Top Tips To Exam Success
Dr Giam - Senior OSCE Examiner - provides advice and practical tips with
regards preparation and performance.
“He who studies medicine without books sails an uncharted sea, but
he who studies medicine without patients does not go to sea at all”
The above quote by Sir William Osler (1849-1919) still holds true.
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Dr. Nigel Giam
Mentor OSCE Course Director
Senior OSCE Examiner
Lecturer in General Practice
MBBS(Hons), MRCP, MRCGP(Distinction)
DRCOG, DFFP, DCH
To maximise success in passing medical finals, one has to develop problem solving skills centred
around patients. Therefore developing and practising CONSULTATION and EXAMINATION skills
with patients and honing PRESENTATION SKILLS early on in the final year is of paramount
importance in preparing for the exam.
1. FOCUS ON HIGH YIELD CASES :
How are patients chosen?
: patients that are chosen for exams are likely to have common CHRONIC and STABLE conditions
with CONSISTENT POSITIVE SIGNS on examination.
: although this may seem obvious, if you start applying this principle to systems, it helps to
narrow the sorts of cases you may encounter in finals and PACES.
: Mentor OSCE Courses will highlight cases which consistently appear in the exam and will make
sure that every delegate is examined under OSCE conditions within a safe and supportive
2. JUSTIFY YOUR DIAGNOSIS :
You can pass an OSCE even if your diagnosis is wrong or you have misinterpreted a sign. What
matters is that the signs or symptoms you do pick up and interpret are consistent with the
diagnosis you propose and most importantly if you can present your examination, findings and
conclusion with confidence.
An examiner will always want to know HOW and WHY you have arrived at a diagnosis. Proposing
a list of investigations is not useful, unless you can justify why these investigations are relevant
to the diagnosis, either in the context of staging of disease or in it's clinical management.
3. BEHAVIOURAL ATTITUDE :
Always show respect to the patient and to the examiner. Over my years as an Examiner, I am
often surprised by the abrupt manner of some medical students during the exam.
FIRST IMPRESSIONS COUNT! - You never have a second chance to make a good first impression
Learn to control nervous anxiety, maintain good eye contact with your examiner and never fail to
greet and thank your patient at the start and end of the examination.
4. FOCUSED CONSULTATION SKILLS :
The purpose of taking a focused history is to ARRIVE AT A DIAGNOSIS and involves the use of
closed, relevant and specific questions. In such stations asking a patient a question such as:
"Is there anything I have missed?" OR
"Is there something else you would like to tell me?" is a BIG NO NO!
It is your job to actively elicit information and this responsibility cannot be passed on in the exam
to anyone else, including the patient!
SUMMARISE - at the end of taking a focused history, as this will give you some breathing space
to put together the facts you have gathered and think about any other RED FLAG questions you
have may have missed. A good summary will often engage the patient more, show that you have
acknowledged their concerns and the patient will often contribute more information to help
facilitate the consultation.
5. COMMUNICATION SKILLS :
It is well known fact amongst examiners, that if you are going to fail an OSCE, the likelihood is it
will be either on a communication or focused history taking station.
Why? - Students often approach communication skills with a degree of rigidity. Although this may
work for examination stations, this does not work where your INTERPERSONAL SKILLS and SELF
AWARENESS are being assessed. A classic example of this is the way in which students will ask
about ICE (Ideas, Concerns and Expectations) as if it is a 'tick' in the OSCE box which they can
forget about once verbalised.
ICE IS NOT A TICK BOX EXERCISE. In such stations there are often global overall marks and
also input from the patients themselves with regards the fluency and rapport with which the
student consults. Eliciting concerns and health beliefs in a natural way is key in passing such
stations. This involves self-awareness, for example by considering the patient's perspective and
putting yourself in their shoes, displaying sincerity and acknowledgment.
6. PRESENTATION :
The key to this is being perceived to manage your uncertainty with CONFIDENCE. You will need
to COMMIT in the exam. Phrases such as
"I thought I heard a murmur" or "It might possibly be aortic stenosis" do not inspire confidence in
an examiner. Aspire to present confidently "I believe the diagnosis is that of aortic stenosis, as
evidenced by etc.."
Take responsibility for your decision making and do not pass the buck! I often hear students
when asked by role-playing patients as to what the diagnosis is, respond by saying "I am sorry,
but I am only a medical student and we will have to ask the consultant.". Again this will not be
deserving of a pass in the exam, as you are being assessed on how you come to a diagnosis and
your decision making skills.
This takes PRACTICE, PRACTICE, PRACTICE. Fluency is key! Passing medical finals will not
come from keeping your head in the books. Get out and see some patients to apply, centre and
practice the theory!
Best of Luck!
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