OSCE Success: Med Students’ Guide to Acing Clinical Exams

They’re stressful. They’re tough. They’re the OSCEs: Exams that train you — the medical student — to be the best doctor you can be.

OSCE stands for objective structured clinical examination, and it’s been around for decades, said Lisa Howley, PhD, MEd, senior director of transforming medical education at the Association of American Medical Colleges in Washington, DC. They can go by other names like clinical practice exams, depending on what your school calls them, she said. 

“They’re a critical part of medical education,” Howley said.

During these exams, you need to take what you’ve learned in the classroom into a “real-life” yet simulated scenario. Most medical schools use people carefully trained to portray a patient with a specific health history, set of symptoms, or health complaints like chest or abdominal pain.

These people are called simulated or standardized patients. Communicating with them clearly and with empathy and understanding is a key part of the assessment.

You’ll take OSCEs throughout medical school, said Sheryl Pfeil, MD, medical director of the clinical skills center at Ohio State University College of Medicine in Columbus.

Usually in the first year, it’s basic, like taking a medical history or learning how to best communicate and build rapport with patients. As you progress through training, it gets a little more sophisticated. Physical exams are added. By the time you are in clinical rotations, you’ll be asked to use your clinical reasoning. That means you’re putting everything together to come up with a list of potential diagnoses and a management plan.

“These are very much behavioral exams and can be unnerving because it’s not the way (students) are typically used to being evaluated,” Pfeil said.

They are meant to be as authentic, standardized, and as fair as possible, she said.

OSCE 101

Here’s what you need to know before you take you first OSCE:

They’re Timed: You’ll work through a series of stations where you’ll interact with the “patients.” You’ll have a few minutes to read the instructions outside the room. You’ll have a set amount of time with each simulated patient. That’s usually anywhere from 5-20 minutes. Then, you’ll move on to the next station. 

Every student taking the exam goes to each station and is evaluated using the same criteria. 

You’ll Get Feedback. You may get feedback directly from the simulated patient and/or a faculty member. Sometimes, the faculty member is behind one-way glass. But, more commonly the OSCEs are recorded, said Pfeil.

Take the opportunity to listen to and learn from the feedback. For instance, you may need to work on your communication skills — like speak slower or louder. Ask if you can watch your recorded encounters.

Formative Vs Summative. Formative exams are meant for you to learn from and don’t count toward your grade. Your score on a summative OSCE is figured into your grade.

How To Crush Your OSCE

Before the Exam:

1. Know the expectations. If your school provides a blueprint of general expectations, review it carefully, Howley said. Find out how many stations to expect and how much time you might have for each one.
2. Review what you’ve learned. If you know there’s an OSCE coming up and you’re in the middle of a gastrointestinal block, for instance, it’s a good idea to review GI systems and go over how to do an abdominal exam, Pfeil said.
3. Practice basic skills. When you’re nervous, it’s easy to forget the basics. It’s not uncommon for a beginning student to put on a blood pressure cuff upside down or try to take a pulse on the wrong side of the wrist.
4. Role play. Work with fellow students or family members to simulate taking a medical history or work up a complaint like chest pain.
5. Don’t cram! It’s not going to help. Try to relax and get a good night’s sleep the night before the exam.

On Exam Day:

1. Dress for success. Don’t show up in sweats if your school says to wear a white coat or scrubs.
2. Know what to bring and what to leave at home. Ask about what medical instruments you may need to bring like your stethoscope or reflex hammer. Some schools let you bring in a paper and pencil; others do not. Don’t bring anything with you that’s not allowed, Pfeil said.
3. Fuel your body. Eat a good breakfast before you leave for the exam.
4. Arrive early. If you cut it too close, you’ll be stressed-out even more. Plan to arrive in plenty of time so you start the exam as calm as possible.

During the Exam:

1. Read the instructions carefully. Do what’s being asked — so don’t skim the directions. If you’re asked to do an upper limb neurological exam and you do a lower one, you’ve messed up.
2. Wash up. Use hand sanitizer or wash your hands as you enter the room and exit the room.
3. Greet the “patient.” Introduce yourself and ask them their name and age. Even though you’ll know, ask them, “what brings you here today?”
4. Ask questions. If for example, a patient says they haven’t taken their medicine, ask why, Howley said.
5. Manage your time. Keep track of how much time you have in a particular station before you go in. Keep an eye on your watch.
6. Don’t jump to conclusions. You might think you have a diagnosis, or an “answer” and stop asking questions, Howley said. That could lead to an inaccurate conclusion, she said.
7. Move on. If you realize you’ve made a mistake at a particular station, don’t dwell on it. If you’re thinking about the previous case when faced with a new one, you’re more prone to make even more mistakes.

Pfeil and Howley agreed: Give yourself some grace. Nobody is perfect and everyone makes mistakes.

“It’s actually one of the great benefits of these simulated performance assessments is to provide the opportunity to make mistakes and to learn from them and move forward,” Howley said.