OSCE Exam
Observed Structured Clinical Exams (OSCE)
During the OSCE, students will be expected to be able to demonstrate all of the PE manuevers that are on the adult PE checklist. You will not be given the checklists ahead of time. Rather students are expected to know what portions of the PE to perform given the chief complaint or patient situation.
Remember that the appropriate PE may not fall neatly just into one system. Someone in
whom you have concerns for congestive heart failure would require as part of
their “cardiac” exam, the cardiac exam, lung exam to check for pulmonary edema,
abdominal exam to check for liver enlargement, and an extremity exam to check for
edema. It all depends on your differential and what information you need to collect to
figure out the diagnosis.
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Here is some information to help address questions that generally come up regarding
the purpose and details of the OSCE.
What is the purpose of the OSCE?
The OSCE is the final exam on the subject of clinical skills. Its purpose is to assure that all
students are clerkship ready in basic interviewing and physical exam skills. It is an opportunity for medical schools to identify and help those who may need additional preparation prior to starting the clerkships. It is also a learning experience to help you consolidate your skills. All students must pass the OSCE in order to start their clerkships.
What happens at the OSCE?
Each student will be assigned to a half day for the OSCE. (more or less). During that time, students will rotate through +/- 6 different examination stations. All stations are about 35
minutes in length with 20 minutes for the patient interaction, 8 minutes for a written exercise, and 7 minutes for feedback. There will be a combination of standardized and real patients, and some of them will have physical exam findings.
The stations represent patients with chief complaints and fall into 3 types:
1. Communication Skills stations (similar to your FPC small group exercises)
2. Physical Exam Skills stations
3. Focused History and Physical Exam stations
The written exercises vary from station to station, are designed to assess certain areas of knowledge as well as your skills in critical thinking/clinical reasoning and written communications.
A case description with specific instructions for each station will be posted on the outside of the individual stations. You will not know to what stations you have been assigned
until you check in and you will not know the patient’s chief complaint until you arrive at each station. You will therefore want to arrive prepared to demonstrate your full range of clinical skills. The tasks that you will be asked to perform, you have learned in the first two years of medical school. At UCSF, for example, students learn this through FPC
lectures, FPC small groups, PE groups, Integrated Exercises, preceptorships, and other blocks such as BMB and Life Cycle.
How will I be evaluated?
As the final exam for the course, students will be evaluated based on their competency in the five foundations of FPC: professionalism, the patient-doctor relationship, communication skills, physical exam skills, and clinical reasoning.
At each station, a faculty member or standardized patient will be present to provide you feedback on your performance. Evaluations will be based on your ability to conduct a patient interview/discussion and perform a basic physical exam. You will be asked to describe, but not necessarily identify, all physical exam findings. All evaluators will
be using checklists similar to those you experienced last year during the mini-OSCE. A sample OSCE checklist is sometimes posted for your review. The actual checklists for each station are secure and will not be released prior to the OSCE. A numerical score will be generated for each student.
Performance on the written exercises will be assessed on a three point scale: above expected competency, at expected competency, and below expected competency. These points will be added to your checklist scores to generate your final OSCE performance score. No student will pass or fail solely based on the points from the written exercises.
How should I prepare?
The best preparation for the OSCE is to review and practice your interviewing and physical exam skills using the Adult PE Review checklist and the attached sample OSCE checklist from 2008. You are encouraged to practice with friends, during the Adult PE Review and
Self-Assessment exercise, and at the Life Cycle Integrated Exercise session. You may also wish to review the Bates videos.
Because you will be seeing patients, you will need to be dressed professionally, similar to your preceptorship dress with your white coat and name tag. You will also need to bring your stethoscope, reflex hammer, tuning fork, and visual acuity card (all other equipment will be provided in the examination rooms). Please make sure that you arrive on
time. Late arrival reflects poorly on your professionalism and lost station time may not be made up.
When do I get my OSCE score and what happens if I don’t do well?
OSCE scores will be posted approximately 2 weeks after the exam. In addition, students who have been identified by faculty as having areas of concern in their performance will be notified separately by email.
For students who do not perform at expected competency levels, we will work with you to arrange for special preceptorship and teaching in your areas of need before the clerkships start. We scheduled the OSCE with enough time before the clerkships begin to assure that anyone who needs further preparation will be able to complete it well in advance of the
clerkships.
Remember, the OSCE may also be a wonderful learning experience. The evaluators will usually be giving you feedback as you go through each station. Students regularly report AFTER the OSCE that they both enjoyed and learned a great deal from it.
Sample introduction to students
