Performance Art for #ACEMFEx Fellowship Candidates at #acemws17 with @SocraticEM

This idea started back in September last year after some disappointing OSCE results for trainees that appeared to have the right knowledge. Through practice sessions, I noted a pattern of behaviours and approaches that made me question whether the impacts of these were significant in what is designed to be an objective format.

Was their medical expertise being lost in the delivery? Was there a subconscious effect on their marks through first impressions, body language, perceived attitudes? How do we help the trainees who cannot "act" in an OSCE, nor buy in to the "fiction contract", those who can demonstrate these skills in real life, but not in an unrealistic exam situation?

The experience of participants in a role-play is fundamentally different from that of a real-life interaction and that the candidate must do much more interactional ‘work’ to keep the illusion up (Atkins et al, 2016)

I thought back to my exam preparation, and the timely oration by Victoria Brazil that included the pre-performance routine borrowed from Cate Blanchett. This struck a chord with me, and it was something I then consciously practised - to have a consultantoid demeanour throughout the OSCE exams. I have since found similar inspiration this quote from John Cleese's autobiography - an excellent role model if ever there was one - and am now an Adelaide Zoo member as well:

“Self-confidence seemed to me more mimicry than anything else and I suggested visiting Clifton Zoo to watch the leaders in a group of baboons, and learn from them: make your gestures slow and deliberate; cultivate a deeper voice; appear casual at all times; eschew all rapid movements. That was all you had to do to look confident. I also knew I could 'do' confident, and it helped enormously socially that I appeared to be able to fake it no matter how insecure, anxious or inferior I actually felt."

So then, what if we can similarly train our trainees how to perform in the OSCE environment? This would have the double effect of helping to pass the OSCE exam through improved technique as well as potentially improving real-life interactions.

I could not find much in the way of resources, so started searching for help in doing so. Victoria Brazil has been generous with her time to discuss this topic in some detail, and together we identified 4 key aspects of performing in an OSCE environment:

  1. Preparation - psychological, physical and vocal
  2. Moving and not moving - entrances, exits, posture (standing and seated), hands, personal space, touch
  3. Vocal performance - exercises, intonation, pauses and summaries
  4. Facial expression - eye contact, situational awareness, nodding, smiling

We are now devising a workshop to teach and explore some of these skills - Performance Art for Fellowship Candidates - which will debut at the ACEM Winter Symposium in the Barossa Valley in July. This workshop is aimed at advanced trainees who are preparing for their clinical exam, or have it in their sights. It may also be useful for FACEMs who are helping trainees prepare for this last hurdle.

A highly interactive and engaging workshop for advanced trainees preparing for the ACEM fellowship clinical exam. The new OSCE exam can be a challenging format for those not used to role-playing, and candidates’ ability to act in a simulated situation will help ensure their medical expertise and skills are adequately shared. Participants will be guided through some of the unspoken aspects of OSCE technique, including body language, movement, vocal performance and engagement. This workshop will comprise a mixture of discussions, activities and technique development, culminating in practice OSCE stations with performance debriefing.

Find out more and register at

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