Preparing for the Second-Year OSCEs
Understand the CONTENT & CHARACTERISTICS of the exam
WHEN the exam is administered and
HOW MANY CASES are used on each exam
Four cases (Part A) are administered in January and Part B consisting of 6 (or 7) cases are administered in April.
CONTENT OF THE SECOND-YEAR OSCEs –Where it comes from and what students can study
Any clinically relevant content that has already been presented in the curriculum to date may be included in the OSCEs. However,
the Second-year OSCEs rely heavily on the ICM II Benchmarks, and the Pocket Guide to the Physical Examination. The ICM II Benchmarks include Benchmarks in
Communication skills, and Professionalism. Because most ICM II Benchmark Appendices are considered as supplementary information, cases are not based solely on concepts found only in the Appendices. An exception to this is the content in the
Cultural Communication Guidelines which are found as an appendix to the Communication Benchmarks. Clinical concepts presented in other courses, such as
ICM I, Ethics, and Nutrition, are also included in the OSCEs.
The best advice for students is “know the Benchmarks well, concentrate on the communication and physical examination skills you have been learning through ICM II, and don’t forget the principles of cultural communications, professionalism, and ethics.
Content that has not been presented to all students will not appear on the OSCE until such time as all students have had the opportunity to be taught the material. For example, if students have not been taught to do a pelvic exam prior to the OSCE, the pelvic exam will not appear on that particular OSCE. If all ICM II groups have not yet reviewed material such as the musculoskeletal benchmarks or the neuro exam, that material will not appear on the exam until it has been presented to all students.
CASE FORMATS used in the Second-Year OSCE
Most cases with a standardized patient will have 2 minutes to read instructions, 8 minutes with the patient, and 2 minutes of feedback. A few cases may be shorter depending on the nature of the case.
You may be asked to take a history or part of a history from a patient. If so, we have designed the task to be manageable within the time frame given. However, don’t forget that if you are seeing a patient for the first time, in addition to exploring the chief complaint, you should explore if the patient has any other medical problems, find out about their past medical history, inquire about their medications & allergies, ask about pertinent family or social issues etc. Don’t assume these items exist in some theoretic chart that you don’t have. (See:
What is a Focused History or Exam?)
You may be asked to do a specific physical diagnosis task. If so, think about what the benchmarks call for and don’t get distracted by taking a history instead.
There are other formats that you will encounter. You may be asked to examine a mannequin and/or answer some questions about the case. You might have a short computer simulation. You might be asked to write answers down on paper about a clinical scenario, or lab interpretation or picture. You might be on the phone with a patient.
How OSCEs are GRADED
Grading Criteria:
In every encounter with a standardized patient, the observers look for two main things: 1) Communication skill must be acceptable, and 2) A checklist is used to record whether you did a sufficient number of things you have been taught to do during an interview or examination.
Specific grading criteria are developed to either grade the case or guide the observer in grading the case. Observers are either trained standardized patients or clinicians. In observed cases, the grading criteria provide guidelines but the final determination of the student’s performance rests with the observer.
Is PART A (first 4 cases) graded differently than PART B (last 6 cases)?
The first four cases in January are graded in the same manner as the last six cases that are administered in March and April. The results of the first four cases are reported to students, and copies of the student’s test materials are forwarded to the student’s College mentor so the student may review the material and receive feedback. However, meeting to review the materials with the mentor is optional for the first four cases, and the number of Needs Development’s (NDs) on the first four cases is not used to determine if remediation is required to meet the Second-year OSCE requirement.
The last 6 or 7 cases are administered in March and April. Those students who fall in a Needs Development category (usually 2 or more NDs on individual cases) on the last 6 cases are required to meet with their College mentor to analyze the material and receive constructive feedback. That meeting must occur in order to meet the Second-year OSCE Requirement, which is a prerequisite to starting the Clinical Clerkships. The purpose of that meeting is to analyze the results, exchange constructive feedback, and determine if any further remediation is required prior to starting the Clinical Clerkships.
How OSCE performance is recorded
The date of completion of the Second-year OSCE Requirement and whether or not the student is required to meet with the mentor for review is recorded in the student’s E-value portfolio, however the results are not for use in the MSPE (Dean’s letter).
Succeed on the Day of the Examination
How to prepare MENTALLY
Have a positive attitude. If you look at this as an opportunity to measure some of your clinical skills in a protected environment, and enjoy yourself, you will come across well to both the observers and standardized patients. The student with a negative attitude often runs into problems.
Get some rest the night before. Flying into SeaTac on the AM of the exam or being on call the night before is not a good idea.
Relax! Most students find the OSCEs to be fun once they relax, and treat the patients like real patients. If there is something you could have done better, don’t keep thinking about it after you leave the room, there’s usually another opportunity awaiting with the next case.
What to WEAR
Dress as you would if you were a student seeing patients in a real doctor’s office or in a hospital. This means casual business attire – slacks, skirt, tie etc.
What to BRING
Come prepared with your own instruments. It helps if you know how to use them. (Hint: It helps to have your batteries charged.) Bring a pen and a blank note-pad. No cell phones, no data storage devices.
DURING and AFTER the Exam
Pay attention to communication basics: Introduce yourself with your name and position, confirm the name of the patient, wash your hands, have the patient establish the agenda, make sure that’s all that’s on the agenda, ask open ended questions then hone things down with more specific questions. Be transparent in what you want to do. Bring the interview to a smooth closure.
If you are asked to verbalize, let the patient or observer know what you are doing or looking at. It may be impossible for an observer to know what you are examining if you don’t make it verbally apparent.
Don’t share the content of the cases with your fellow students. We have observed this phenomenon for several years and find that sharing of content either does not improve student overall performance, or actually worsens performance on certain items. Not all students receive exactly the same cases, and occasionally we purposefully alter case findings/presentations over the course of the exam.
PRACTICE before the Second-year OSCE
We do not offer a “practice OSCE” per se. However, the first four OSCEs will give you a feel for the type of cases, and the pace of the exam with few if any punitive consequences. You will also have and opportunity to practice working with standardized patients earlier in the year. Some students decide to practice together. If you wish to do that, one student can take the benchmarks and observe how their colleague is able to move through an exam on another student. Other students may find that solitary review of the benchmarks or other study material is more effective.
We ask that College mentors and College groups do not have official OSCE practice sessions. The reason for this is that in the past, this has created an uneven playing field with some groups imagining that they are prepared differently or less intensely than others. If College groups wish to practice the Benchmarks or other clinical skills, they are more than welcome to do so.
Results and Feedback on OSCE Performance
How much feedback will I get about my performance? (AKA “I want more feedback.”)
Thanks to the College mentoring system, the University of Washington gives more feedback about individual student’s OSCE performance than any other school that we know of. There are two primary ways that feedback is given to students.
Some of the cases will be observed and at the end of the case, there will be a very short opportunity to receive feedback from the observer and/or the standardized patient.
We provide copies of all your written materials to your College mentor after the examination, and we encourage students to review that material with their College mentor. For test security reasons, we do not return checklists, or write-ups directly to students.
Students who fall into an overall needs development rating for the Part B (last six) OSCE cases are required to meet with their mentor to analyze the results and receive constructive feedback.
In addition, when results are sent to students a short summary of the class’ performance is usually included so individuals may compare their performance to the class overall. A more detailed OSCE Report is also given to each of the College Mentors.
Administrative Issues
Who is in Charge of the OSCEs?
The Operations Director of the UW OSCE Program is Jennie Struijk, M.Ed.
janim@u.washington.edu
The Medical Director of the UW OSCE Program is David Losh, M.D.
Who makes the OSCEs?
The OSCE cases are written by faculty from various clinical disciplines, and by members of an OSCE Workgroup charged with administering the OSCEs. The overall OSCE Program is governed by an OSCE Steering Committee chaired by the Dean of Academic Affairs. Test results are analyzed by members of the OSCE Workgroup including a testing statistician.
Who should I ask if I have questions about the OSCEs?
Jennie Struijk (janim@u.washington.edu) is a good person to direct your initial question to. You will be notified via e-mail if scheduling or other issues are to be directed to another person.
To whom can I give feedback about the OSCEs?
Feedback may be directed to Jennie Struijk M.Ed., Operations Director of the UW OSCE Program, or to David Losh, M.D., Medical Director of the UW OSCE Program.
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!