OSCE

MADE EASY

FOR ALL

MEDICAL TEACHERS, MEDICAL STUDENTS,

UNDERGRADUATE, POSTGRADUATE

ALL INTERESTED PERSONS IN MEDICAL TEACHING

By

Prof.

RAED MANSOUR, MD
Professor of Tropical Medicine
Alazhar University
2013
 Introduction
One day Hafiz, a Malaysianmedical student wrote

I sat for my repeat OSCE today and it was quite tough. There were four
stations; two history stations and two physical exam stations.

We are required to take history for epilepsy and dysphagia. I couldn't

remember all the questions you should asked for epilepsy and I ran out of
time in that station. There are a lot of questions that you need to ask when
you are interviewing for epilepsy patient and I also forgot to ask about
smoking and alcohol due to time limit. Dysphagia station was a bit easier
but I think I could do better if I wasn't too nervous.

The first physical exam station is to perform shoulder exam on a real

patient. Fortunately, I have studied well in shoulder exam. The diagnosis is
painful arc syndrome (sub acromial bursitis). The examiners ask us to name
two anatomical structures in the shoulder girdle that can cause shoulder
pain and sites that referred pain to the shoulder. They also asked to explain
the pathology or mechanism behind painful arc syndrome.

The next physical exam station is to perform cardiovascular exam on a real

patient with cardiac murmur. It was aortic stenosis and the examiner asked
me to describe all the signs of aortic stenosis. Somehow I'm able to
remember few signs of aortic stenosis but I couldn't finish my answer due to
time limit.

Alhamdulillah, I received an email few hours later telling me that I passed. I

would not forget this experience and this is certainly one of the most
difficult OSCE I've ever had.

Hafiz words actually summarize a lot about OSCE. I hope that after finishing
reading this book you will find understanding OSCE made easy.

DR.RAED MANSOUR
 ‫إهداء‬

‫الي الذين أيقنوا أنهم مالقوا ربهم ف أحسنوا عملهم‬

‫الي الوالدين و اسرتي الذين أحسب أنهم من هؤالء‬

‫دكـتـور‬

‫رائــد مـنـصـور‬
‫أستاذ الجهاز الهضمي و الكبد و المناظير‬

‫بطب األزهر‬

‫‪All rights reserved no part of this book may be transmitted in‬‬

‫‪any form without permission in writing from the author.‬‬
What is Objective Structured Clinical Examination,
OSCEs?
Objective Structured Clinical Examination (OSCEs) is a form of
performance-based testing used to measure candidates’ clinical competence.
During an OSCE, candidates are observed and evaluated as they go through
a series of stations in which they interview, examine and treat standardized
patients (SP) who present with some type of medical problem.

“The OSCE is an approach to the assessment of clinical competence in

which the components of competence are assessed in a planned or
structured way with attention being paid to the objectivity of the
examination” Harden, 1988 .

OSCE is a form of multi-station examination for clinical subjects first

described by Harden et al from Dundee (1975). It was first reported from
Dundee and Glasgow (Harden and Gleeson, 1979). It was firstly adopted in
North America in a widespread manner. Then widely adopted in the UK in
the 90s. The principle method for clinical skills assessment in medical
schools and licensure bodies across USA, Canada, UK, Australia, New
Zealand and other countries, is now the OSCE.

Objective Structured Clinical Examination (OSCEs) has proved to be so

effective that it is now being adopted in disciplines other than medicine, like
dentistry, nursing, midwifery, pharmacy and event engineering and law.

“The OSCE examination tests a wide range of skills thus greatly reducing
the sampling error. This very significantly improves the reliability of the
examination” Harden, 1988.

“The real power of this type of examination lies in the ability of those
responsible for teaching and testing to examine their trainees with
imagination and forethought, in a reliable way, in areas seldom or never
tested before” Hart, 2001.

The curriculum tells the staff what to teach

The OSCEs tells the students what to learn
Features of the Objective Structured Clinical Examination
(OSCEs):
• Stations are short,

• Stations are numerous

• Stations are highly focused; very specific instructions

• A pre-set structured mark scheme is used hence.

Emphasis on:

• What candidates can do rather than what they know.

• The application of knowledge rather than the recall of knowledge

Typically:

• 5 minutes most common (3-20 minutes)

• (minimum) 18-20 stations/2 hours for adequate reliability

• Written answer sheets or observer assessed using checklists

• Mix of station types/competences tested

• Examination hall is a hospital ward

• Atmosphere active and busy

Additional options:

• Double or triple length stations

• Linked stations

• Preparatory stations

• “Must pass” stations

• Rest stations
How is the OSCEs done? The exam day:
Although OSCEs are performed in many settings in regard to the exam
purpose, the organizing institution, and available facilities, they all share
similar procedures. On the examination day, you will go through the
following steps in sequence:

1. Registration: The first step is the registration. You will:

• Show your examination invitation card and identification.

• Be reminded about the exam rules.

• Be checked for things allowed and other not allowed things.

• Receive your exam envelope which contains your ID badge, stickers, a

pencil, a notebook (with numbered blank papers)

2. Orientation: The next step is orientation. An orientation video may be

shown.

• Exam format, procedures and policies will be reviewed.

• Introduced to your team and team leader.

• Instructed about your starting station and how to proceed.

• Your questions will be answered (not allowed beyond this step).

3. Escorting to exam position: Now it is exam time.

You will be escorted to your station. You will stop by the assigned room
door until a long bell / buzzer announces the start of the exam.

4. Station Instruction Time:

This is one or two minutes to read the instruction about this station
situation, patient, and required tasks. Read carefully. At the next bell /
buzzer enter the room.

5. The Encounter:

Start your meeting with the SP. This is a 5-20 minute meeting. Perform the
required tasks. Stop at the next bell / buzzer.
 6. Post Encounter Period: Next is a question period.

There are some differences here. Some OSCEs will have no post encounter
periods. Some will have one or two minutes of the encounter period assigned
to oral questions asked by the examiner inside the exam room. No more
communication is allowed with the SP. Others have written questions to be
answered on paper or computer outside the exam room for 5-10 minutes. At
the next long bell / buzzer, the first station ended as well as the next station
has started. You have to proceed to the next station quickly as it is the same
long bell / buzzer at step 4.

7. Repeat Steps 4 to 6:

Steps 4 to 6 will be repeated until you have been in all the stations. Some
OSCEs will offer one or two short rest periods.

8. Exam ended / Escorting to dismissal area: The exam is over.

You will be escorted back to the dismissal area for signing out. You will be
asked to handle back all what you had received on signing in, the ID badge,
remaining stickers, all the papers, and the pencil. You may also be asked to
stay without outside contacts for some time (sometimes hours) for exam
security reasons.

It is a stressful exam, right?! But you will make it just fine if

!..you prepare for it and practice, practice, practice

Definitely you will be through many OSCEs throughout your medical under
and post education. So, you will face all the different OSCE formats. Thus,
it is wise to prepare once for all and keep repeating practicing over and
over... and your clinical and communication skills will improve more and
more... one practice after another... and one OSCE after another!!

For detailed information of your OSCEs, check with OSCEs

.organizers
SYSTEMATIC OSCEs EXAMPLES

I- Cardiovascular OSCEs, EXAMPLES

Prepare yourself for these common cardiovascular topics in Objective
Structured Clinical Examinations

The common topics that have been tested in OSCE exams during USMLE
Step 2 CS, MCCQE Part II, PLAB 2, OSCEs for medical students and
medical school clinical finals:

• Chest pain.

• Myocardial ischemia/infarction: ER management.

• Cardiac arrest.

• Palpitation. • Atrial fibrillation.

• Syncope.

• Hypertension.

• Hypotensive shock: ER management.

• Digoxin toxicity, ER management, and counseling setting.

• Pericarditis. • Infective endocarditis.

• Heart failure/ generalized edema/ ankle swelling.

• Intermittent claudication.

• Acute/ chronic leg pain.

• Deep venous thrombosis.

• Complete cardiovascular examination.

• ECG interpretation.

• Cardiopulmonary Resuscitation (CPR).

CVS: OSCEs, scenarios
1. Aly Zanaty is a 47 year old man who comes to your office with chest
pain. In the next 5/10/15 minutes take focused history and address his
concerns. (Chest pain).

2. Medhat Salah is 52 year old man, who is a known case of

hypertension. He came to your office for his annual check up. In the next
5/10/15 minutes perform a complete physical examination. On the last
minute the examiner will stop you and ask you questions.(Hypertension).

3. Diab Gawish is a 68 year old man who had brought to the emergency
because he passed out earlier today at home. In the next 5/10/15 minutes
perform a complete physical examination. (Syncope).

4. Labib Soliman is a 56 year old man who got a sudden bad chest pain
when he was having lunch with his family. He was brought to emergency
few minutes ago. In the next 5/10/15 minutes manage him. (MI).

5. Amin Shaker is a 53 year old man who comes to your office because
ho got swelling of his legs. In the next ten minutes take focused history and
address his concerns. (Heart failure).

6. Darwish Nady is a 51 year old man who came to emergency because

of chest pain and palpitation. In the next 5/10/15 minutes take focused
history and address his concerns. (Chest pain/ Atrial Fibrillation).

7. Awad Mohsen is 60 year old man who has a cardiac arrest while the
ambulance is rolling into the emergency. He is quickly brought into the
resuscitation room. In the next 5/10/15 minutes run code blue and manage
him. (Cardiac arrest).

8. TmamBdar is a 39 year old male who came to emergency because of

sharp chest pain. He feels unwell and trouble breathing. In the next 5/10/15
minutes take focused history and perform a focused physical examination.
(Pericarditis).
Now;

You have to cover the checklist and the differential diagnosis.

How to ask in an efficient and respectful way?

How to perform a complete, safe, and respectful physical examination?

Your biggest challenge in OSCE exams is the limited available time.

You need to memorize sets of questions and actions to be asked and

!done while you're in an autopilot manner

HOW TO MANAGE STATIONS

Gastrointestinal OSCEs,EXAMPLES
Prepare yourself for these common gastrointestinal topics in Objective
Structured Clinical Examinations

The common topics that have been tested in OSCE exams during USMLE
Step 2 CS, MCCQE Part II, PLAB 2, OSCEs for medical students and
medical school clinical finals:

•Difficulty swallowing (Dysphagia(

•Nausea / vomiting .

•Heartburn/ Gastroesophageal Reflex Disease .

•Peptic ulcer disease .

•Upper GI bleeding &•Lower GI bleeding .

•Diarrhea, acute & chronic & .Constipation .

•Steatorrhea .

•Irritable bowel syndrome .

•Inflammatory bowel disease, Crohn's&UC

•Diverticulosis/ Diverticulitis .

•Abdominal pain, acute & chronic .

•Jaundice .,Biliary colic .

•Hepatomegally/ hepatitis ..Splenomegally.

•Abdominal distension .

•Abdominal mass .

•Complete abdominal examination .

•Liver function tests interpretation .

Are all skills in a check list, weighed equally in all stations?

Answer is NO.
Common gastrointestinal, OSCEs scenarios.

(Please note: For USMLE Step2CS, there is no examiner in the room. The
encounter is video monitored and taped. Thus, there will be no questions
asked in the room other than the patient's questions).

1. Ahmad Samy is a 73 year old man presents to your office complaining

of trouble swallowing. In the next 5/10/15 minutes take focused history.
(Dysphagia).

2. Nadia Hashem is a 36 year old woman presents to your office

complaining from diarrhea for six months. In the next 5/10/15 minutes take
focused history. (Diarrhea).

3. Molhm kamel is a 52 year old man who was brought to emergency

with abdominal pain and vomiting. His vitals are: BP 80/40 mmHg, HR 120
bpm, RR 18 bpm, Temp 37.5 C. In the next 5/10/15 minutes mange
him.(Upper GI bleeding).

4.khaled is 81 year old who was brought to emergency by her daughter

because of blood with bowel motion. Her vitals are: BP 140/90 mmHg, HR
70 bpm, RR 17 bpm, Temp 37.5 C. In the next 10/15 minutes take focused
history and perform focused physical examination. (Lower GI bleeding).

5. Salem is a 62 year old man who came to emergency complaining of

LLQ pain and fever. In the next 5/10/15 minutes take focused history and
perform focused physical examination. (Diverticulitis).

6. Lotfy is a 62 year old man who came to emergency complaining of LLQ

pain. In the next 10/15 minutes take focused history and perform focused
physical examination. (Ischemic colitis).

7. kandylis 19 year old male who was brought to emergency because of

abdominal pain. His vitals are BP 90/50 mmHg, HR 120 bpm. In the next
5/10/15 minutes mange him.(Appendicitis).

8. Mona is 25 year old female who came to emergency complaining of

recurrent RLQ pain. In the next 10/15 minutes take focused history and
perform focused physical examination. (Crohn).

9. Nabil kamel is 27 year old man who came to emergency because he

turned yellow. In the next 10/15 minutes take focused history and perform
focused physical examination. (Jaundice).
10. Noor is 40 year old woman who came to emergency complaining of
recurrent RUQ pain. In the next 5/10/15 minutes take focused history and
perform focused physical examination. (Cholecystitis).

11. AYAT is 22 year old woman who came to your office complaining of
greasy foul smelling stool and weight loss. In the next 5/10/15 minutes take
focused history. (Steatorrhea).

12. kAREM is 64 year old man who comes to your office requesting a
laxative because he is always 'blocked up'. In the next 5/10/15 minutes take
focused history. (Constipation).

13. NADERA was brought to the emergency by his friends after

vomiting blood. In the next 5/10/15 minutes take focused history and talk to
him about your possible plan of management. (Hematamesis).

________________________________________

Now;

You have to cover the checklist and the differential diagnosis.

How to ask in an efficient and respectful way?

How to perform a complete, safe, and respectful physical examination?

Your biggest challenge in OSCE exams is the limited available time.

You need to memorize sets of questions and actions to be asked and

done while you're in an autopilot manner!
Hematology OSCEs, EXAMPLES:
The common Hematology topics are:

•Anemia.

•Eosinophilia.

•Neutropenia.

•Thrombocytopenia.

•Easy bruising/ Bleeding tendency.

•Patechae/ Purpura.

•Elevated hemoglobin/ Polycethemia.

•Splenomegaly.

•Hypercoagulable state.

•Urticaria/ Angioedema/ Anaphylaxis.

•Allergic reactions/ Atopy/ food allergies.

•Lymphadenopathy; Generalized/ localized.

•Blood transfusion reactions.

•Neck mass.

•Mediastinal mass.

•Complete hematological examination.

•Abnormal Complete Blood Profile, WBC.

Common Hematology & immunology OSCEs, scenarios
1. YASMIN is a 17 year old woman who presents to your office with
recurrent episodes of bleeding from her nose. Please take focused history in
the next 5/10/15 minutes. (ITP).

2. LATIFA YASEN is 22 year old woman who has been booked by the
surgeon to undergo laparoscopic cholecystectomy in two days. She comes to
your office with questions about the risk of blood transfusions as her friend
warned her about the possibility of HIV and Hepatitis infection. Please talk
to her in the next 5/10/15 minutes. (Blood transfusion).

3. TAHA AHMAD is a fifty year old man who is supposed to have his
forth blood transfusion today. He has a hematological disease that he needs
blood transfusion every few weeks. Last time he had a bad reaction. He
refused to go on until he talks to you because he is afraid it might happen
again. Please talk to him in the next 5/10/15 minutes. (Blood transfusion).

4. KHALED is a 47 year old man who comes with fatigue and a

hemoglobin of 95. Please talk to him in the next 5/10/15 minutes and address
his concerns. (Anemia).

5. NAHLA MORSY is 23 year old woman who came to your office after
she felt a lump in her right side of her upper neck. In the next 5/10/15
minutes take a focused history and perform a focused physical exam. (Note:
She keeps her bra and thighs exposed with gestures of seduction. The case is
infectious mononucleosis and she is sexually active. Take sexual history and
safe sex counseling too.) (Lymphadenopathy/ Seduction/ Safe sex).

6. BELAL is a 45 years old man who is a known case of Hodgkin disease

under the care of your colleague Dr, James Brown who is away and you are
covering for him. He came to your office for a follow up. In the next 5/10/15
minutes take a focused history and perform a focused physical exam.
(Lymphadenopathy).

7. Mary Hunter is a 31 year old woman who had delivered a healthy boy
last week came to your office because of bluish dots and areas over her
body. In the next 5/10/15 minutes take a focused history. (Patechae/
Purpura).

8. Nermeen Nabil is 27 year old business woman who had just returned
from Asia in a business trip came to your office because of right calf pain. In
the next 5/10/15 minutes take a focused history and perform a focused
physical exam. (DVT).
 Outside the station, students
reading OSCE SCENARIOS

OSCE
STATION,OBSERVER,STUDENT&
SIMULATED PATIENT

OSCE STATION
Neurology OSCEs, EXAMPLES:
The common neurology topics in OSCE exams are:

•Head injury: ER management.

•Cervical spine trauma.

•Bacterial meningitis.

•Unsteadiness/ Dizziness/ Ataxia.

•Loss of consciousness/ Comatose management.

•Tremor/ Parkinsonism.

•Stroke/ TIA. •Subarachnoid hemorrhage.

•Headache: all types and settings.

•Temporal arteritis.

•Seizure: attack at ER setting/ Follow up consult.

•Memory impairment.

•B 12 neuropathy.

•Chronic back pain.

•Carpal tunnel syndrome. •Sciatica/ leg pain.

•Gait disturbances. •Weakness.

•Numbness.

•Pituitary adenoma.

•Complete neurological examination.

•Limb neurological examination.

•Cranial nerves examination.

•Coordination examination.

•Glasgow coma scale.

Common CNS OSCEs, scenarios are:

1. Medhat is a 32 year old man who presents to the you in the walk-in
clinic complaining of headache. Please take focused history and address his
concerns in the next 5/10/15 minutes. (Headache).

2. Nabil is a 53 year old gentleman who comes to the emergency

complaining of sudden severe headache. Please take focused history and
perform a focused physical examination in the next 10/15 minutes.
(Headache).

3. Zaghlol is a 55 year old bus driver who was brought to the emergency
by family members because he had a 'spell'. Please take a focused history in
the next 5/10/15 minutes. (Seizure).

4. Gamal is 55 year old man who comes to your office for the first time to
have acheck up examination. Please perform a complete cranial nerves
examination in the 5/10/15 ten minutes. (Cranial nerves examination).

5. Ali Badr is 67 year old man who came to your office because he has
been having frequent falls which made him very concerned. Please talk to
him and address his concerns in the next 5/10/15 minutes. (Fall /
Unsteadiness/ Dizziness/ Ataxia.).

6. Frank Sullivan is a 57 year old man who came to the emergency by an

ambulance because of weakness of his right arm and leg. Please take a
focused history and perform a focused neurological exam in the next 10/15
minutes. (Stroke).

7. Yahya is 58 years old man who had some transient attacks of left eye
blindness and was rushed to the emergency by his family. Please take
focused history and address his concerns in the next 5/10/15 minutes.
(Temporal arteritis).

8. Brakat is a 66 year old businessman who comes to your office because

of unsteady walking pattern. Please take focused history and perform a
focused neurological exam in the next 5/10/15 minutes. (Unsteadiness/
Dizziness/ Ataxia.).

9. A middle aged man was brought by the police to the emergency after
being found unconscious. Please manage the case in the next 5/10/15
minutes. (Loss of consciousness/ Comatose management.).

10. John Smith is 80 years old man presents to the emergency having
sudden onset of speaking difficulty earlier today. It has now resolved. Please
take focused history and perform a focused neurological exam in the next
5/10/15 minutes. (TIA).

11. Tony Longfield is 16 years old male who is a know case of epilepsy on
medication came to your office referred from the driver licence authority.
Please talk to him in the next ten minutes. (Epilepsy).

12. Nadia Nader is 60 year old woman came to your office complaining of
tremor. Please take a focused history and perform a focused neurological
exam in the next 5/10/15 minutes. (Tremor/ Parkinsonism).

13. George Magdy is 26 year old man who was brought to the emergency
by his partner. She said that he had the 'flu' for the last two days and has
complained of headache and fever. Please take a focused history and
perform a focused neurological exam in the next 5/10/15 minutes.
(Meningitis).

14. Leanne Price is 32 year old who came to your office because of right
hand tingling and numbness. Please take a focused history and perform a
focused neurological exam in the next 5/10/15 minutes. (Carpel Tunnel).

15. Abd-el Kareem is 44 year old man who came to your office because of
fatigue and problems with walking with staggering. Please take a focused
history and perform a focused neurological exam in the next 5/10/15
minutes. (B12 Neuropathy).

16. Eric Brown, a 28 year old male, was brought to the emergency
unconscious after falling from a platform at work this morning. Please
perform a complete neurological exam in the next 5/10/15 minutes. (Head
injury/ Cervical spine: ER management.).

17. Bob Jackson, a 46 year old construction man, came to your office
because of sudden back pain for two days. Please take a focused history and
perform a focused neurological exam in the next 10/15 minutes. (Back pain).

18. Leo alfanso is 47 year old man who had leg pain for years getting
worse recently. Please take a focused history and perform a focused
neurological exam in the next 5/10/15 minutes. (Sciatica).

19. Khaled Fawzy is 26 year old male who had a minor car accident a
week ago. He came to your office because he noticed that he don't see on the
sides. Please take a focused history and perform a focused neurological
exam in the next 10/15 minutes. (Pituitary).
Respiratory OSCEs, EXAMPLES:
Prepare yourself for these common respiratory topics in Objective
Structured Clinical Examinations

The common Respiratory topics are:

• Asthma: in all scenarios: Acute ER setting management, Worsening

follow up, After attack follow up, Consult.

• Wheezes.

• Pneumonia, typical and atypical.

• Chest pain.

• Cough.

• Coughing up blood (Haemoptysis).

• COPD: in all scenarios: Acute ER setting management, Worsening

follow up, After attack follow up, Consult.

• Shortness of breath. • Chronic shortness of breath.

• Pulmonary embolism in ER setting.

• Anticoagulant counseling for pulmonary embolism.

• Bronchiectasis. • Pleural effusion.

• Interstitial lung disease, occupational cough/SOB.

• Solitary pulmonary nodule on X-ray.

• Pneumothorax in ER setting.

• Rhinorrhea / Sore throat. • Sinusitis.

• Chest X-ray interpretation.

• Pulmonary Function Tests interpretation.

• Arterial blood gases interpretation. • Smoking consult.

• Respiratory system examination.

Common respiratory OSCEs, scenarios:
1. Deda Oraby is a 43 year old man who comes to your office complaining
of shortness of breath. In the next 5/10/15 minutes take focused history.
(SOB).

2. Nabil Hekal is a 52 year old man who has come to your office because
of frequent episodes of shortness of breath. In the next 5/10/15 minutes take
focused history. (SOB).

3. James Fairman is a 57 year man who comes to your office because

during an employment routine check up he was found to have a nodule in
his lung. In the next 5/10/15 minutes take focused history. (Lung nodule).

4. Waled Moafy is a known case of chronic bronchitis who has come to

your office for a regular check up. In the next 5/10/15 minutes perform
focused physical exam.

5. Albert Henderson is a 62 year old man who comes to your office with
cough for three months. In the next 5/10/15 minutes take focused history. In
the last minute the examiner will stop you to ask questions, (Cough).

6. John Hunter is 54 year old man who comes to the emergency because
of cough and recurrent lung infections. In the next 5/10/15 minutes take
focused history. (COPD).

7. Samer Zaky is a 32 year old man and an asthmatic patient of your

colleague Dr. Eric Goodson. He comes to your office for a follow up visit as
your covering Dr Goodson while he is away. In the next 5/10/15 minutes talk
to him (Asthma).

8. Badr Omran is a 29 year old woman who has been diagnosed with
asthma recently. In the next 5/10/15 minutes talk to her. (Asthma).

9. Steven Copper is 19 year old man who came to emergency with sudden
right sided pain. In the next 5/10/15 minutes take focused history and
focused physical examination. (chest pain/ Spontaneous Pneumothorax).

10. Diab Hamed is a 77 year old man who came to your office
complaining of hoarseness for three months. In the next 5/10/15 minutes
take focused history.(Cough).

11. James Timothy is a 66 year old man who comes to your office
complaining of coughing up blood. In the next 5/10/15 minutes take focused
history. (Hemoptasis).
12. Abdel Baky Noor 65 year old man known case of COPD who comes
to the emergency complaining of shortness of breath for two days. In the
next 5/10/15 minutes, mange him.(COPD exacerbation).

13. Julie Osler is 67 year old woman who came to your office because of a
bothersome dry cough for two months. In the next 5/10/15 minutes take
focused history and answer her concerns. (Cough/ Atypical pneumonia).

14. Hamdy Hasan is 22 year old asthmatic woman who comes to the
emergency because of worsening shortness of breathing. In the next 5/10/15
minutes manage her. (Asthma exacerbation).

15. Sandy Homer is 22 year old asthmatic woman who comes to the
emergency because of worsening shortness of breathing. You managed her
and she is stable now. In the next 5/10/15 minutes talk to her before
discharge. (Asthma exacerbation).
Renal OSCEs, EXAMPLES:
Common renal topics in Objective Structured Clinical Examinationsare:

•Urinary tract infection/ Dysuria/ Frequency.

•Urethral/ penile discharge in males.

•Hematuria/ red urine/ blood in urine.

•Renal failure, acute and chronic.

•Protienurea.

•Hyperkalemia/ Hypokalemia

•Hypernatremia/ Hyponatremia.

•Impotence/ Erectile dysfunction.

•Incontinence.

•Benign prostatic hypertrophy.

•Prostatic cancer.

•Scrotal pain.

•Scrotal swelling/ mass.

•Hernias.

•Abnormal serum hydrogen ion concentration.

 Common renal OSCEs,SCENARIOS:
1. Jasmine Corel is a 22 year old woman who comes to the emergency
complaining of burning sensation with urination. In the next 10/15 minutes
take a focused history and perform a focused physical examination. (UTI).

2. Jack William is a 70 year old man who comes to the emergency

complaining of difficulty making his urine. Take a focused history and
perform a focused physical examination. (UTI/ Prostate).

3. Mick Humper is a 48 year old man who comes to the emergency

complaining of the worst pain he has ever had and at the hospital he noticed
is urine is red.. In the next 10/15 minutes take a focused history and perform
a focused physical examination. (Renal colic/ stone).

4. Sam Longwill is a 69 year old man who comes to your office because he
saw blood in his urine. In the next ten minutes take a focused history and
perform a focused physical examination. (Hematuria).

5. Marie Brono is a 56 year old woman who comes to your office

complaining of urine leaking. In the next 5/10/15 minutes talk to her.
(Incontinence).

6. Andre Heatherford is a 19 year old male who comes to the walk-in

clinic complaining of penile discharge. In the next 5/10/15 minutes talk to
him. (Urethral/ penile discharge).

7. Anthony martin is a 43 year old man who presents to your office

having a problem getting and maintaining erection. In the next 5/10/15
minutes talk to him. (Erectile dysfunction).

8. Eric Smith is a 82 year old man he comes to emergency complaining of

problems with emptying his bladder. Talk to him. (Prostate).

9. Amy Davidson is a 61 year old woman who is a patient of your

colleague Dr. Wong. She comes to your office complaining of being unwell.
Dr Wong sent for some investigations and she is here for the results. Her
hemoglobin is 100, creatinine 1000, and BUN 22.4. In the next 5/10/15
minutes talk to her. (Renal failure).

10. David Robert is a 64 year old man who is a patient of your colleague
Dr. Wong. He comes to your office complaining of being unwell. Dr Wong
sent for some investigations and he is here for the results. His blood
pressure is165/ 100, and creatinine 700. In the next 5/10/15 minutes talk to
her. (HTN/ Renal failure).
Endocrine OSCEs,EXAMPLES:
•Diabetes, all scenarios including ER for DKA and consult.

•Hypoglycemia. •Hypercalcemia.

•Abnormal lipid profile / Hypercholestrolemia

•Obesity / Weight gain counseling.

•Weight Loss. •Hirsutism/ Virilization. •Galactorhea.

•Gynecomastia. •Neck mass.

•Thyroid nodule/ Enlarged thyroid/ Hyperthyroidism/ Hypothyroidism.

•Pituitary adenoma. •Polydipsia.

•Adrenal insufficiency/ excess.

•Failure to mature.

•Failure to thrive.

_____________________________________

Common endocrine OSCEs,EXAMPLES:

1. Dick Homer is an 21 year old man came to the emergency complaining
of nausea, vomiting and diarrhea. In the next ten minutes take focused
history. At the eighth minute the examiner will stop you to ask questions.
(Lab results).(DKA).

2. Debbie Hamilton is thirty year old woman who came to your office
complaining of fatigue for two months. In the next ten minutes take focused
history. (Hypothyroidism).

3. Rochelle Patrick is 58 year old woman who came last week for her
routine annual check up. Her investigations came back with serum calcium
12 mg/dL. In the next ten minutes take focused history and perform focused
physical examination. At the eighth minute the examiner will stop you to
ask questions. (Hypercalcemia).

4. George Hunter is 51 year old man who came last week for his routine
annual check up. His investigations came back with elevated serum
cholesterol. In the next ten minutes take focused history and address his
concerns. At the eighth minute the examiner will stop you to ask questions.
(Hyperlipidemia).
5. Victoria Atkins is a 31 year old woman who comes to your office with
hoarseness. In the next ten minutes take focused history. (Hypothyroidism).

6. Patricia Spence is 28 year old woman who was sent by the community
nurse to you because of abnormal thyroid tests. Take focused history and
perform focused physical examination. (Hyperthyroidism).

7. Tanya Allison is 48 year old woman who was sent by the community
nurse to you because she thinks she felt a thyroid lump. In the next ten
minutes take focused history and perform focused physical examination.
(Thyroid nodule).

8. Mary Hamilton is a 53 year old woman who is a patient of your

colleague, Dr. Watson, came to your office because you are covering for Dr.
Watson while he is away. Her blood glucose results has come back 8.7 and
9.1 mmol/L in two fasting tests. She is very anxious to know what is wrong.
Talk to her and address her concerns. (DM, initial visit).

9. Mr. Russell Shantini is a 49 year old man who is a known case of

diabetes. He came to your office for his annual follow up bringing his log
book. In the next ten minutes talk to him . (DM, follow up).

10. Sandy Robert is a 23 year old woman who comes to your office
complaining of recurrent headache and abnormal hair growth on her chin.
In the next ten minutes take a focused history. (Pituitary adenoma).

11. Laura Battler is 26 year old woman who comes to your office
complaining from weakness and weight gain. (Cushing).

12. Sarah Anderson is 18 year old girl who came to your office because
she notice her neck is wide. In the next ten minutes take focused history and
perform focused physical examination. (Goitre).

13. Tony Black is 30 year old man who came to your office complaining
from feeling dizzy and weight loss. In the next ten minutes take focused
history. (Adrenal Insufficiency).

14. Martin O'Malley is 34 year old man who cam the emergency because
of persistent headache and heart racing. In the next ten minutes take
focused history. (Pheochromocytoma).

15. Jim Charles is 12 year old boy, who is know for diabetes type I, was
rushed to the emergency by his parents after falling unconscious. Please
mange him in the next ten minutes. (Hypoglycemia).
________________________________________
Musculoskeletal OSCEs,EXAMPLES
•Back pain, acute and chronic.

•Siatica.

•Neck pain/ trauma.

•Ankylosing spondylitis.

•Joint pain/ any joint

•Osteoarthritis.

•Inflammatory arthritis/ Rheumatoid.

•Septic arthritis.

•Osteoporosis.

•Complete joint examination: Cervical and lumbar pain, shoulder, elbow,

wrist, hip, knee, and ankle.

•Wound suturing.

________________________________________
Common musculoskeletal OSCEs, SCENARIOS

1. Eric Samuel is 43 year old man who came to your office complaining of
lower back pain for two days. Please take a focused history and perform a
focused physical examination in the next 10/15 minutes. (Back pain).

2. Cathy Smitherman is 62 year old woman who came to your office

complaining of bilateral leg pain for years which getting worse recently.
Please take a focused history and perform a focused physical examination in
the next 10/15 minutes. (Sciatica).

3. John Hamber is a 40 year old man who came to your office

complaining of neck pain after a car accident two months ago. Please take a
focused history and perform a focused physical examination in the next
10/15 minutes. (Whip splash injury).

4.Michael Turner is 36 year old man who came to emergency because of a

sudden right knee pain during football game. Please take a focused history
and perform a focused physical examination in the next 10/15 minutes.
(Joint pain).

5. Patty Applewood is a 47 year old woman who came to your office

because of right shoulder pain. Please take a focused history and perform a
focused physical examination in the next 10/15 minutes. (Joint pain).

6. Tony Andreson is 22 years old who came to your office because of right
knee swelling. Please take a focused history and perform a focused physical
examination in the next 10/15 minutes. (Septic).

7. Elizabeth Johnson, a 55 year old woman, came to you office because of

stiffness in her fingers. Please take a focused history in the next 5/10/15
minutes. (Inflammatory).

8. Anthony Smith is a 65 year old man who came to your office

complaining of right hip pain. Please take a focused history and perform a
focused physical examination in the next 5/10/15 minutes. (Joint pain).

9. Susan Rinker is a 55 year old woman who has been investigated by

your colleague, Dr Mark Brown. She came to see you as you are covering
for Dr. Brown while he is away. The results of the bone density scan came
back as 'Osteoporosis'. Please counsel her and address her concerns in the
next 5/10/15 minutes. (Osteoporosis).
 EXAMPLES OF OSCE STATIONS
Station 1: Hand washing
Instructions: You are about to examine a patient. Wash your hands.
Time allowed: 6 minutes.

1. Thoroughly wets hands with warm water 0 1

2. Applies liquid soap or disinfectant from dispenser 0 1

3. Washes hands using Ayliffe technique: palm to palm 0 1 2

4. right palm over left dorsum and vice versa 0 1 2

5. palm to palm with fingers interlaced 0 1 2

6. back of fingers to opposing palms with fingers interlocked 0 1 2
7. right thumb clasped in left palm and vice versa 0 1 2
8. fingers of right hand clasped in left palm and vice versa 0 1 2
9. Rinses hands thoroughly and appropriately 0 1 2
10. Turns taps off with elbows 0 1 2

11. Dries hands with paper towel 0 1

12. Disposes of paper towel appropriately 0 1

Examiner’s global score

0 1 2 3 4

Examiner’s comments

Total marks possible: 24

Station 2: Examination of a superficial mass and
of lymph nodes
Instructions: Mr Colin Lyas is 34 years old. Please examine the lump on his right arm.
Time allowed: 6 minutes.

1. Introduction and orientation 0 1 2

2. Ensures patient’s comfort, asks about pain 0 1 2

3. Inspects lump and overlying skin 0 1 2

4. Palpates lump and assesses: temperature 0 1

5. number 0 1

6. size 0 1

7. shape 0 1
8. surface 0 1
9. consistency 0 1
10. mobility 0 1

11. Transilluminates lump 0 1 2

12. Assesses whether lump is pulsatile 0 1 2

13. Indicates need to examine proximal lymph nodes 0 1

Examiner to ask: “Please summarise your findings and offer a differential diagnosis.”

14. Summarises key findings 0 1 2

15. Offers an appropriate differential diagnosis 0 1 2

Examiner’s global score

0 1 2 3 4

Patient’s global score

0 1 2 3 4

Examiner’s comments

Total marks possible: 30

 [email protected]

Station 3: Chest pain history

Instructions: 56-year-old Mr Biswas Singh presents to A&E with acute onset chest pain.
Please take a history focusing on the presenting complaint and the history of presenting
complaint, but including key aspects of other parts of the history.
Time allowed: 6 minutes.

1. Introduction and orientation (explains task, asks for consent) 0 1 2

2. Ensures patient is comfortable 0 1 2

3. Asks about nature of chest pain using open questions 0 1 2

4. For the pain, determines: site and radiation 0 1 2

5. character 0 1 2

6. severity 0 1 2

7. onset and duration 0 1 2

8. aggravating and alleviating factors 0 1 2
9. associated symptoms 0 1 2

10. Past medical history, key aspects 0 1 2

11. Drug history, key aspects 0 1 2

12. Family history, key aspects 0 1 2

13. Social history, key aspects 0 1 2

Examiner to ask: “Please summarise your findings and offer a differential diagnosis.”

14. Summarises key findings 0 1 2

15. Offers an appropriate differential diagnosis 0 1 2

Examiner to ask: “What investigations would you carry out to help confirm your diagnosis?”

16. Suggests appropriate investigations, including physical examination 0 1 2

Examiner’s global score

0 1 2 3 4

Examiner’s comments

Total marks possible: 40

 [email protected]

Contents

I- INTRODUCTION………………………………1
II- WHAT IS OSCE?..............................................3
III- FEATURES OF OSCE…………………………4
IV- THE EXAM DAY………………………………5
V- SYSTEMATIC OSCEs SCENARIOS………...7
CVS………………………………………………7
GIT……………………………………………….11
HEMATOLOGY………………………………..14
CNS……………………………………………….17
RESPIRATORY…………………………………21
RENAL…………………………………………..24
ENDOCRINE……………………………………26
MUSCULOSKELETAL………………………..29
VI- EXAMPLES OF CHECKLISTS……………….30