OSCEs
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Objective Structured Clinical Examination (OSCE, OSCES, OSCEs)
is now widely used in medical schools as part of the examination process.
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They are used in the medical finals (MBBS, MBChB) and in the
earlier years as well.
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They are also used in postgraduate examination and in licensing
examinations such as PLAB and USMLE.
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The Royal College of Physicians of the United Kingdom (MRCP UK)
has a modified type of OSCE known as the PACES examination or Practical
Assessment of Clinical Examination Skills; this is an advanced type of OSCE
with fewer more complex stations.
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However, the skills required for this examination (MRCP PACES)
are similar to those required for an OSCE (OSCEs) although more specialised
and requiring greater depth and expertise.
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OSCES (OSCE, OSCEs) usually test practical skills rather than
knowledge
The skills tested are:
Clinical (Bedside) Skills
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History Taking Skills
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Physical Examination Skills
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Communication Skills
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Ethics (Attitudes)
Procedural Skills
For example
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Intravenous injection
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Catheterisation
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Recording an ECG
Management Skills
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Planning investigations
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Interpreting investigations
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Treatment
Depending on the medical school or examining body the
emphasis of the examination may vary, but most largely wish to examine the
clinical components as the rest of the skills required to be a doctor may be
tested using multiple choice questions.
Preparing for OSCEs
(preparation for OSCES, OSCE)
When preparing for examination such as OSCEs, which are
largely practical examinations, it is essential to set about it in a
systematic manner
Concentrate on the following:
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The examination
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Methods
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Relevant knowledge base
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Presentation
The Examination (OSCE, OSCEs)
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Read up ACES for PACES chapter 1.
This will give you an idea about examinations in general and the PACES
examination in particular. Although the MRCP PACES is more advanced than OSCES
the principles of a structured clinical examination are the same and this will
give you a good insight into how these examinations are conducted and
importantly how candidates at this type of structured clinical examination are
assessed.
Methods
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When learning a method of performing any practical task, it is
essential to break the task down into its components, learn each component and
then learn how to string the components together.
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It is also essential to have an idea as to why you do what you
are doing. If you understand what you are doing then perfecting you method
becomes much simpler.
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If you have a good teacher then ask them to teach you the
methods in a systematic fashion
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If not read a book on methods
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Practice endlessly. This is the secret of success
Clinical Methods
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First learn why
you do what you do
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Read ACES for PACES chapters 2 to 7
♥ Learn the method of history
taking and practice it repeatedly
(ACES for PACES chapter 4)
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Next, learn how to examine the different
systems. (ACES for PACES chapter 8-17)
The first part of each chapter will take
you through clinical method in detail
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Learn the method of communication
(ACES for PACES chapter 18)
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Practice the methods, revise the
chapters, repeat ad infinitum.
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Ethics are discussed in
ACES for PACES chapter 18
Management Skills
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Learn how to plan investigations and
treatment by reading ACES for PACES chapter
18
Relevant Knowledge Base
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At a clinical examination it is essential to have an idea about
what findings one may come across are and how one should interpret these
findings
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The best way to learn this is by seeing as many patients as
possible
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Supplement this with extensive reading
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As experience is limited at medical student level one should
read widely
♥ The chapters on the various
systems in ACES for PACES
have a section on lesions that may occur. Study this so that you are aware of
the lesions that may occur and focus your studying on these lesions.
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Read the chapters on the various
systems in ACES for PACES
and learn the clinical features that may occur in diseases of the different
systems and their causes
Presentation
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This is vital without good
presentation it is not possible to score highly however good your skill may be
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Present you findings in the order in
which you performed the designated task and this makes it easier to recall
findings and the relevant negatives
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If asked a diagnosis give the complete
diagnosis and be prepared to back it up with reasons
ACES for PACES chapter 3
For more details on
ACES for PACES see
www.acesforpaces.com
Making a Diagnosis
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There are several methods clinicians use to make a diagnosis
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The most commonly used and the method that most clinicians
ultimately use is called the hypothetico-deductive method
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This is where an initial idea comes to mind and one pursues this
finding clues in favour of and against this idea and ultimately deducing the
answer
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The examples given in the aces for paces website and the cases
described in the clinical skills blogspot will make this clearer
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For a further explanation of this method read the preface in
ACES for PACES
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Another method that is described is pattern recognition
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In this method one gathers all the information available and then
tries to match these features to a pattern that one may recognise
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This is an unreliable method and is not recommended
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In addition in the PACES examination one is not given time to
think about the diagnosis after finishing examination
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Questions will be asked almost immediately and one’s thoughts
should be clear by then
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The hypothetico- deductive method allows one to come to a
diagnosis more quickly and with greater reliability and is hence the method of
choice
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In summary
Use the hypothetico-deductive
method not pattern recognition
