OSCE No1 Question

general practice Aug 15, 2018

Okay, hi, it's Tom Rolley here for Graduate Medicine.

I've just completed my day and it was a pretty good day.

We had some interesting cases, but what I wanted to talk to you about is that some of you may be approaching the final hurdle in your path to fellowship, which of course, is the OSCE.

And if you're going to pass the AKT and pass the KFP, then you might think, "Hey, this OSCE thing, it should be pretty easy."

And you'd be right, because of course it is closest to how we actually work.

Yes, it's a little bit stylized, because it's eight minute cases, or it's the two long OSCE cases, which are 19 minutes.

But, you still need to know how to perform well, and also of course, it is quite a serious investment.

I think it's up around $4,000 plus mark at this point.

It's a long day as well, so you really want to have the capacity to step in confident, and actually know that yes, your money is well invested into getting this for RACGP and you've put the time in so you pass!

And often, there's not that much time between sitting AKT and KFP and then into OSCE, it can creep up.

It seems quite some time now that the AKT and the KFP were done, and yet the results are still not out until next week for AKT, and then the week after for the KFP.

So hopefully, if you've been following along at all, that you've actually been practicing your clinical skills, and these are now well practiced.

Either from all the way before your AKT and KFP, or actually now that you're through those exams.

So I would recommend that you have these well practiced.


Well, first of all, it's obvious who's been practicing in the actual exam.

I've sat in on enough OSCE prep cases to know it's quite clear who's smooth and well practiced and can speak out loud while doing the clinical exams and who hasn't.

People who have just been practicing in their mind and trying to translate from the thinking in the mind into the action - usually they are quite "clunky" in their actual live performance.

So, it comes across quite obviously who has been practicing or and who has not.


The second thing is, hopefully you've got them so well practiced that you're actually in a place where you can receive the information as it's told to you about the case And actually integrate that information into what you think is going on with this case.

Are you trying to work out between multiple differentials, or have you pretty much lined it up that, "Yes, this is a single diagnosis" and you're just confirming that?

But, if you're still trying to remember the clinical skills, it makes it very difficult to receive the information and actually work out what's going on.

There's a couple more things to think about, and one is how do you recover if you have a bad case?

Luckily for me, my last case, wasn't the greatest of all time.

It was talking to a doctor about the clinical guidelines for usage of antihypertensive medications in diabetics.

It was quite a challenging case to come to at the end of having been through all of the other cases.

Mainly, because of the fatigue factor, and also, it wasn't a classical seeing a patient.

It was more of a discussion with the doctor, and so it was a little bit of a shock to my system.

Nonetheless, I did get through it, and of course, I passed my OSCE.

So you do need to think about how you recover from a bad case.

And also, something else to consider is how you're going to spend the breaks.

Remember in the OSCE, there are three breaks, and possibly four, and have a think about beforehand, what are you going do in those breaks.

I used meditation. It worked really well to let go of the past cases - which I could do nothing about - and prepare for the next cases  Also which I did not yet know anything

So where does this go?

If you're sitting the OSCE, either you know that you are or you're expecting to, once your AKT and FKP results are in...

What's the path forward?

Well, I would still consider the OSCE to be a amalgamation of the requirements for being a good GP, which are, of course, good clinical knowledge, good clinical skills, and good clinical reasoning.

You need to be practicing out loud, speaking through what you're doing, and also what you're finding, how you're reasoning, because remember, the examiners that are watching you, and cannot mind read.

They might be able to make some judgments about you from what your questions you're asking the patient and about what that shows you're thinking.

But, really, it makes it a lot easier if you practice your thinking out loud.

"Well, now I'm doing this."

"I'm examining this."

"I'm thinking about this."

"I've excluded this."

Even a little summary in between, as you transition, in a long case between your history exam and investigations, into your management really helps the examiners see what you're thinking, where you're at, and that you are competent to be a independent GP.

Also, other useful resources for you, which you should be aware of... Of course there is the Susan Wearne book.

It's in the third edition at this point, so you should definitely have this.

Of course, if you haven't sat KFP or AKT yet, get that book now as it is useful in preparation for the KFP.

And then of course, the last part is the study group.

You really should be getting together with your study group, or even at your practice at lunch times or before work, talking through cases, talking through what you would do, breaking down segments of a consultation.

Remember that, because it's eight minutes, sometimes it'll only be sections of a typically patient encounter.

You won't get the full patient encounter, because some parts will take that full eight minutes.

So look, if you've found this helpful, I do have a more in-depth training video.

This has previously only been available to General Practice Exam Accelerator Members, and in exchange, if you could give me your number one question about the OSCE.

So if you click the link below this video, it'll take you through to a short page where you put in your name and your email, and your number one question about the OSCE.

So hopefully you found this helpful, and look forward to seeing you again on future trainings from GraduateMedicine.com.

Click this link to access the full OSCE training video...



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