How to Prepare for an OSCE exam as an IMG

Why Are OSCEs Challenging for IMGs?

Right off the bat, let’s make something very clear: OSCE exams are difficult for everyone. Graduates of medical schools in Canada and the US also struggle with OSCEs. However, IMGs do face some specific obstacles that make OSCEs even more intimidating.

To understand these challenges, it’s important to discuss what OSCEs typically evaluate. While there are some very well-known OSCE exams, such as NAC OSCE, or the recently canceled MCCQE Part II and USMLE Step 2 CS, there may be other OSCE exams you will have to face throughout your medical training in Canada and the US, so let’s take a look at the general evaluation criteria for all OSCE exams:

The first and most important challenge for IMGs who graduated from medical schools outside of the US and Canada is that their clinical training may have been slightly different from the standards set by North American medical schools. This does not mean that the education was any less valuable or quality – it simply means that your patient interactions and practical details of your clinical education may not be exactly what is expected in an OSCE performance.

The second challenging aspect of OSCEs for international grads is the assessment of verbal and non-verbal communication with patients. This is a challenge for all future doctors. IMGs who may have been educated or practiced abroad may not always be in a habit of practicing small details expected of doctors in patient interactions. Once again, this does not mean that there is anything wrong with the way you communicate in your everyday life, but OSCEs evaluate specific standards for communication skills and behavior, which all students must meet.

Both of these are a challenge. You must show that you can perform basic clinical tasks, such as history taking, physical examinations or data interpretations, and meet the standards set by the medical council of the country where you want to practice. And we want to emphasize that all students must do this, whether they are an IMG or not.

The truth is, all residency hopefuls need OSCE prep, as it is not an easy obstacle to overcome on your way to becoming a practicing physician in Canada and the United States. The OSCE challenges we discuss above are familiar to both local applicants and IMGs, and both student categories need some guidance. For IMGs, with their valuable knowledge and experience, OSCE prep can compensate for the fact that they did not have the opportunity to study and be fully exposed to clinical practice in the US and Canada.

Interested in learning more about the NAC OSCE and the Do's and Don'ts you should know? This infographic is for you:

Some Things to Keep in Mind Regarding OSCE Structures

As an IMG, you might have performed on similar exams already. Undoubtedly, during your medical school education, you have been asked to work on long or short cases and were evaluated by an examiner. So, the format of an OSCE station will not be unfamiliar to you. However, OSCEs are structured and designed in a way to assess your skills in comparison with other people taking the same examination. This is why OSCE exams are considered objective and standardized. All students review the same cases, are asked the same questions by the examiner, and are given the same data if such data is relevant for the case.

We strongly encourage you to familiarize yourself with the structure of OSCE exams in detail, but we will briefly outline it here. Every OSCE room you enter will present a patient case. Before you enter the room, you will read the instructions located on the door of the room. Once the buzzer sounds, you will enter the room and begin the station, based on the instructions you read on the door. Inside, you will meet a standardized patient and the examiner. Pay attention to the patient only as you perform your task. The examiner may ask you questions at the end or provide relevant data for the case, but do not take note of their demeanor or actions while you are in the station. You will perform the necessary task based on what you read in the instructions on the door and on what the patient shares with you. There is typically a buzzer at the 1 minute mark, signifying that you should wrap up this station. This is a great time to complete the task, provide a diagnosis, and arrange a follow up plan. 

All OSCEs typically consist of 6 to 10 stations that test different clinical knowledge and skills. In every station you may be asked to perform the following tasks:

A couple of other things to keep in mind:

1. Always answer the questions of the examiner. When the examiner asks a follow up question, it is important that you address their question specifically. For example, if they ask "What is your diagnosis? And what is your differential diagnosis?", you should respond in the same sequence. When it is unclear how many differential diagnoses they are looking for, it is recommended to include three to five. 
2. Do not assume. Some data may purposefully not be provided and you will need to ask for such information. Some key areas this is important for is asking for vital signs, as you will not always receive vital signs as you enter the station and thus assuming they are normal may veer you in the wrong direction. Another time this is key to remember is when the examiner may ask you what kind of investigations you would like to do. Omitting a key investigation, such as an ECG, may reduce your score, as you are supposed to articulate this yourself. The instructor cannot read your mind, so do not assume they know that you would perform the necessary maneuver.

Note that all these tasks are mostly aimed at assessing the 2 main challenging aspects of OSCE we discussed above: clinical skills and communication skills. The way you behave and interact with the patient is key. Even if you ask the most accurate questions and decide on the correct diagnosis, if you seem disinterested, apathetic, and simply there to “get the job done” while ignoring the patient, you will not perform well on the exam. This is why practicing these behaviors is so important as part of your OSCE prep. You need to be able to habituate yourself to perform your clinical tasks with care, enthusiasm, and professional attitude, instead of just performing them on autopilot, with disregard of who is in front of you. What’s the best way to do this? Find out in our next article section.

Interested in tips on video about how to prepare for the NAC OSCE? Take a look at this:

How to Prepare for OSCE exams as an IMG

What is the best OSCE prep for IMGs? Only mock OSCE stations and feedback can help you prepare. By the way, this is the case for both IMG and non-IMG students, but IMGs will especially benefit from the opportunity to experience the standards and expectations set by these examinations. What can be better than the first-hand experience of OSCE stations during your prep? So let’s dive into what can help you prepare for your OSCE exams in more detail.

Mock OSCE Exams

Firstly, let’s discuss what a mock OSCE exam is. An OSCE mock exam is designed to help you experience what a real OSCE station is like. The mock recreates the station’s environment exactly, so you learn what to expect at the real station when you enter the room.

Mock OSCEs are also designed for you to demonstrate your clinical skills and communication skills. Just like in the real exam, you will enter or begin a station with instructions, perform clinical tasks, and answer examiner questions. Essentially, you will experience the atmosphere and structure of an OSCE exam first-hand.

There are dozens of advantages of participating in mock OSCEs, but we would like to focus on the main 3 that will help you ace this exam.

1. Getting Used to OSCE Examiners.

One of the aspects of real OSCE stations that really throws off most students is the examiner in the room. Why? Because the examiners are instructed to remain silent and unintrusive but to take careful notes of your performance. Therefore, many students are intimidated by the calm and looming presence of the examiner, who gives no reaction to their performance. Instead of paying attention to the patient, the examinees start to analyze what kind of scoring they are getting while they are in the room.

A mock OSCE exam can help you overcome this anxiety. Professional OSCE advisors are also trained to act just like the examiners in your station, so you will also not receive any encouragement or signals from them as you perform in the station. They have the same list of items you will be assessed on in the real examination, which helps them objectively evaluate your skills while you are in the station. Doing a mock OSCE exam with an examiner will help you understand that just because an examiner is not reacting to your performance does not mean that you are doing poorly. You need to simply get used to performing your tasks instead of trying to read any cues from the examiner. 

2. Practicing the Correct Behavior

As a medical student or a pre-resident, you probably have limited exposure to patients. So how can you practice appropriate behavior expected of you in the OSCE? This is where mocks can really help. They can really help you solidify the behavior required to meet the expected standards. While you may be full of knowledgeable information about diagnoses and cases, you must be able to perform your tasks using correct conduct. For example, mocks will help you get used to introducing yourself when you enter a patient’s room. Mocks will also help you improve on any of your behavior that might be considered a red flag, such as not looking at a patient when you talk to them or asking impertinent questions. You will also be able to practice your tone of voice, your non-verbal cues, such as smiling and nodding, as well as polite farewells.

One other huge advantage of practicing in a mock OSCE is habituating yourself to voice every step of your examination. This is crucial for your success. When you perform any of your examinations in an OSCE station, you must clearly articulate what you are doing and why. For example, if you are performing a physical exam, you will start with “First, I am going to wash my hands”. Sounds unnecessary? No, the examiner needs to see you know exactly what you are doing in each type of station. Another example: the station instructions clearly state the patient's history and when you enter the room you decide to perform a blood pressure measurement. You will have to voice everything you are doing, like this: "Based on your history, I will be taking your blood pressure to see if…" Be very precise with the maneuvers you perform and why you think they are necessary.

There is a major reason why this is required in OSCE exams. As we already mentioned, this way the examiner knows that you know the steps required for each station. Essentially, the examiner cannot read your mind. If you do things with your back to them, for example, they might miss little details that can make a difference between a pass or fail. Remember, they will not be asking you "And what are you doing now?" – it's your job to demonstrate to them that you know what you are doing without any of their involvement.

Let’s face it, most physicians do not literally articulate everything they are doing when they examine you. If you are an IMG with extensive practice abroad, then you might find it strange or challenging to describe to the patient and the examiner what maneuvers you are performing. You are simply not used to that. But even if you are a recently graduated IMG, you certainly have not had much practical experience and therefore even if you were taught during your rotations and electives to voice your maneuvers, you simply do not have enough practice of doing so. This is why going through mocks and cementing this behavior is so important! 

3. Building Confidence

The biggest advantage of a mock exam or interview is that it helps you build your confidence. The same is true of OSCE mocks. Remember, the examiners you face in a mock are even more qualified to assess your behavior than trained examiners in a real station. The mock examiners are usually MD or DO graduates who have gone through this process personally and can share useful tips and advice regarding your performance.

Additionally, you will receive feedback that will help you improve. This is very important as you prepare for the test. While nobody doubts your clinical knowledge, it is vital for you to be prepared to act and perform in accordance with OSCE expectations. Your mistakes can be really minute, such as lack of eye contact, too many questions, forgetting to voice one of your maneuvers, and so on. But if you hear feedback that points out your misses, you will digest them faster and next time you will implement them without hesitation. Only personalized feedback on your performance can help you improve. And the only way to get personalized feedback is through mock OSCE exams.

Based on the feedback you receive, you will also be able to focus your personal study time on areas that need improvement. For example, if you missed something in the diabetes history-taking station, you should review the maneuvers you need to perform in such a station. This means that your personal study time will be efficient and focused.

If you're would like to see more OSCE prep tips, check out this infographic:

Memorization

One of the things you can do on your own when it comes to OSCE prep is to memorize the maneuvers you will be performing for a specific task on the exam. In other words, you should practice and habituate yourself to apply your clinical knowledge to specific cases.

For example, if during a mock you run into problems with a patient problem relating to a physical exam with a patient that has a history of heart disease, go back to your notes and textbooks to review what kind of maneuvers you will need to perform to successfully complete a physical with such a patient. Make sure to write down or practice the sequence of actions and questions you need to perform and ask. Practice the maneuvers until they are second nature to you. The goal is to make these maneuvers almost instinctual when you perform them. 

Group Practice

Just like mock exams, group practice allows you to apply your clinical skills to specific cases. Furthermore, they can be fun and engaging, reminding you that you are not alone in your journey.

The best option for group practice is finding out if any of your classmates and comrades are preparing for an OSCE. For example, if you are attending one of the Caribbean medical schools, you most likely have colleagues in your year that are preparing for one of the OCSE exams in the US and Canada to become eligible candidates for residency. Reach out to them and ask to do study sessions together. Each can take turns pretending to be the standardized patient for different cases, each can take turns being the examiner, and each can take turns being the examinee. Take careful notes on your feedback and learn together! This can really help you improve. During the examination, make sure to cover the following questions as each of you play an examiner: What other diagnoses are possible in this situation? Why did you identify this diagnosis instead of the other options? Which maneuvers are essential for this case? Why? "What should the physical examination include? What else should you assess? And so on.

To get the best results, advise everyone in your study group to create a list of clinical objectives or skills they find the most challenging. This way, everyone can learn from these study sessions, and even if you do not find your comrade’s objective challenging, there is nothing wrong with repeating a skill you are already a pro at!

Lastly, group practice can be a great way of learning to recognize patterns and identify a differential diagnosis from presenting concern. This can help outline the questions that should be asked of the standardized patient and ensures that you do not miss emergency and urgent presentations.  

Curious how BeMo can help you with the OSCE as an IMG? Check out this student's testimonial to see what we can do:

Conclusion: Top OSCE Prep Tips to Remember

As our article demonstrates, how to prepare for an OSCE exam as an IMG is not much different from the preparations of a non-IMG student. However, as an international grad, you must be as competitive of a candidate as possible due to lower matching rates, which means reaching far and beyond the expected. This means that your OSCE performance must be flawless. In conclusion, we would like to share with you the top 3 items you should keep in mind as you prepare and as you enter your OSCE station.

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To your success,

Your friends at BeMo

BeMo Academic Consulting

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