How to Ace Your Medical OSCEs

Mastering Communication & Clinical Skills

The OSCE Mindset

In an OSCE, you are acting. You are playing the role of a safe, competent F1 doctor. Examiners do not just mark you on what you know, but how you make the patient feel.

The Golden Framework: ICE

You will fail the "Global Score" if you do not ask about the patient's perspective. This is often the key to unlocking the station's hidden agenda.

  • I - Ideas: "What do you think is going on?"
  • C - Concerns: "Is there anything in particular you are worried about?" (Always ask this!)
  • E - Expectations: "What were you hoping we could do for you today?"

History Taking Structure

Sticking to a structure prevents silence and panic.

  1. PC: Presenting Complaint (Open question).
  2. HPC: History of PC (SOCRATES for pain).
  3. PMH: Past Medical History.
  4. DH: Drug History & Allergies (Never forget allergies!).
  5. FH: Family History.
  6. SH: Social History (Smoking, Alcohol, Occupation, Home situation).
  7. ROS: Systems Review.
Red Flag: If a patient mentions a symptom like "weight loss" or "blood in stool", you must screen for red flags immediately. Ignoring a red flag is a safety fail.

Breaking Bad News (SPIKES)

Used for stations involving cancer diagnoses or medical errors.

  • S - Setting: Private room, tissues ready, eye level.
  • P - Perception: "What do you understand so far?"
  • I - Invitation: "Is now a good time to discuss the results?"
  • K - Knowledge: "I am afraid I have bad news..." (Give a warning shot). Speak slowly. Use the word "Cancer" if true; do not use euphemisms.
  • E - Empathy: Acknowledge their emotion. Silence is powerful here.
  • S - Strategy: Summary and follow-up plan.

General Tips

  • Wash your hands: Do it visibly or state it loudly.
  • Summarise: Halfway through, summarise what the patient told you back to them. It shows you are listening and buys you thinking time.
  • Don't waffle: If you don't know, say "I would like to check the guidelines" or "I will consult my senior." This is safer than guessing.