station is that you don’t have to know the topic very well to collect the ancillary marks around the edges if you are good at the game.
  • A History Station
    • At FRCEM level you are going to have a relatively simple history but with a complication. Here the trick is finding the complication, as until you do many of the marks will be unavailable to you. So you need to use broad questioning techniques to start off with, and respond to the cues from the actor, it is likely there will be a ‘difficult question’ you have to ask, then the history will open up for you. These are scenarios like:
      • Saturday Night Palsy + Language Barrier
      • PR bleeding secondary to sexual assault
      • ?PE but might be pregnant
  • An Examination Station
    • At FRCEM level these are most likely going to be a teaching station, so you are going to have to teach a medical student to do an exam.
    • Again doing an OSCE style exam in 7 minutes while explaining what you are doing and why is quite challenging, but it can be practiced VERY easily with friends.
    • It is important to not forget the ‘teaching’ aspect of the exam, because there will be ancillary marks for signposting and checking understanding.
  • Explaining Station (these are the commonest type of station)
    • Complaint
    • Explain a diagnosis
    • Consent – eg Thrombolysis for stroke, procedural sedation
    • Explain a procedure/policy (eg DNACPR)
    • Break Bad News
    • Conflict
  • Resus Station
    • Lead the team
    • Maybe deal with conflict
  • Managerial Stuff
    • Triage a group of patients waiting for Assessment
    • CDU board round with F2
    • USS governance
    • Drunk/intoxicated junior

It is good OSCE technique to have a opening and a closing paragraph for each kind of station. You have a minute of reading time to collect your thoughts prior to the station. It is best to use that time to work out what ‘script’ fits best, and use it.

On reflection there was a lot more talking than doing during my exam, and there was a lot more ‘teaching’. However I can see how putting a ‘teaching’ slant on many scenarios gives the examiner a better insight into how much you know, and gives the actor licence to probe a bit more.

Have a look at the OSCE scenarios page for specific mark schemes I’ve made up,.

How do I revise?

  1. Assemble a Team.You can revise scenarios with a team of other people who are sitting the exam. I would also recommend writing scenarios and questions. This is useful because it gives you insight into what kind of things will carry marks.

2. Practice Playing the game. I would also write a script for each broad OSCE type and memorise it. This will give you some momentum when you come into a scenario and allow you to not forget the simple marks for washing your hands, offering pain relief, or checking level of understanding.

3. Enlist Allies. Trainees who are post exam will be helpful, consultants will also be happy to provide some time to help with exam preperations. Some consultants really like doing this. Find them, get them to help you.

Good LUCK!