Tips on the new ACEM Fellowship Clinical Exam

Update 23/2/15: The example OSCE marking sheet has been released. As expected, it is along the same lines as the Shift Report WBA form.

Update 20/3/15: ACEM have provided some more details on application, dates and resources available for the upcoming OSCE

The Official Word

You'll be able to find these details on the ACEM website, reproduced below for your reading pleasure. I'd recommend checking the official website as things may change. OSCE example stations and videos are available in the Resources tab and worth checking out to get a feel for the style.

 

The Inside Word

ACEM recently ran a workshop for examiners on how the OSCEs will work, including a number of trial OSCEs using some lucky trainee volunteers. Our inside man (or woman) returned from this with a few hints and ideas about what to expect when D-Day arrives... (with a few updates added on 5/2/15)

Types of Stations

The types of stations likely to appear in the OSCEs can be broadly grouped into 6 categories:

  1. High level resus or emergencies using high-fidelity simulation or simulated patients
    An example of this is the Asthma OSCE example available on the ACEM website, including a video of the scenario in action

    It has been debated whether this will occur, given logistical difficulties, but it seems reasonable to assume there will be some simulated scenarios

  2. Communication
    This could be explaining and obtaining consent for a procedure, breaking bad news, conflict resolution, patient discharge advice, responding to a complaint or staff management for example
  3. Procedures
    Much like the new WBA DOPS, for example setting up ventilators, LP, chest drain, paracentesis, US guided vascular access
  4. Simple non-resus patient management
    For instance, migraine, asthma, snake bite or fracture management.
  5. Teach or explain the results of an investigation (eg ECG, ABG or radiology) then develop a management plan for accompanying patient or scenario
    For example, for a defined case presented by a registrar, you may need to interpret a result, and then develop a management plan
  6. History taking (more likely) or physical examination (less likely, as more difficult to standardise)

Curriculum Domains

For each of these stations, there will be an expectation to address some of the curriculum domains outlined in the new curriculum framework.

  1. Medical Expertise—the most important domain
  2. Prioritisation and Decision Making
  3. Leadership and Management
  4. Communication
  5. Teamwork and Collaboration
  6. Professionalism
  7. Health Advocacy
  8. Scholarship and Teaching

These will not be prompted for, so will require consideration as the scenario progresses to ensure as many domains as possible are being addressed. Not all domains are expected to be demonstrated in every scenario, but over the course of the 18 stations, these will be heavily tested. It was observed in practice OSCEs that hitting all of the required domains could be difficult if not cogniscent of this requirement (eg, doing well in a scenario for expertise, decision making and advocacy, but failing due to communication, teamwork or leadership).

Just a Day at the Office

It is expected the combination of OSCEs will end up representing what we do—just another (really busy and challenging) day in the office. A couple of other key points to note is that:

  • The examiner will not be interacting with you, but merely observing, and is best ignored from your point of view—you will need to immerse yourself in the simulation
  • Therefore you will not be prompted or guided, nor receive feedback on your progress
  • This also means that noone will be time-keeping for you. You will need to manage your own time in each station

How will it run?

Up to 18 OSCEs in 2 separate sessions (9 OSCEs and 1 rest station per session, 10 minutes each OSCE).

3 minutes reading outside exam room. Laminated sheet provided with information on the station, and at the bottom of the shee, the candidate will be advised which domain(s) they will be assessed. This needs to be read very carefully. A high degree of planning is required during this reading time to perform well.

7 minutes in exam room. For most types of OSCEs there will be no interaction between the candidate and the 2 examiners. If the OSCE involves demonstrating a procedure or use of a piece of equipment, interaction with examiners may be required. For all other OSCE types the interaction will be with actors who play roles of patients, patient family, junior medical staff. There is no opportunity for the examiners to direct candidates who are performing poorly or to time keep to ensure timely completion of the OSCE.

How will it be marked?

There will be a number of domains that will be assessed for each OSCE. The marking is almost identical to the marking of WBAs. There is a global mark given for each OSCE: clear fail, marginal fail, borderline, marginal pass or clear pass.

A numeric mark is also generated for each OSCE. The pass mark for the entire OSCE component is determined by the college when the examination is completed.

What can I do to prepare?

  • Candidates need to familiarise themselves with ACEM assessment domains
  • Practice to achieve consultant level performance of these domains during routine WBAs
  • Focused practice of OSCE types in the categories mentioned above
  • Opportunities for these are:
    • SIM sessions
    • Fellowship teaching sessions
    • Clinical shifts—resus shifts, procedures, on the floor interaction with consultants and junior staff
    • Self directed study group learning

Update 23/2/15: OSCE Marking Sheet

As alluded to in the comments below, the marking sheet for the OSCE is quite similar to the WBA Shift Report form.

Update 20/3/15: OSCE Dates

An email today from the college has provided this information:

"We are writing to provide you with an update on the FE15.1 clinical (OSCE).

  1. Please remember to send in your application for the OSCE if you intend to sit (even if you don’t know your written exam results) before the closing date of 10th April – we will check everyone’s eligibility once results are available and will only charge the OSCE fee once we have the final list of those eligible.
  2. Please be aware that due to large candidate numbers, we will now also be examining on Wed 6th May and therefore you will need to make yourself available for the entire 3 day period (Wed 6th - Fri 8th May). You will receive your Candidate Information and personalised exam timetable details as soon as possible after results have been determined. We advise against booking flights until this time when we will advise you which of the 3 days you need to be here.
  3. Please take note of the resources available to help you to prepare for the OSCE. The ACEM website has a variety of information including a full set of OSCE questions, videos and information on the exam format (including guidance on what to wear and bring to the OSCE). Keep a look out for a new online module which is being released today. It has been prepared by a trainee to give a candidate's perspective on how to prepare effectively.
  4. Physical examination in the OSCE​: There have been a number of questions about how trainees should prepare for the OSCE and how their DEMTs should assist them. The following information has been prepared for you by the Censor-in-Chief and Chairs of the Fellowship Exam and Examiners' Committee for candidates preparing for the 2015.1 OSCE.

Physical examination is an important skill for Emergency physicians and may be examined in the Fellowship clinical exam (OSCE). Advice to trainees preparing for the 2015.1 OSCE is that they should refine and rehearse their physical examination skills in the real context of Emergency Medical practice. In an OSCE station, their physical examination should be tailored to the clinical scenario and patient as presented in the station. Where instructed, candidates should perform an appropriate and focussed examination, as would be expected if faced with a similar case in the emergency department."

In addition, as mentioned in another post, there is a new online OSCE database in the FOAM realm where people can contribute and test themselves with OSCEs laid out in the new ACEM structure.

 

Are you excited yet?

Hopefully that is helpful (and accurate)! If anyone else has any tips or recommendations to help preparations for the new format exam, please feel free to share!

 

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