Presenting in OSCE examinations

Before – WIPE

Wash hands
Introduce self (including full name and grade)
Patient’s name, DOB and what they like to be called
Explain examination (± chaperone if intimate exam) – also tell the patient you will be talking to the examiner throughout

During

Tell them the exam should not be painful but, if there’s any discomfort, to let you know
For general inspection, always stand back at the foot of the patient’s bed with your arms behind your back and then present. Comment on the general appearance first, e.g. ‘On general inspection, this patient looks well.’ Then go on to present other relevant patient details (e.g. ‘There is no evidence of jaundice, cachexia or pallor.’) and comment on the presence/absence of things around the bed.
Ask if they have pain anywhere before touching them and use the patient’s name and talk to the patient during the exam
Examine from the patient’s right-hand side – a medical tradition
Most medical schools like you to talk through your findings as you go. If this is the case, turn to the examiner in between each part of your examination (e.g. the hands), and confidently present your findings, for example: ‘On examination of the hands, there was stage three clubbing, but no evidence of leukonychia, koilonychia or palmar erythema.’ Then do the same for the next section (e.g. eyes, then mouth etc.). DON’T SAY, ‘I am looking for koilonychia.’ Say instead, ‘There is no evidence of koilonychia.’

After

Thank the patient and restore clothing. Then take your stethoscope off and hold it in your hand. Stand straight with your arms behind your back, look the examiner in the eyes and say with confidence:

‘I would complete my examination by …’ (state other examinations, NOT investigations)
‘In summary, this is Mr X and I have examined his respiratory system.’
- Major finding(s): ‘The major finding was…’ (state the most striking finding(s) first to capture their attention)
- Additional findings to back up your case: ‘In addition…’ (state other important positive and relevant negative findings)
  - Don’t list irrelevant negative findings
  - Avoid presenting a long list of findings without thinking about their clinical significance
  - If you know the diagnosis, think about the cause and consequences of the condition
- Diagnosis/differential: ‘These findings would be consistent with…’ or ‘My differential diagnosis would include…’
‘After taking a full history, further investigations might include…’ – make these relevant to the presenting complaint

OSCEstop Top tips

OSCEs are about acting. Even if you don’t feel confident or haven’t seen something before, act as if you have done it 100 times!
How you say things matters as much as what you say. Be confident but not arrogant.
Flaunt your knowledge! If you have good background knowledge, show it to the examiner whenever you can.
Try to use buzzwords, e.g. ‘There is a symmetrical deforming polyarthropathy, with no active synovitis.’
Read the question carefully – there will always be one station where you will lose marks for not reading the question correctly
Some examiners act grumpy and uninterested even though they may actually be very nice and generous. Go in expecting every examiner to act like this and you won’t be thrown when they are.
Pauses to think are absolutely fine. Don’t mumble, say ‘errrr’, or speak before you know what you want to say.
Never forget to wash your hands. It should be the first thing you do when you go in.
For orthopaedics, don’t forget to say you would like to examine joints above and below, and assess neurovascular status
In all psychiatry stations, don’t forget about risk to self and others
If you don’t know what to do, just go back to basics: inspection / palpation / percussion / auscultation for most exams; or look / feel / move / special tests / function for orthopaedics
Lastly, and most importantly, try to enjoy yourself. Take satisfaction in demonstrating your knowledge and spotting rare signs. Examiners are all very generous in finals and the stations are usually basic: the medical school and examiners do not want you to see you fail.

Here’s how you could structure systematic answers to questions you may be asked

Think how you would do it first, then consider our strategy – there’s no right answer as long as you have a good structure!

Causes of a condition

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Investigations

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Treatment

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Complications

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