The 10 things you need to know to Master OSCE Clinical Exam Technique
One topic that continually crops up in medical student questions is exam technique, and issues that can revolve around it. For this reason we have produced a list of the most important things you need to know.
This is based on common errors in exam/ OSCE techniques that crop up in medical examinations from our experience.
Here are the first 5 tips for preparing for your verbal examinations, the next follow soon.
Let’s consider the following features and clinical examination…
A 36 year old male gives the following history:
“I’ve been getting hot for the last 6 weeks, on and off and have been off my dinner, pretty much all the time. I’ve been generally not right, tired and that. I’ve started to get a bit breathless too, not coughing and the like, but still having problems when I’m out. Bad like. Gets worse when I have a fever. Like I’ve had a friend who had the same thing about 3 years ago and he had really bad lung fibrosis, because of infections during his childhood. Not like me and that I’ve always been well. I have still got problems injecting the drugs and that, but like my key worker, she says that me methodone will help me deal with that kind of problem, so form that side I’m pretty happy.
Your Examination Findings are:
- Hands Normal.
- Pulse 80.
- No Signs in the face.
- BP 182/92 Pan systolic murmur left sternal edge.
- Otherwise NAD.
Tip 1. Look professional
Dress smartly and conservatively, in accordance with the accepted policy for dress and infection control. We think this means, white shirts (ironed!), smart black shoes, trousers or dress.
Tip 2. Organise your presenting posture to minimise nerves
This is it. Hands behind your back. Head up. Speak clearly and decisively. By organising your posture fidgeting with your hands (common in stressful situations) will not be possible. Standing with an open posture (feet apart, slightly out turned) is a common technique used in business, and will help you present in an organised fashion.
Tip 3. Structure your presentation of medical terminology
This needs to be structured in the same was that you elicited the history. PC, HPC PMHx, for example:
Mr X is a 36 year old male with a background of intravenous substance use, who presents with a 6 week history of malaise, retired office worker presents with a three week history malaise, night sweats, dyspnoea and anorexia…
Note the use of medical terminology to describe symptoms. This is not the same as describing clinical signs in the history, which you should not do!
Tip 4. Interpret as you go
Don’t be afraid to explain your interpretations as you assess the situation. For example with history: “The history importantly raises concerns: substance misuse (introducing a blood borne infection, other viral infections and T cell Disorders transmitted by IV drug use), symptoms that suggest a systemic illness/ infection (fevers, malaise, anorexia) that would have a wide differential based on this information that would include….”
Tip 5. Learn to summarise in one sentence
Floundering, being vague, or summarising in a small essay just won’t do. Be clear and to the point – for example “36 year old male, current problem of intravenous substance misuse with 6 weeks of symptoms that include anorexia night sweats and general malaise.”
We hope this helps some of you student doctors in preparing for your OSCEs…. view the final 5 tips here!
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It’s cool. but some examiners don’t like the orthodox way of presentation,rather what they expect is the impression,(inference)i.e the most probable diagnosis or the differential diagnoses.
Absolutely, it can be really difficult. You’ll often find quite senior doctors getting quite a hard time from consultants when they take this approach.
When you look at the main types of clinical reasoning, some people prefer a hypothetico-deductive approach, others prefer to use things like ‘illness scripts’ to memorise key features of cases so you can give the correct answer.
One interesting factor suggested by an editorial in the NEJM (content.nejm.org/cgi/content/extract/355/21/2217) was the fact that learning to concisely syntehsise representations of clinical problems is an important part of the student become an expert.
If you’re asked-what are the main causes of hypercalcaemia, you’re not going to look clever if you put down ’sarcoid’ (a rare but possible cause) over primary hyperparathyroidism (probably the commonest cause for incidental finding of hypercalcaemia). So it is difficult, and you probably have to master a bit of everything.