The Idiot’s Guide to the OSCE Exam. Part 1 : Tips for Supervisors

The OSCE exam

The FRACGP exam comprises three exams, or modules, each aimed at testing different aspects of knowledge. The OSCE is the ‘highest order’ exam, in which a candidate ‘shows’ what they can do.

Currently, candidates must pass the AKT before they can attempt the OSCE. This will be changing, so that both the AKT and KFP will need to be passed before the OSCE is attempted.

The Exam is structured around 14 stations with different cases, through which candidates rotate.  They are divided into:

• 2 Long Cases (19 minutes + 3 minutes reading time)
• 12 Short Cases (8 minutes + 3 minutes reading time)

These will usually include one Viva, one or two Physical Examination stations and one Indigenous Health Case. 

Each station has two examiners. Usually the ‘case’ will be played by one examiner, while the other examiner observes. Both examiners mark the case. There is a standardised marking schedule for each case which helps with the allocation of marks.

How can supervisors help their registrars?

Your registrar is about to sit the OSCE exam. As a supervisor, what do you need to know and how can you help her prepare? Interestingly, despite years of supervising, a detailed understanding of the mechanics of the exam can often be fairly opaque to supervisors.  

Exam ‘preparation’ is something that doesn’t fit neatly into supervision, which focusses primarily on clinical safety.  Helping a registrar with exam preparation can be an overlooked aspect of the supervisor’s role.  I can’t help feeling that as supervisors, we could do more, particularly now that there are proposed limits on the number of exam attempts for registrars.  The cost and stress associated with failing is considerable.  

Now, I must admit that, while I have a strong interest in medical education, I am not an OSCE expert. Fortunately, I am surrounded by a number of very talented and qualified Medical Educators as part of my role in curating the Medcast RACGP Exam Preparation Course. So, in this article, I have tried to distil some of their collective experience and reduce it to an ‘Idiot’s Guide’.

Tips for Supervisors

1. Susan Wearne’s book “Clinical Cases for General Practice” comes highly recommended. (You can order the book online from any of the major online retailers). Supervisors can use this book to help registrars to practice scenarios. TIP: when you are practicing, make sure registrars get used to the timing of cases, as it is easy to run out of time.
2. Do practice Vivas – get the Registrar accustomed to talking about a topic and answering a question in a logical and sequential manner. This can be any topic – choose a case that has been seen that day. For example – discuss the differential diagnosis of an acute red eye in a 55 year old female. Or, what is your registrar’s approach to a 58 year old male who presents to your practice with severe left-sided chest pain?
3. Do Random Case Analysis of your Registrar’s notes, using the following article as a guide: http://www.racgp.org.au/afp/2013/januaryfebruary/random-case-analysis/ This will help cover a broad range of conditions, and help the Registrar reflect on their differential diagnoses, their prescribing habits, their ordering of investigations, and their management of patients.
4. Try to cover all five domains of General Practice. Discuss ethical dilemmas, the business of General Practice, prevention and screening and communication skills. 
5. Be aware of the different OSCE preparation support courses that are available, and suggest them to appropriate registrars - for example RACGP runs a number of courses, as do other private providers.
6. If you don’t already use the PROMPT strategy by Murtagh, discuss it with your registrar and encourage her to use it in consultations and in exam practice. It is a diagnostic strategy guiding doctors to consider the Probability diagnosis, any Red Flags (things not to miss), the Often Missed (Masquerades such as UTI and depression) and what is the Patient Telling you. This is highly recommended.