PA Student Guide to the OSCE
OSCEs are widely used in medical education and training (think PA, MD, PT, RN, NP, etc.) to assess a broad range of clinical skills, including history taking, physical examination, diagnosis, patient management, and communication skills.
What is an OSCE?
An Objective Structured Clinical Exam (OSCE) is a practical examination used in medical education and training to assess a PA Student’s clinical skills and knowledge.
It is a standardized, objective, and structured assessment that typically involves a series of stations, each of which focuses on a different aspect of clinical practice, such as history taking, physical examination, or patient management (think of it like an MMI, but with clinical scenarios/cases with simulated patients!).
How does an OSCE work?
In an OSCE, the PA student rotates through each station, performing a task or scenario that is observed and evaluated by an examiner (practicing PA, MD, PA clinical instructor).
The tasks are designed to assess specific skills and knowledge, that may simulate real-life patient case
The examiner’s job is to evaluate the PA student's performance based on predetermined criteria, such as the accuracy and completeness of their history taking or the quality of their physical examination technique.
How can I study for an OSCE?
Familiarize yourself with the exam format: Make sure you understand the structure of the OSCE and what skills and knowledge will be assessed at each station.
Review the exam criteria: Familiarize yourself with the specific criteria that will be used to evaluate your performance, and make sure you understand what is expected of you at each station.
Practice, practice, practice: The best way to prepare for an OSCE is to practice, either alone or with your classmates. This will help you become comfortable with the format and the types of scenarios you might encounter during the exam.
Use simulated patients: Consider working with your PA classmates to practice your history taking and physical examination skills. This will help you become more comfortable and confident in these areas. If a PA classmate is not available, practice on a family member, friend (or in my case, my pet!).
Study the material: Make sure you have a strong foundation of knowledge in the areas that will be covered on the exam. Review notes from your clinical exam skills or your Physical Examination Textbook. This might involve studying your textbook or attending lectures, or it might involve doing extra reading and research.
Focus on effective communication: Communication skills are often a key component of an OSCE, so be sure to practice effective communication techniques, such as active listening and clear, concise language.
Get feedback: Seek feedback from your instructors or classmates to identify areas where you need to improve, and use this feedback to guide your studying.
Stay calm and focused: On the day of the exam, try to stay calm and focused. Take deep breaths, eat a nutritious breakfast, and get plenty of sleep the night before.
Tip: Use OSCE Checklists to Prepare!
A typical OSCE checklist includes a list of steps to be followed in a specific patient scenario (e.g. history taking, physical exam or both). It can help you ensure you cover all the relevant steps in a systematic and thorough manner, which helps you focus on performing the clinical task well instead of worrying about forgetting important steps or details.
You can google “OSCE checklists” to see examples, however, keep in mind that these may not be all-encompassing based on what your PA program is looking for when evaluating. I would recommend creating your own OSCE checklist for different history and physical exam scenarios for different body systems and chief complaints.
Example of a “History Taking OSCE Checklist”
This checklist serves as a guide to ensure that all relevant aspects of the patient's medical history are covered during the history taking process. It may also serve as a reminder of key questions to ask, important details to gather, and best practices for patient-centered communication.
Enter room, wash your hands.
Introduction: Greet the patient, introduce yourself as a PA student, mention who you’re supervising physician is, and explain the purpose of the history taking.
Patient's chief complaint: Ask the patient to describe their main problem and the reason for their visit.
History of Presenting illness: Ask about the onset, duration, and course of the current symptoms, including any changes or fluctuations. Ask about any relevant associated symptoms
Past medical history: Ask about any relevant past medical conditions, including surgeries, hospitalizations, and chronic illnesses.
Medications: Ask about current and past medications, including dosages, duration of use, and any adverse effects.
Allergies: Ask about any known allergies and adverse reactions to medications or other substances.
Family history: Ask about any relevant family history of medical conditions, such as heart disease or cancer.
Social history: Ask about relevant social history, including alcohol and tobacco use, occupation, and living situation.
Review of systems: Ask about any relevant symptoms in different body systems, such as fatigue, weight loss, or skin rashes.
Closing: Thank the patient for their time and summarize the main points of the history taking.
It is important to keep in mind that the checklist should not be followed rigidly and that it is also necessary to use clinical judgment and adapt to the specific needs and circumstances of each patient.
Example of “OSCE Physical Exam Checklist”:
Physical Exam checklists help you ensure you cover all relevant aspects.
Many physical exams are best done following an organized flow, and use mnemonics can help you remember the steps. For example the cardiac exam you can use “IPPA”, which stands for Inspection, Palpation, Percussion and Auscultation.
For Orthopaedic exams you can use “Look, Feel, Move” (inspect, palpate, range of motion).
Enter room, wash your hands.
Introduction: Greet the patient, introduce yourself as a PA student, and explain the purpose of the knee exam.
Inspection: Observe the knee for any swelling, deformities, or asymmetry.
Range of motion: Assess the patient's knee flexion and extension, and check for any pain or crepitus.
Palpation: Palpate the knee for any tenderness, swelling, or masses in the joint space, patella, and surrounding structures.
Special Tests:
McMurray's test: Perform McMurray's test to assess for meniscal tears in the knee.
Lachman's test: Perform Lachman's test to assess for anterior cruciate ligament (ACL) injury.
Anterior drawer test: Perform the anterior drawer test to assess for ACL injury.
Posterior drawer test: Perform the posterior drawer test to assess for posterior cruciate ligament (PCL) injury.
Valgus and varus stress test: Perform the valgus and varus stress tests to assess for collateral ligament instability.
Closing: Thank the patient for their time and summarize the main findings of the knee exam.
What is the OSCE evaluating?
The OSCE is an important tool for quality assurance and professional development in the training of PAs, and helps to ensure that future PAs have the necessary skills and knowledge to deliver safe, effective, and patient-centered care in their practice.
Here is what the OSCE is evaluating:
Clinical history taking: The ability to gather and interpret relevant information from the patient's medical history.
Physical examination: The ability to perform a thorough and accurate physical examination, including the use of appropriate techniques and equipment.
Communication and interpersonal skills: The ability to communicate effectively and empathetically with patients, their families, and other healthcare professionals.
Clinical Reasoning and diagnosis: The ability to interpret and integrate data from the patient's history, physical examination, and laboratory results to reach a diagnosis.
Management and treatment planning: The ability to formulate a management plan, including the selection and initiation of appropriate treatments, and the explanation of these treatments to the patient and their family.
Professionalism and ethics: The demonstration of professional and ethical conduct, including confidentiality, informed consent, and respect for the patient's autonomy.
Helpful tools to prepare for the OSCE
Textbooks: Relevant textbooks on physical examination and diagnosis, such as "OSCE and Clinical Skills Handbook" by Katrina Hurley can provide a comprehensive overview of the physical exam and the skills needed to perform it effectively.
Online videos: Online videos of physical exams on Youtube can help you to see how experts perform the exams and to learn from their techniques and approaches.
OSCE checklists: OSCE checklists can help you to stay organized and to ensure that you cover all the relevant aspects of the exam. You can create your own checklist, or find checklists online that have been created by other students and clinicians.
Study groups: Practice with fellow PA students! This can provide an opportunity to practice physical exams and to receive feedback on your skills.
