MRCPsych OCSE exam: What happens in the actual exam?

There are twelve stations and a rest station.  In each station there will be a patient and an examiner.  An observer might by present in some of the stations. You will be given a minute to read the instructions posted outside the station.  A copy of the instructions will also be present in the station and you can check them should you need to.  Its best not to do so as it will not only waste valuable time but will also interfere with developing rapport with the patient.  Before you start the OSCEs you will be given a writing pad and a pen and you can take down name of the patient or any other important information. 

After a minute a bell will ring and you can then enter the station.  Acknowledge the examiner.  S/he will check your roll number.  After this you are not expected to interact with the examiner, unless the instructions say otherwise.  Proceed with the task and focus all your attention on the patient but make sure that you speak loudly so that the examiner can hear you.  A bell will ring after six minutes indicating that you have only one minute left.  It’s best to summarize in the last minute and ask the patient if he would like to ask any questions.  Another bell will ring after a minute.  You must then leave the station and proceed to the next task.  If you have not done well in the last station try not to think about it and get in the habit of changing your mind set quickly. You will have three weeks after the exam to analyse your performance minutely and shred yourself to pieces about real and perceived failings.

Sometimes a station is followed by a post encounter or tag station and you are expected to answer question about the encounter in the previous station.  The instructions outside the first link station will tell you that it will be followed by a tag station. In my OSCE exam we had to assess risk of self harm in a lady who had presented after taking an overdose and in the tag station had to discuss the risk and management plan with the on call consultant.

Remember the Royal College has already assessed your theoretical knowledge.  OSCES check your skills as a clinician. 

Do’s and Don’ts 

• Before the exam, practice with as many patients as you can.
• It helps to practice in groups.  Observe your colleagues and seniors.  You might pick up useful interviewing techniques.
• Dress professionally
• Greet the patient
• Shake hands
• Introduce your self by name.  My name is Dr. Alex Martin.  Don’t say that you are an SHO.  To most people it means nothing.  It is best to introduce yourself as a psychiatrist.
• Ask the patient’s name if not given in the instructions
• Adopt an open posture.  Sit with feet resting on the floor.  Lean forward slightly if the situation demands but don’t invade patient’s personal space.
• Explain your task to the patient
• Make and maintain appropriate eye contact
• Ask clear questions.  Don’t use medical jargon.  If you have to use technical terms explain yourself
• Begin with broad open questions and then move to close questions
• Don’t ask multiple questions
• Ask follow up questions
• Use non-verbal and verbal encouragements (head nods)
• Give pauses and let patient talk freely for the initial 30 seconds or so
• If you don’t know the answer to a patient’s question, say so
• Acknowledge patient’s concerns
• Be honest but sensitive
• Summarize. 
• Use all the allotted time.
• End by thanking the patient.  Never leave the station abruptly. 
• Use the rest station to calm your self down and to think about the next station.  Remain positive and confident. 
• In physical examination stations describe the manoeuvres and explain what parts of body you would need to expose and touch.  If it’s an opposite sex patient ask for a chaperone.
• Help the patient get on and off the couch.
• Ensure patient’s dignity and comfort