UW SOM OSCE Program

Year IV OSCE starts July 2010

2010-05-21T09:41:00.000-07:00

More information will soon be posted about the Year IV OSCE. In the meantime, check the SP calendar for dates, and if you haven't yet signed up, contact Amy Heather in Curriculum amyheath@uw.edu to do so.

Confirmation emails with specific instructions for the OSCE will be sent out in June 2010. We look forward to seeing you this summer!

Year II OSCE Part A - Information

2009-11-20T10:46:00.000-08:00

Many of the posts on the Year II OSCE Part A from last year still apply to preparing for this year. A couple of changes -- the session has been moved into early January to allow for more time to reflect and prepare between OSCE part A and part B (April). We're also encouraging you to take some time to consider the Cultural Communications appendix of the Communication and Medical Interviewing Skills benchmark.

Here are a few older posts that give you some great info about the Year II OSCE and what to expect:

Wait, are we being graded on this?

Written Ethics OSCE sample case

How to "Verbalize"

Dr. Losh's letter about the Year II OSCE

Year II OSCE Part A

2009-11-10T09:31:00.000-08:00

Dr David Losh will be speaking to the 2nd year class on Nov 12th about the upcoming Year II OSCEs and how to prepare for them. Part A is a 4-station OSCE in January 2010 (6th-22nd) and Part B will consist of a 6-station OSCE March 31 - April 15, 2010.

Much of the material posted for the Year II OSCE in 2009 still applies to this year -- we'll be sharing the information again and linking relevant posts. In the meantime, if you have specific questions, send them to Jennie Struijk @ janim@uw.edu and we'll try to answer them for the class on this blog.

And now for something completely different...

2009-07-29T11:54:00.001-07:00

The students at Washington University Medical School put together this cute little rap:

"SP Baby"

Save the Date: Year IV Remedial OSCE Oct 22, 2009

2009-06-11T08:23:00.000-07:00

While most students will do very well on the upcoming Year IV OSCE, those who have trouble across a number of stations or skills will be asked to return to Seattle for a Remedial OSCE in October on Thursday the 22nd.

We suggest that you NOT schedule out of town residency interviews or other important activities on or about October 22 on the remote chance that you will be required to re-test on that date.

If you have any questions about the Remedial OSCE or Year IV OSCE in general, please email Jennie Struijk. We look forward to seeing you this summer!

Year IV OSCE dates and making changes

2009-04-15T09:40:00.001-07:00

Confirmations of Year IV OSCE dates are currently being mailed out to students. If you decide you wish to change your OSCE date, we ask that you arrange to swap dates with a classmate, and then email: osce@u.washington.edu (be sure to also CC your classmate) to let us know of the swap.

For your convenience in determining swap requests the dates are listed again below:

The 2009 Year IV OSCE will be offered on July 8, 9, 10, 13, 14, and 15, and on August 5, 6, 7, 10, 11 and 12, 2009. Each day begins at 8:15 and will end prior to 1:00pm.

Year IV OSCE Format and Suggestions from Dr. Losh

2009-04-15T09:34:00.000-07:00

Re: Senior OSCEs

Dear Senior Medical Students,

We would like to give you some information about the up-coming Senior OSCE that you will be taking in July or August. Several folks have asked “How should I study for the OSCEs?” So here is a short run-down of why the exams are being given, how they work, and how to prepare.

Successful completion of the Senior OSCEs is a requirement prior to graduation from the UW School of Medicine. This requirement derives from the underlying principle that each medical student graduating from the UW, regardless of his or her planned career track, shall demonstrate competence in a variety of basic clinical skills prior to graduation. The OSCEs may also help you practice some of the skills you will need when you take the USMLE Step 2 Clinical Skills Examination (CSE) that is currently a requirement for licensure.

Most of you will pass the exam. However, those who do not pass, will be expected to take a set of remedial OSCEs on October 22, 2009. Therefore you should NOT schedule out of town residency interviews or other important activities on or about October 22 on the remote chance that you will be required to re-test on that date.

The Senior OSCEs are a little different than the Second-year OSCEs that you have already taken. The 2^nd year OSCEs asked you to demonstrate a specific physical examination technique or limited part of an interview. The Senior OSCEs are designed to see if you can make a reasonable differential diagnosis and plan from the information you obtain by interviewing and examining the patient. You will have more time for each station but a number of stations will require you to interview the patient, do an appropriate examination for the specific problem, write up your findings and come up with a differential diagnosis and plan.

Here is a general outline of how the OSCEs will work this year:

Each student will rotate through 10 stations dealing with common clinical scenarios. Some of the stations will be with standardized patients, and some of the stations are cases that are done on either a computer, a mannequin, or involve short written answers to clinical scenarios. Each case with a standardized patient will involve 14 minutes in interviewing or examining the patient and nine (9) minutes in either receiving feedback from an observer, or in writing up your findings.

Some of the Standardized Patient cases will require you to write out your findings which will be graded later by trained UW physician graders. The write-up cases will use forms similar to those used in the CSE. (The write-ups are done on one page and are divided into 3 sections: 1) Findings (History and Physical findings), 2) Differential Diagnosis with the most likely diagnosis listed first, and 3) The Plan including diagnostic needs and/or therapy.)

If you finish your patient interview or examination early, you will be allowed to start your write-up early.

On the Standardized Patient cases that do not require a write-up, you will receive some immediate feedback from the standardized patient and/or a volunteer physician or other observer.

We anticipate that the results of the OSCEs should be available in late September or early October.

How should you prepare for the OSCEs?

Like the real practice of medicine, there is no way to study specifically for the exact clinical cases that may confront you each day. However, there are several things you can do that will prepare you to do well in the OSCEs.

Get enough sleep the night before and arrive on time, relaxed and mentally prepared. Rushing to make it to the OSCEs after a hard night on call is not an advisable way to take the exam.

Be sure to bring your own clinical equipment – that way you will know you have (and know how to use) whatever you need for each station. The minimum recommended is your own stethoscope oto-ophthalmoscope. General clinic supplies will be provided, as will any “less common” equipment you might need. You will not be able to use any reference cards or texts during the exam.
Remember: Most of the material for the OSCEs is linked to the ICM II Benchmarks and the goals and objectives and other material you covered in your Clinical Clerkships.

When you take a history from ambulatory patient, don’t forget to include the basic elements of a history: HPI, current other health problems, PMH, current meds including OTCs and CAM, allergies, smoking & drug/substance use, dietary habits, family history, and social history.

When you need to do a focused physical examination, run through the portions of the physical exam you learned in ICM II that you feel a reasonable clinician should obtain in a patient presenting with the particular problem. For example, a patient presenting with chest pain (in addition to auscultation of the heart) might also require vital signs, a general description of their appearance, (cyanosis, respiratory distress, sweating), auscultation of the lungs, palpation of the chest, a check of their pulses and evaluation of the vascular system including palpation and auscultation of the abdomen for aneurysm or bruits.

Basic patient-centered communication skills and professionalism issues will be measured, so don’t forget to greet the patient, confirm their identity, introduce yourself, and establish the patient’s agenda. Its always a good idea to find out what the patient feels is causing their symptoms or problem. Try to use an effective combination of non-judgmental open and closed ended questions. At the end, smooth closure can often be accomplished by a brief summary and letting the patient know what you would like to do next.

The material covered may rely on your knowledge of pediatric through adult problems and may rely on special skills interviews as well as general examinations.

Most of you will do quite well on this examination. A very large effort is being made by staff and volunteers to make the examination clinically relevant and helpful for you. We hope that it will actually be fun and that the feedback you receive will be helpful and informative. We also hope it will help give you practice and confidence as you prepare for your CSEs.

David Losh, M.D., Members of the UW OSCE Work Group

Professor, Med. Director of OSCEs

Dept. of Family Medicine

Question about OSCEs and Transcripts

2009-04-08T10:47:00.000-07:00

We love it when people contact us about "rumors" -- it's a great way for us to clarify things and, we hope, reduce uncertainty and anxiety for students.

Today's question: There have been a few rumors in class that the spring but not the winter osce will be depicted somehow on our transcripts. Can you clarify?

Dr Losh's reply:

"Yep, that's just a rumor. Students have to successfully complete the 2nd year OSCE requirement before they are allowed to proceed to the clinical clerkships, but to my knowlege there is no statement regarding the 2nd year OSCE on the transcript.

If s student gets 2 or more "needs development" ratings on these last 6 cases, they must meet with their College Mentor for constructive feedback, to analyze the results, and to determine if any further remedial work is needed. That process must be completed before the student is allowed to start the clinical clerkships.

Hope that helps clarify things."

Question from a Student

2009-03-31T08:56:00.001-07:00

A student asks (paraphrased): What does "Yearly Exam" mean? What is a reflection?

Dr. David Losh, OSCE Medical Director, answers:

Many patients come to their doctor for general exams. - Depending on the system, these exams might be called a "Yearly Exam", a "CPX (complete physical exam)", a "Health maintenance exam", a "Checkup", a "Preventative maintenance exam", a "Physical", or an "Annual Exam." The patient may simply want a check-up, but often some of the patient's ongoing health problems are addressed during these exams, and patients sometimes bring up other agenda items at these times.

Don't worry, you won't be asked to do an entire yearly exam and history update in 8 minutes, but you should be prepared to do any element in general history and physical exam.

Reflection and writing are techniques that can be applied to almost any area including but not limited to ethics.

When I see my patient list at the start of the day, its only a rough guide. I never know exactly what the the issue is until I have a chance to talk with the patient. As far as the OSCEs go, almost anything is fair game, but we try hard to stick with clinical skills, knowledge, and reasoning that you have already been exposed to in the curriculum.

David Losh, M.D.
Professor / Medical Director, UW OSCE Program
University of Washington Dept. of Family Medicine

Year II OSCE Patient Schedule

2009-03-18T14:17:00.000-07:00

Year II OSCE Part B Patient Schedule

Physicians often check their appointment schedule before seeing their patients. In order to help the OSCEs be more like real patient care, and to insure that all student's receive the same information prior to the examination, your appointment schedule has been made available to you.

A quick check of your schedule reveals the following patients and the reason they scheduled their visit. Your front office staff (aka the OSCE staff) will schedule the actual patient times according to their availability.

Patient 1: Shortness of Breath
Patient 2: Ear problem
Patient 3: Vomiting / Diarrhea
Patient 4: Knee problem
Patient 5: Yearly Exam
Appt Slot 6: hold for writing and reflection

(Please be aware that, as in real life, patient's presentations and symptoms often change over time, so you should trust your own findings and diagnosis rather than those of a colleague.)

Year IV "Senior OSCE" Summer Dates

2009-03-06T10:01:00.000-08:00

Students are currently signing up for their Year IV OSCE during their Year IV scheduling appointments. Once the entire class has signed up, we'll send a confirmation of your date to you via your official UW email address.

The 2009 Year IV OSCE will be offered on July 8, 9, 10, 13, 14, and 15, and on August 5, 6, 7, 10, 11 and 12, 2009.

Please keep an eye on this blog for additional information as we draw closer to the Year IV OSCE.

Year II OSCE Basic Orientation Information

2009-02-06T10:21:00.000-08:00

Some students like to get a jump on preparing for their OSCE session by reviewing the material we'll cover in the orientation -- if this is you, read on. If not, don't worry, we'll cover it all again verbally on your OSCE date.

YEAR II OSCE PART A ORIENTATION - Held in T-550

1) You will rotate through FOUR different OSCE stations today. The stations will include taking a history, doing a written case, and doing two physical exams on manikins. It’s really similar to the POSCE, but we’ll go back through the details:

a) History and Interviewing – be sure to read the instructions and do the type of history or interview that is requested – there will not be time to do a complete intake interview. You will not do any physical exam in this station.

b) Physical Exam – be sure to "verbalize" your physical exam as you do it so we know what you are doing and looking for. This is how the Clinical Observer will be able to rate you during the Spring Part B OSCE, so it’s good to do it on the manikins today. An SP observer will be there to guide you through the station, and to remind you to verbalize if you forget! You will not take any history in these stations.

c) Written Case – you will have 10 minutes to complete a written case and a proctor will be there to help you get started.

2) Please do not share information about these cases with your fellow students. Performance information on OSCE Part A lets us help students identify the areas they will want to spend more time on before you all head onto the wards, so you all want the chance to take it "fresh".

3) The timing of the History and Written cases today is the same as the Practice OSCE:

a) 2 minutes to read the instructions on the door before entering – you will then
hear a bell which signals you to enter and begin.

b) 8 minutes for the actual case. You will hear the bell again when it is time to stop the interview. NOTE: there is no feedback for a written case, so you can just keep writing through this 2nd bell.

c) 2 minutes for feedback. You will then hear a longer bell when it is time to leave the station and move to the next one.

4) The Manikin Physical Exam stations are each 5 minutes long. When you enter the stations the SP-Observers will be there to guide you and keep track of the time. The stations are short so you will have plenty of time to complete them and we’ll be there to keep you on schedule. You can ignore all but the final bell for these stations. There will be hand sanitizer and tissues in these stations.

5) In order to get all the students through the right stations, we’ll have a Pink Track and a Blue Track, similar to the tracks on the Practice OSCE. Station 3, the manikin physical exam station, is slightly different, but the SP-Observers will be there to guide you. For stations 1 and 2, just be sure to enter the station coded with your track color, which is highlighted on your stickers. All of the stations are in T-562 and 563.

6) So that we can identify your score-sheets and written materials, you’ll have an OSCE Number on stickers. Be sure to give your sticker to the observer in each station on the way out, and to place it on your written materials.

7) When you have finished the OSCE, you’ll pick up your stuff from the counter and you are free to go. We will have the results available for you and your mentor within a couple of weeks, and then we’ll see you for OSCE Part-B in Spring Quarter.

8) Bring your stuff along with you as we head down to T-562. Please turn off all of your phones, etc, and remember no chatting with each other during the OSCE, it's a test!

And, as much as you can, relax, have some fun, learn something and thanks for coming – everything we do, we do for you!

Year II OSCE Part A Starts Next Week!!

2009-02-06T10:18:00.000-08:00

Just a reminder that the Year II OSCE Part A starts next week and continues through February 26. The next post will contain a lot of the information we'll cover in the orientation, and the post below this one, from January, has more information about how this OSCE is scored, and the type of feedback you and your mentor will receive about your performance.

As always, feel free to submit your questions for the OSCE blog.

See you next week!

Wait - Are we being graded on this? Year II OSCE Part A

2009-01-13T08:48:00.000-08:00

A couple of people have asked whether they'll be "graded" on the upcoming Year II OSCE Part A in February 2009, or if they'll just be getting feedback from their mentors on their performance.

The answer is both, sort of:

While the OSCE doesn't give you a "grade", you will get a score on each station -- possible scores are: Meets Expectations, Exceeds Expectations, and Needs Development.

Students who receive all Meets Expectations and/or Exceeds Expectations on their stations can feel fairly confident they are developing those skills at the pace we hope they will. Students with one or more Needs Developments will probably be asked to talk to their mentor about how they can improve in the areas they didn't do as well on. This is a great chance for those students to polish their skills prior to OSCE Part B in April and of course, Year III on the wards.

A few points to remember:

The Standardized Patients and Observers record what you do and don't do in that station. Final scores for each station are set by the OSCE Working Group.

The OSCEs are not "graded on a curve" -- instead the OSCE Working Group looks at what constitutes a clinically reasonable performance for each task to set score cutoffs.

It won't help your friend if you tell him/her about which stations are on the OSCE -- not only might you be robbing them of the chance to test themselves and get some feedback about what they might need to practice before heading out to the wards next year, studies have shown prior knowledge of which cases are on an OSCE actually doesn't improve performance.

Keep those questions coming, and see you in February!

OSCE and PBL - partners in learning

2009-01-07T08:56:00.000-08:00

This year in Hubio 559 Problem-Based Learning, each new case starts out with a pink "clinic note" giving you some information about your patient: name, age, vitals, a line or two about his chief complaint and where you are seeing him (ER, clinic, etc). Each group is asked to throw out some thoughts (things like: Where will you start? What are you worried about? Do you have a working diagnosis yet?) based on this short sketch before they get another piece of information that usually covers things like basic history, physical exam, and sometimes labs.

Why do this? It's to get you thinking about patients the way you'll need to during an OSCE, and then ultimately, on the wards. Using just this basic info, you'll want to be able to quickly consider the pertinent history, physical exam and review of systems you want to focus on when you first meet with the patient. It's not an easy skill, certainly not one you are expected to have down pat by the 2nd quarter of 2nd year! But one you'll want to develop, and will use over and over again in your career.

How to "Verbalize"

2008-12-08T10:42:00.000-08:00

We had a lot of students ask during the Practice OSCE for more information about "how to verbalize" for the OSCE. Is it for the observer, or do I say it to the patient? Do I use jargon?

The best answer is that you speak to the patient, describing the exam for the patient all the while that you are doing the exam, and that if you use jargon to explain what you are doing (for instance, "I am now checking cranial nerve XII") you explain what you mean ("so to do that I need you to stick out your tongue and move it from side to side").

A terrific example of this sort of verbalization can be found in these OSCE introduction videos for Nurse Practitioners at London South Bank University. As it's nursing, and from Britain, the technique of the exam may be a little different, but the verbalization style is quite good. These videos demonstrate well how a student can relate to the patient throughout an exam, but keep the patient (and the observer) aware of what they are doing at each step. It's well worth 6 minutes a piece to take a look!

Knee Exam with verbalization

Abdominal Exam with verbalization

Written OSCE Stations - Ethics Sample Case

2008-12-02T11:17:00.000-08:00

One type of station you might see on the upcoming Part A or Part B OSCE is the "written station". These stations don't involve doing a history with a Standardized Patient, or a physical exam on either an SP or a model. Instead, these stations put a clinical, ethical or professional situation in front of you and ask you to speak to it during the 10-minute station period.

This past Fall, evaluating ethical scenarios using a 4-box method was covered during one of the lectures. If you haven't yet taken the opportunity to work through the practice case, we've linked it here. Try setting yourself a 10-minute period to work through the 4-box and questions, then compare it to the sample writeup. If you don't get EVERYTHING, don't beat yourself up -- we aren't looking for perfection on the OSCE, just a sense that you understand the basic issues!

SAMPLE ETHICS CASE

JH is a 76 yo male who has recently been diagnosed with colon CA. He is scheduled later today for a right hemicolectomy. Prior to his recent diagnosis, JH was in moderate health. He has a history of CAD and is S/P MI, he has occasional angina, and he takes medication for his hypertension.
JH is a widower and lives alone independently. He has several friends and neighbors that he sees with some regularity. He has no children and his only living relative is his brother who is 79 yo and lives in a nursing home in Ohio.
Shortly into the interview it became apparent that JH was confused. When asked about his diagnosis and upcoming surgery he seemed puzzled and indicated that he felt fine and hopes to be going home soon.

Medical Indications (box 1)

Patient Preferences (box 2)

Quality of Life (box 3)

Contextual Features (box 4)

Please Identify Core Ethical Issue:

Give a few sentences to describe your Action Plan:

Done? Check your work by examining the sample writeup!

Dr. Losh's Letter about the Year II OSCE

2008-11-14T10:22:00.000-08:00

We'll be handing this letter from the OSCE Medical Director, Dr. David Losh, out to everyone after they take the POSCE in November, but just wanted to post it here for your reference as well:

OSCE – INSTRUCTIONS FOR SECOND-YEAR MEDICAL STUDENTS -- READ CAREFULLY

OSCEs stands for "Observed Standardized Clinical Examination". A classic "OSCE" involves student performing a task with a standardized patient who is taught to act and respond in a standard way, time after time regardless of who is doing the interview. We also employ other ways of testing clinical skills during the OSCEs such as written exercises, computer simulations, and mannequins. You will take part A of the Year II OSCE in February, and part B in April.

How to prepare to do well on this exam.

In every encounter with a standardized patient, our observers look for two main things:

1) Communication skills must be acceptable.

2) We use a checklist to record whether you did a sufficient number of things you have been taught to do during an interview or examination.

In most cases, the skills we observe, including ethics, professionalism and communications, may be found in either the ICM II Benchmarks, or in the ICM II Pocket Guide for History and Physical Examination. The cases rely heavily on the skills you have been taught in ICM II during your Clinical Tutorials and other learning sessions. You won't be asked to do anything that can't be done within the allotted time.

Therefore, you may be asked to do things like:

1) take a history from a patient with a specific complaint.

2) gather general background history in a patient who is new to you

3) know how to take specific portions of a history such as a family history, a sexual history, a social history, or a review of systems.

4) demonstrate how to examine various parts of the body using the proper techniques you were taught in ICM II that are described in the Benchmarks.

5) analyze or respond to an ethical or professional dilemma.

6) describe a physical finding that you have seen or heard during an examination and offer a reasonable explanation for the finding(s).

The communication expectations for each case are pretty straightforward and can be found in the communication benchmarks. Relax, be pleasant with the patient. Pay attention to how you introduce yourself, establish rapport, discover the agenda or explain what you have been asked to do. Try to use good interviewing techniques, such as a combination of open and closed questions and try to have a smooth closure of the interview.

There are no official "practice OSCEs" other than the ones you are taking today. In preparing for the exam, some students have found it helpful to meet with other students to check each other's physical diagnosis skills and knowledge of the Benchmarks. However, other students may find it more helpful to study on their own or in other ways.

For the small number of students who have difficulty with several cases on the OSCEs, a meeting with their College mentor will be required to analyze their performance and offer constructive feedback.

Over the years, most students have enjoyed participating in the OSCEs. We anticipate that the vast majority will do just fine and it will be a fun and interesting learning activity. Good luck on your exam!

David Losh, M.D.
Professor, Medical Director UW OSCEs
University of Washington Dept. of Family Medicine

How Can I Prepare for the OSCE?

2008-09-25T13:50:00.000-07:00

Ok, so you've read the letters, you've watched the YouTube parody, but you are still feeling nervous! Isn't there anything else you could be doing?

Actually, there are some web-based resources, generally compiled by fellow students, which aim to demystify the OSCE and to provide some practical advice on approaching a station. While we can't vouch for the accuracy of any of these sites, since they are not developed here at the UW, some of the more popular online resources are:

OSCE Skills

OSCE Tube

OSCE Review

University of Arkansas General OSCE Tips

Indiana University's "A Day at the OSCEs"

One thing you really shouldn't need to do is purchase additional "OSCE Prep" materials to help you study for the OSCEs. Everything we'll test has been covered in your curriculum thus far -- especially in patient history, physical exam, ethics and professionalism benchmarks. So save that money for a celebration after you successfully complete the exam!

Can The OSCE Be Fun?

2008-09-16T08:27:00.000-07:00

Good question! Some people definitely think so, because the whole concept is based on what is often called "serious games" -- e.g., using simulation and play-acting in a way meant to mimic, teach and test actions in a similar real-world situation.

Of course, for most of us it's also more fun when it's not so high-stakes, right? Or maybe having the extra incentive ramps up your enthusiasm? Perhaps the slightly odd/surreal atmosphere of the OSCE puts you off? Or you might find it hilarious and enjoy every minute of it.

Clark Aldrich has spent his career looking at simulation and serious gaming in education. In this blog post, he says:

You can't predictably make educational content "fun," only "more fun for some people"

What do you think?

OSCE and SP Humor

2008-09-10T08:46:00.000-07:00

Let's face it, simulated clinical situations are sort of rife with comic possibility. Some of your fellow students have placed their takes on SPs, OSCEs and simulations on the web, and as we find 'em, we'll post 'em.

Today's selection was created by the students at the University of Maryland School of Medicine for their "Freshman Follies", which I am assuming are similar to our Humor in Medicine session.

Enjoy!

Thoughts on the OSCE - Year II

2008-09-09T10:41:00.000-07:00

One of the biggest fears students have about the OSCE is that it's hard to prepare for -- potentially any of the benchmarks from ICMi and ii, as well as all your basic science material, is "fair game". This is actually one of the reasons we use OSCEs in the curriculum -- imperfect as they may be, they give some us some of the best ways to assess your progress in integrating all the different knowledge and skills you've been working on for the past 1+ years.

So, on one hand, you shouldn't NEED to "cram" for this exam -- you've been studying for it all along! On the other hand, it's still scary, because you don't entirely know what to expect. So the next few posts will share some musings on the OSCE by people who've been closely involved with the creation of the exam.

Terry Mengert, MD, one of the founding UWSOM College Heads, the intial OSCE medical director, and a true philosopher, had this to say (also in ICMii syllabus):

OBJECTIVE STRUCTURED CLINICAL EXAMINATION (OSCE)
prepared by Terry Mengert, MD and Jennie Struijk, M.Ed.

Definition

The term OSCE refers to the objective structured clinical examination. It is a simulated student doctor-patient encounter or other focused clinical task designed to test a particular clinical skill or set of skills.

Explanation

Let’s start with an example from a future experience. During your senior year of medical school you will probably take an Advanced Cardiac Life Support (ACLS) course. This typical two-day course will go over cardiac arrhythmias, emergency cardiac care, and how to run resuscitation on a patient in cardiac arrest (from, for example, ventricular fibrillation). It is a powerful learning experience, and, as part of it, you will be asked to run several make-believe resuscitations on patients, who are really just plastic mannequins attached to a rhythm simulator. Admittedly, running a code, even a mock code, is scary. But, it is also a wonderful way to learn and a great confidence booster. Well, those make-believe resuscitations are, in fact, examples of sample OSCEs – make-believe clinical experiences that model what physicians are expected to know how to do in real life. OSCEs are focused sample clinical packages where, at the bedside, you are evaluated by what you say and do in the setting of a student-simulated patient encounter.

Medicine is not a passive profession - although that may be the impression one often develops during the first two years of medical school sitting in large lecture rooms. Medicine has always been an active and living experience that takes place at the bedside, in the clinic, in the hospital - where doctors actively evaluate and care for patients. As educators, the more we recognize that, the more we make our evaluations as close to reality as possible; the better for the student and, ultimately, the better for the patient.

How It Works

At this point in your pre-clinical training you will complete a series of OSCEs which you must pass prior to entering 3rd year. These will be based on your clinical evaluation skills: history-taking skills, physical examination skills, and assessment of your early differential diagnosis generating abilities. The goal is to make sure you have the necessary skills to begin your third-year rotations with the appropriate clinical tools and confidence to “shine” on the wards.

Speaking of tools – be sure to bring your own clinical equipment with you – you will want it during the physical examination stations!

Each OSCE station will last about 5 to 10 minutes with brief breaks in between each. You will rotate through up to 7 of them all on the same day. You will be asked to perform some segment of a history or physical examination and your skills will be simultaneously assessed. Any of the following would be reasonable OSCE stations:

• Evaluate a patient’s pain complaints. (For example, a person in a room with a headache, chest pain, abdominal pain, or back pain.)

• Perform some aspect of a careful physical examination. (For example, a person in an examination room on whom you will be asked to perform a quality neurological examination, an abdominal examination, or a head and neck examination.)

• Perform a directed patient interview. (For example, a substance abuse history, a sexual history, or a quality psychosocial history.)

• Evaluate a patient with a straightforward complaint (for example, a cough), for which you are asked to look at radiographs, listen to and interpret heart sounds, listen to and interpret lung sounds, and then generate a limited but appropriate differential diagnosis.

Empathetic Closure

All of us know how scary and painful it can be to be evaluated in this format - the demons of fear of failing, performance anxiety, and self-doubt all come to the surface. We have all been there at one time or another, and not just in the setting of the OSCEs. Similar situations will occur throughout your training. We already discussed the Advanced Cardiac Life Support course example in the introductory comments above. After medical school, the American College of Surgeons offers a wonderful course called the Advanced Trauma Life Support Course (ATLS). At the completion of that course, you are asked to run the simultaneous evaluation and resuscitation of a simulated major trauma patient. Similar evaluations will be part of your residency training. Many Specialty Board Examinations include similar skills station demonstrations as part of completing your Boards. The OSCEs are here to stay - and will become a recurrent theme throughout your training.

All of us acknowledge the sage words of the British writer and cleric C.C. Colton:

Examinations are formidable even to the best prepared, for the greatest fool may ask more than the wisest man can answer.

Please remember the following: The OSCEs that you must pass at the end of your second year are not designed to make your lives harder than they already are. They are designed as an evaluation exercise to make sure you are ready for the third year. Your College mentor in ICM II will work tirelessly with you and on your behalf to make sure you are ready for the OSCEs. Students from past years almost uniformly agreed that the evaluation was an exceptionally worthwhile learning experience.

Great advice, Terry -- Thanks!!

What is the OSCE?

2008-09-08T09:57:00.000-07:00

OSCEs stands for "Observed Standardized Clinical Examination". A classic "OSCE" involves student performing a task with a Standardized Patient who is taught to act and respond in a standard way, time after time, regardless of who is doing the interview. We also employ other ways of testing clinical skills during the OSCEs such as written exercises, computer simulations, and mannequins.

In this blog we'll explore some of the facets of the OSCE, attempt to de-mystify some of the reasoning behind the exam, give you some hints and tips for being prepared, and answer your questions.

If you have something you'd like to see addressed on the UW OSCE Blog, please email Jennie Struijk @ janim@u.washington.edu