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How to improve your OSCE marks

Well, of course you do…who would ever say their OSCE mark was high enough?

The REAL question is — how do you maximise your OSCE marks?

There are countless medical student OSCE mark schemes and methods out there, so where do you start? Where do you focus your time?

Let’s look at the following example: medical schools use multiple factors when setting OSCE exam checklists including knowledge (exploration of problem, identifying differentials and clinical reasoning), performance (structure, pace, identifying clinical signs) and attitude (active listening, patients’ concerns). How can you know which ones to focus on first?

The reality is that you will NEVER be able to do all these things if you’re thinking about them at the same time.

Even the examiners don’t focus on everything. Why? Because it’s nearly impossible.

But we are still able to get amazing results like no one else because we know a handful of tactics that actually gain you marks.

Just take a look at the failure rates in medical school OSCEs:
– Average failure rate at Year 2 = 3%
– Average failure rate at Year 3 = 13%
– Average failure rate at Year 4 = 7%
– Average failure rate at Year 5 = 10%
The key reasons why people fail stations are this:
1. Instructions not followed
2. Histories aren’t focused enough
3. Communication with the patient
4. Examination skills aren’t polished
5. Struggle finding a differential diagnosis
6. Investigations given are irrelevant

Follow our guide below for our OSCE top tips so you can understand the purpose of the exam and see how you can tackle each of these areas that are hold you back in your OSCEs…

1. Not following the candidate instructions given

Your reading time is the most important part of your station. This is where you discover the OSC station purpose. The great news is the instructions contain everything you need to know to score top marks in both your OSCEs histories and examinations.

Stations are practised with junior doctors and faculty to ensure that the instructions represent the task, if there is any issues with the wording it is usually sorted out way before the exam.

Many students have told me they feel like stations are trying to trip them up and that is simply not the case.

For example, if a stations says “please examine the chest only” about half will begin by examining the hands.

This is frustrating as an examiner is unable to give you any marks and it wastes time where you can either be examining or answering questions at the end.

Use your reading time wisely to read through the candidate instructions. If you’re allowed highlight or underline key words, this can help focus you when you are already under pressure.

All of our OSCE cases with mark schemes are written to get you practicing this skill. During your practice make sure you simulate the reading time you have in the actual exam, this gets you familiar with the exam format and how much time you will have on the day.

2. Histories aren’t focused enough

Rushing stations – Many students try to race through stations as they feel it is not possible to get through all the information in the time provided.

This is simply not the case, all stations are time tested to ensure the average candidate can complete the task.

By rushing you do not allow your examiner to hear and mark what you are saying and your patient gets confused and frustrated.

Candidates who work through a history at a steady pace tend to elicit more from the actor as they are actually listening and responding to the cues they are being given.

This is vital to scoring well in your station! Remember to take you time and slow down.

General questions – Remember when it comes to histories to start with general questions about the symptom and then focus on the specific questions that help you determine possible causes.

Jumping straight into focused questions to “tick all the boxes” leaves students confused and the histories do not flow naturally.

The actors are on your side and are much more engaged if you take your time and ask some broader questions at the beginning.

If you practice you will actually find this approach much quicker than asking more focused questions.

Symptoms – Whenever a new symptom is mentioned by an actor it is important to ask about the nature, duration, exacerbating and relieving factors.

Structured history – Often students take an excellent history of presenting complaint but are often let down by forgetting to finish of the rest of their history.

Usually this includes a past medical history, drug history, social history including smoking and alcohol.

Guessing – Many students think they can blag a history but it is actually pretty obvious when they are guessing.

You need to practice and have a clear structure or framework that you work through in every history. This will provide a good structure to ensure all the information required is covered.

3. Communication with the patient

Not listening to responses – Many students are abrupt with patients and it is obvious that they do not mean this.

From my time examining it is obvious some students are so focused on thinking of the next question that they do not respond or interact with what the actor is actually telling them.

For example a common example will be an actor saying their parent died of a condition and the candidate without pause will ask if they smoke.

This comes back to being really familiar with history taking and really practice interacting with a simulated patient in an OSCE environment.

The key to an OSCE station is listening, processing and responding appropriately to information provided. This will provide flow to the consultation and usually the simulated patient is trying to give you the thread of what you need to ask about next!

Empathy – Empathy is a skill that is commonly tested in both history and communication stations and students often struggle with how to reply empathetically.

For example one station I examined the simulated patient was expected to say“my husband passed away last year” and a typical student response would be “cool!”or “okay.”

Acknowledging and responding appropriately is vital to your global score and a markers overall impression of you.

Practice with a friend and think of some phrases you can use in this situation. When a student replies to one of these statements from a place of empathy it usually sets them massively apart from the rest of the candidates.

Medical jargon – One of my top tips is to avoid medical terminology both in OSCEs and in clinically environments all together.

All of the simulated patients you will come across in your OSCEs are trained to reflect back any medical words you use and this only detracts from the station and wastes you valuable time.

Inappropriate eye contact –  Many students try to visualise what they are talking about but this can come across badly in OSCEs.

For example when students are asked to take an abdominal history a percentage will subconsciously start looking at the patients abdomen.

Most simulated patients find this uncomfortable and most students don’t realise they are doing it. I would recommend keeping eye contact with the patients lips or eyes to focus on what they are actually saying.

No knowledge or the wrong knowledge  – this goes without saying that you need to know your history structure and the condition in general before you can start focusing on the OSCE.

Scared the patient with the possible diagnosis – Simulated patients are trained to ask difficult questions like “is this cancer” or “am I having a heart attack” and some students panic and say “yes” or “you would have to ask the doctor that.”

The best way to approach this issue is to acknowledge what the patient has said and explore why they think this.

4. Examination skills aren’t polished

Forget to wash hands – And such an easy mark to miss!

In the moment, many students fail to wash hands and have to be prompted.

Not only does this loose you a mark but many students get thrown off by this. If this happens to you, take a second to reset and move on.

The examiner will not think twice about this if you do not highlight it.

Forget to check for any pain the patient may have

Forget to look at the patient to check for pain or discomfort

Unpracticed – Some students feel they can wing examinations but it is actually pretty obvious when a student has either not practiced enough or has only watched a video on how to examine a patient – for example palpating a kidney.

Failed to expose appropriately – Many students are embarrassed about the exposure conversation at the beginning of an examination.

Practice this so it becomes second nature.

We are unable to give you marks if you are unable to see the pathology, it makes it seem like you do not know what you are doing.

For example, if you have to examine someones chest the patient will have to take off their shirt.

No consent – For every history and examination it is essential to gain valid consent!

Students regularly struggle with this and it takes up far too long of your station time. A simple “I have been asked to examine your heart today, this will involve me having a look, feel and listen to your chest. This will require you to remove your top so I can do this correctly. The examiner will act as a chaperone today. Is that okay with you?” would be more than sufficient.

This is only worth one mark, so think of a sentence that feels comfortable for you.

5. Struggle finding a differential diagnosis

When students are examining or taking a history they need to have a think about their differentials diagnosis and appropriately excluding conditions from that list.

Many students are able to come up with the diagnosis but struggle to think of any other differentials, for most stations you will be required to think of 3 differentials.

In many cases this can be vaguely related to the area of concern. For example if someone has gastritis type symptoms think what is in the upper abdomen and then give some lists of conditions e.g pancreatitis, biliary colic, duodenal ulcer, ect.

6. Investigations given are irrelevant

It is important when giving a list of investigations that you do not start with a pre-learnt list of every test you know.

Always start with bedside tests (ECG, urine dip, peak flow), then blood tests (FBC, U&Es, LFTs, CRP, Amylase, G&S, Blood cultures) and then simple imaging (CXR, AXR).

Most of the time this simple structure stops you from missing out any necessary tests

Practice, practice, practice…

The best advice we can give is you need to practice, practice, practice. We cannot say this enough. If you put into practice all the tips from above you willscore top marks in your exams.

Choose a platform that understands the exam and what you need to do to score top marks.

If you are going to prepare well start early so you can identify your weaknesses early and find a practice partner. Try to practice often with the same person so you can both develop each of your weaknesses. Do this as many times until all of the above is second nature.

Good luck with your exams and hopefully you find this site useful

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