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        Integrated Comprehensive Clinical & Communication Skills Approach For Patient Interviews & OSCE Exams

USMLE Step 2 CS   MCCQE II   PLAB 2    ECFMG   Medical Student

 

 
     
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Clinical Skills Assessment Medical OSCE Exam (OSCE home)

OSCE Exam Formats

 

Objective Structured Clinical Examinations (OSCEs) stations in USMLE Step 2 CS, MCCQE II, PLAB Part 2 and medical school clinical exams are differently designed to assess one or more of your clinical skills depending on the purpose of that exam. However, required medical knowledge, clinical skills, and communication skills are the same among these OSCEs. It is important to fully understand what is exactly required to be performed in each station and to what medical extent. You will be assessed for only those skills asked in that station. Tasks other than those requested or more than expected at this stage of your medical knowledge, regardless of whether you performed them right or wrong, wont be counted and most critically will waste your valuable limited time. 

 

The length of the OSCE station is generally 5-20 minutes. You will perform a medical encounter with a standardized patient (SP) just like a real medical encounter. In some OSCE exams, an examiner (a physician)  will be present during these encounters to assess your clinical skills and communication skills based on a standard checklist. Other OSCE Exams use videotaping the entire encounter to be assessed by more than one examiner later. A nurse may also be present in management stations to receive management orders from you and inform you about the progress.


There are mainly four OSCE formats:

Focused History Taking OSCEs

Focused Physical Examination OSCEs

Consult OSCEs

Emergency Room OSCEs

For detailed description of each format click on the links above. 

Combination of the above formats is the usual for USMLE Step 2 CS and is common in other long OSCEs, like a focused history taking and a focused physical examination, or a focused history taking and a consult.


Some OSCEs ends with a one or two minute oral questions period usually called "Post Encounter Probe (PEP)". During this time, you are not allowed to talk to the SP but only the examiner. The examiner will ask you 2-4 standard questions which are usually: 

  • What is your one working diagnosis for this patient?
  • What is your three most relevant differential diagnosis?
  • What are the risk factors of this patient?
  • What is your only / three investigation you are going to order for this patient and why?
  • What is your initial / short term plan of management?
  • What is your long term plan of management?
  • Interpret this lab findings / imaging...etc.
  • Prognosis? If this patient came back in .. days / weeks with .. what will be your explanation

Some OSCEs alternate with a period of  written questions PEP covering the same upper listed questions.

There are few other modified formats that fall into one of the above listed types, such us: 

  • Patient write ups (Admission, discharge, progress, follow up, pre-op, post-op notes, and referral and thank you letters.). 
  • Consult over the phone with a patient, a caregiver, or another physician
  • Interpretation of diagnostic materials such as labs, microscopic, ECGs, X-rays, CT.. etc.
  • Presenting the case to the examiner with or without a differential diagnosis, plan for immediate and long term managements as an evaluation of your clinical reasoning. 
  • Performing practical skills such as venepuncture, inserting a cannula into a peripheral vein, suturing a wound, vaginal bimanual exam, rectal digital exam, PAP smear, breast exam, testes exam, prostate exam, ophthalmoscope, diagnostic procedures, basic cardio-pulmonary resuscitation (adult and child), performing urinary catheterisation, mixing and injecting drugs into an intravenous bag, giving intramuscular and subcutaneous injections, safe disposal of sharps .. etc by using manikins.

Some of these may also be included in or at the end of the above formats.


As you know, all medical students and graduates will take several OSCEs during their medical life starting from the medical school OSCEs then any of USMLE Step 2 CS, MCCQE II, PLAB Part 2 OSCEs. So, develop your clinical skills and use them repeatedly during the OSCEs and also, for your benefit, later in your practice. 

As in each station within the same exam day you'll encounter a different standardized patient and examiner, you may repeat the same skills and even the same words and descriptions. Assessment of each station is done separately by different evaluators.

 
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