Objective Structured Clinical Examination (OSCE) (PLAB PART 2)

Objective Structured Clinical Examination (OSCE) (PLAB PART 2)



PLAB part 2
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The aim of the OSCE is to test your clinical and communication skills. It is designed so that an examiner can observe you putting these skills into practice.

Overall nature of Exam

When you enter the examination room, you will find a series of booths, known as 'stations'. Each station requires you to undertake a particular task. Some tasks will involve talking to or examining patients, some will involve demonstrating a procedure on an anatomical model. Details of the tasks are explained below under 'Content'.

There will also be two rest stations in the circuit. Sometimes these stations will contain instructions asking you to read or write something about the station you are about to go to or the station you have just left. If there are no instructions, you should remain quietly in the booth until the bell rings signalling the end of that station.

You will be required to perform all tasks. You will be told the number of the station at which you should begin when you enter the examination room. Each task will last five minutes.

Your instructions will be posted outside the station. You should read these instructions carefully to ensure that you follow them exactly. An example might be:

'Mr McKenzie has been referred to you in a rheumatology clinic because he has joint pains. Please take a short history to establish supportive evidence for a differential diagnosis.'

A bell will ring. You may then enter the station. There will be an examiner in each station. However, unlike in the oral examination, you will not be required to have a conversation with the examiner; you should only direct your remarks to him or her if the instructions specifically ask you to do so. You should undertake the task as instructed. A bell will ring after four minutes 30 seconds to warn you that you are nearly out of time. Another bell will ring when the five minutes are up. At this point, you must stop immediately and go and wait outside the next station. If you finish before the end, you must wait inside the station but you should not speak to the examiner or to the patient during this time.

You will wait outside the next station for one minute. During this time you should read the instructions for the task in this station. After one minute a bell will ring. You should then enter the station and undertake the task as instructed.

You should continue in this way until you have completed all the tasks. You will then have finished the OSCE.

Content of the stations

Each station consists of a scenario. An examiner will be present and will observe you at work.

The scenario could be drawn from any medical specialty appropriate to a Senior House Officer (SHO).

Although the tasks you will be instructed to do will involve a number of skills, one skill will predominate.

The skills to be tested are set out below. They will not necessarily be tested in the order given here. Under each skill area you will find some examples. Please note that these are only examples; other topics will be tested.

History taking

Your candidate instructions will set the scene. You will be asked to take a history from an actor pretending to be a patient (a simulated patient). The actor will have been given all the necessary information to be able to answer your questions accurately. You should treat him or her just as you would a real patient.

Examples: abdominal pains, rectal bleeding, amenorrhoea, severe headache, pneumonia

Examination skills

You will be asked to examine a particular part of the body. You may have to examine a simulated or real patient or perform the examination on an anatomical model. Although you should talk to the patient or model as you would to a patient in real life, you should only take a history or give a diagnosis if the instructions require you to do so. You may be asked to explain your actions to the examiner as you go along.

Examples: breast examination, cardiovascular examination, examination of abdomen, hip examination, knee examination

Practical skills/use of equipment

This is to assess some of the practical skills an SHO needs. The stations concerned will normally involve anatomical models rather than patients.

Examples: IV cannulation, cervical smear, suturing, blood pressure

Emergency management

These stations will test whether you know what to do in an emergency situation. You may have to explain what you are doing to the patient or to the examiner. Your instructions will make this clear.

Examples: resuscitation, chest pain, trauma

Communication skills

There will be a communication skills element in most stations. However, in some stations this skill will be the principal skill tested. Areas tested may include interviewing (including appropriate questioning, active listening, explaining clearly, checking understanding) and building rapport (including showing empathy and respect, sensitivity to others' emotions and coping with strong emotions in others).

Examples: instructions for discharge from hospital, explaining treatment, consent for autopsy, ectopic pregnancy explanation