OSCE Prep Cases to Practice with

The Objective Structured Clinical Examination (OSCE) is a practical exam that not many students know how to prepare for. Typically, it is not a stand-alone examination but rather a part of a larger exam such as the USMLE for students in the United States, the MCCQE for Canadian students, and the NAC for International Medical Graduates. Practical clinical exams like the OSCE are essential because they examine your readiness for the practical aspects of medicine in a way that theoretical and written examinations simply can’t. The OSCE helps assess your communication skills, professionalism, ability to perform physical examinations, take history, application of theoretical knowledge, and other practical aspects of the medical profession.

As you prepare for the exam, and even on test day, you should remember the core competencies outlined by the AAMC. If you are trying to become a physician in Canada, you should review the CanMEDS framework which outlines the important roles of a physician in Canada. These are the skills that the examiner will be assessing during this practical, competency-based exam.

Considering getting professional help for your upcoming NAC OSCE? Check out our tips:

The format the OSCE

Before we take a look at some examples and prep cases, you need to understand the format of the OSCE so that you know what to expect.

The exam consists of several timed stations that represent real-life clinical situations. Each candidate has to go through each station individually and perform the same task within the same specific timeframe. Since there are usually several candidates on one exam track, you will be rotating through the stations. Once you have registered, you will be escorted onto the exam track and told which station you have been assigned as a starting point. Each station will have a number on the door to help you navigate through the exam track. As the stations are timed, you will be given a signal when it is time to go in and when it is time to leave the station.

Each station is unique and will include a task that is designed to assess at least one of these eight competencies:

You will have instructions at the door and a copy of those same instructions inside each station that you can consult at any point during your time in the station. The setting, equipment, and Standardized Patients (SP) will vary depending on the purpose of the station. If the case in a particular station requires additional materials, such as a lab results, growth charts or other relevant information, they will be available to you unless requesting them is a part of the solution to your case. In which case, that stations' props will only be available if you indicate the need for them. For example, a patient's vital signs might not be given to you unless you specifically ask for them.

There will be a physician examiner (PE) at each station observing, assessing, and recording your performance while you interact with the SP. They are only there to assess your interaction with the SP and provide additional information in specific cases, so you do not need to introduce yourself to them or focus your attention on them. You only need to interact with them to confirm your candidate ID when you enter the station, or when your instructions ask you to verbalize your physical examination. In those cases, the PE may provide the results of the exam that you performed, such as the vital signs that we mentioned earlier or a patient’s blood pressure if you indicate that you are taking the patient’s blood pressure as part of your examination.

Once you have gone through all of the OSCE stations on the exam track, then you’ll be released from the exam.

OSCE Prep Cases to Practice with

To help you prepare, take a look at the OSCE prep cases below and use them to rehearse. For each prep case, read the instructions in the first tab and imagine that these are the instructions provided on the door of the OSCE station. After entering the room, presenting your candidate ID and introducing yourself to the patient, what would you do? Think through the scenario and then click over to the next tab to see if you were on the right track. Take note of questions or steps that you may have missed and keep them in mind as you continue preparing for your OSCE.

OSCE Prep case #1

Solution: 

Ask about the onset of the symptoms and how long they have been present. 

Screen for depression using SIGECAPS:

 Are there any red flags? 

• Is the patient hearing voices others don't hear? 
• Is the patient seeing things others don't see?
• Are they experiencing any paranoia?

Take a social history 

• Do they live with anyone? 
• Do they have family, friends, pets, or any kind of support? 
• Do they smoke? Drink alcohol? Use any other recreational Drugs?
• Ask about their income/Work/Welfare

Take a previous medical history 

•  Do they have any history of depression or other mental health issues?
• Is there a history of depression or other mental health issues in their family?
• Get their overall Medical History
• Are they on any medication at the moment? 

OSCE Prep case #2

Solution:

Step 1: 

First, explore the details of the back pain using SOCRATES: 

Are there any red flags? 

Consider the things that are considered a red flag when it comes to back pain:

• Back pain in those younger than 20 or older than 50
• Non-mechanical pain
• Thoracic pain
• Saddle anesthesia
• Bladder dysfunction (e.g. urinary retention, incontinence)
• Fecal incontinence
• Limb weakness
• Associated trauma
• Weight loss
• Nausea
• Vomiting
• Photophobia
• Fever
• Structural abnormality of the spine

Step 2: 

Take a social history 

• Do they live in an apartment, a home with stairs or without stairs? 
• Do they live alone or with anyone? 
• What is their level of functional independence?
• Do they smoke? Drink alcohol? Use any other recreational Drugs?
• Ask about their current occupation.

Take a previous medical history.

• Has the patient experienced similar symptoms in the past? If yes, were they similar to what they are currently experiencing? 
• Take an overall Medical History, asking specifically about the following: 

• Are they on any medication at the moment? (Prescription or over the counter)

Travel history:

• Has the patient traveled to areas of high tuberculosis (TB) prevalence if considering TB as a cause (e.g., Pott's disease)?

Systemic inquiry:

• Abdominal pain
• Nausea and vomiting
• Lower urinary tract symptoms
• Haematuria
• Weight loss
• Appetite
• Fevers

The patient's response reveals that there are no red flags, they do not drink or smoke, they live in a house with no stairs with their spouse, and they work as a lorry driver. 

Step 3:

Since the patient's history has raised no red flags, you should do a simple Spinal examination, lower limb neurological examination, and basic observations of vital signs. 

Your assessment of the spine reveals normal alignment, with no tenderness on palpation, and a normal range of movement of the cervical, thoracic, and lumbar spine. Meaning that the patient is experiencing simple musculoskeletal pain.

A modified version of a wait-and -see approach would be recommended. Simple musculoskeletal pain can be improved with over-the-counter analgesics and some behavioral modification, so patient should be advised to do some back stretches, take over-the-counter Tylenol or NSAID, and return if there is no improvement within a few weeks.

If there is no improvement within a few weeks to a month, a more extensive workup would be mandated due to the increased risk of more problematic aetiologies.

Tips for tackling OSCE cases

Now that you know what to expect from the format of a typical exam, let’s go over a few strategies that can help you as you navigate the different stations and ace the OSCE:

1. Use your notebook

When you are registering for the exam, the OSCE will provide you with a notebook. The candidate identification code that you will need to present to the PE upon entering each station will be printed on this book, but you can also use it to take notes, and we highly recommend that you do so.

While you are reading the instructions before entering the room, write down specific details about the patient information that relates to the task. You should also write down any thoughts that you have about the patient description, questions and examination techniques that come to mind, and general reflections that could be helpful to you.

Writing things down helps people remember them, so when you write down some of the patient details, they are likely to stay fresh in your mind. Furthermore, once you are inside the station and you have started interacting with the SP, don't be afraid to take a moment to consult your notes. This will help you ensure that you have not forgotten any steps or questions.

That said, don't forget that the instructions are also available inside the station, so you don't need to write down everything on the instructions outside of the door. You can always recheck the patient information inside the station.

2. Use your words

Some stations will specifically ask you to verbalize your actions, but we recommend that you still try to do so even for the stations that don't. Remember that one of the competencies that you want to demonstrate is communication. So, it is important that you talk to your patient and carry them along with you as you examine them. This is a great way to build trust between you and the patient.

Furthermore, since you are being assessed on your ability to communicate effectively with a patient, the PE will not only be looking at what you say but also how you say it to the patient. When you enter the room, you need to behave as a physician would. Introduce yourself to the SP professionally, ask them questions instead of just listing items from your checklist, and speak to them directly, not to the PE. This brings us to our next point...

3. Focus on the patient, not the examiner

Candidates sometimes assume that they need to be saying things for the benefit of the examiner, and while this is true to an extent, the examiner will know what you are doing from your interaction with the SP. So, it is best to focus on your patient, ask them questions and tell them what you are doing. Your examiner will hear you, so they will be aware of your actions, but they will also see that you are using appropriate questioning techniques and genuinely connecting with the patient.

Furthermore, if you focus on your patient, you are less likely to get distracted by the examiner's pencil. Candidates sometimes start to worry if the PE is not checking items on their list or if they seem to be taking additional notes. There is no way for you to know if those things are positive or negative. Some checklists can only be completed after you have left the room, and some need to be done right away. The only thing you can control is your performance with the SP, not the examiner's actions, so focus on your patient and just do your best.

Not sure how to prepare for the OSCE? This video can help:

4. Keep track of time

Remember that the OSCE stations are timed, so it goes without saying that time management is an essential part of this exam. You will be given a warning signal close to the end of each station, but you should also keep track of time on your own, especially for cases that ask you to perform two different tasks.

One of the best ways to learn how to do this is to time yourself when you are practicing for the OSCE. If you are finding it difficult to finish your task within the allotted time slots, then it may be a sign that you need to learn how to improve patient assessment skills. Many physicians have reviewed these tasks and found them appropriate. Additionally, most candidates are able to complete them within the time limit. So if you are having trouble while practicing, you may want to consider investing in an OSCE prep course  (or if you are taking a specific exam like the NAC, then you can register for a NAC OSCE prep course) for additional support.

FAQs

To your success,

Your friends at BeMo

BeMo Academic Consulting

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