Getting yourself OSCE ready: passing the fellowship clinical exam (part 2)

This is the second in this 2-part series of my thoughts on getting ready for the ACEM Fellowship Clinical exam. The first part was on the preparation phase, and this one is hopefully about a suggested technique. Getting ready ends when you walk into the room. I've got no advice past that...

An OSCE technique

Communicate, communicate, communicate

The OSCE format is all about communication. Successful candidates need to share their knowledge completely and succinctly within the bounds of the surreal framework provided by the OSCE scenario. Anecdotally, candidates with a less polished communication style, including having English as a second language, seemed less likely to pass the clinical exam, despite having at least as good knowledge.

Your practice OSCEs and time with your study group are the chances you have to polish your communication. This includes preparing a 'spiel' on common topics—HIV/hepatitis exposure, complaints, underperformance, febrile convulsions, lack of capacity, breaking bad news, the uncooperative referral, PE in pregnancy, LP for subarachnoid haemorrhage, the list goes on. These are the easy points.

You and your study group need to be harsh on each other. You will hear good turns of phrase used by your colleagues—steal these. You will also hear bad phrasing, poor word choice and clumsy delivery. Call these out and work out a better way to say it. This will benefit all involved. Be ready to be on the receiving end of this. Listen out for mannerisms or repeated phrases such as 'you know', 'um', 'it's like', and call these out too.

Look the part

During this exam, you are a FACEM.

The exam allows you to wear what 'you would normally wear at work', but make sure this is neat and appropriate for a consultant to wear. Some people also chose clothes that made them feel special, strong, lucky—their suit of armour for the exam. Get used to wearing this during your practice sessions.

Stride into the room with confidence, making sure you don't cross the line into arrogance. You must remain open and receptive to what lies ahead. I liked the routine Vic Brazil described in one of her talks that she said came from Cate Blanchett's pre-stage routine: imagine that your are putting on your crown to bring your head up and neck long, putting on your cape that draws your shoulders back into a strong, open stance, and turning on the stage lights under your chin to lift up and project your chin forwards.

You are a consultant, walk the walk and talk the talk.

Use the full 3 minutes

When you sit down at a new station you have 3 minutes to prepare yourself for what's awaiting you behind the door. To me, the tasks in this time are:

  1. Clear your mind from what just passed. Maybe you just endured a screaming relative, a mute psychiatric patient or completely rocked a resuscitation. None of that matters or can be allowed to cloud your mind, you must move on. Breathe.
  2. Read the scenario in full. Make sure you understand all the information and consider the significance of each component. They've always said that every piece of information is included for a reason. Why is the scenario in a rural centre, who are the people involved, what help can you expect (and call for if appropriate), what considerations are specific to this scenario?
  3. Make sure you have the task clear in your mind. What are you expected to do in this time? In approaching this, make sure you consider the domains being assessed (more on this below).
  4. Start mapping out what you need to say to address the task in the bounds of the scenario. Work out which expertise spiel may be required and how it needs to be adapted. Go through the relevant treatment algorithm, all the way to the end. How do you expect the scenario to progress? What are the key points you need to make sure you fit in, and how will you phrase them?

Consider the domains

The 8 curriculum domains are a new consideration for the clinical exam. For each scenario, you are given a list of domains being assessed. To pass the scenario, you need to 'perform' adequately in each domain. On the marking sheet for the last OSCE, each domain was scored individually and contributed to the mark.

All scenarios will test Medical Expertise, and that's ok, you've got that nailed. But when the assessment includes Health Advocacy, Leadership and Management or Scholarship and Teaching, you need to work out what part of the scenario and what part of your response is going to address this. It could be smoking cessation, investigation avoidance, team management, conflict resolution or being up to date with the latest literature. Part of your 3 minutes should include working out the key issues to address for each domain on the list.

Walk through the doors

Your destiny awaits...

You walk through the doors with confidence, you head up and shoulders back, receptive to what lies ahead. You hand over your sticker sheet, if that is still the process, then you immerse yourself into the scenario. Part of simulation is the 'reality contract', that is, believing in and immersing yourself into the scenario. The room is not an ED, there are people watching and your crashing patient does not look distressed, despite having no arms or legs. No matter, you believe it's real, you greet your patient, staff and actors as you would in real life, and then you start delivering and checking off the key points you prepared in your 3-minute warm up.

The end is nigh

Congratulations to all of you who have passed the written (and commiserations to those who didn't). Now is the time to start the even harder grind towards the clinicals.

You're near the end now...  soon you (and your support team) can rejoice.

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