Medical Council of Canada /
Common mistakes made on Objective Structured Clinical Examination stations
Common mistakes made on Objective Structured Clinical
Examination stations
The following page outlines common mistakes made on Objective Structured Clinical Examination (OSCE) stations. Be
careful to avoid these scenarios
Not reading the instructions carefully
Read the task as well as the patient problem. The verbs in the instructions matter, as do the limits stated in the
questions.
For example:
If the task is to conduct a focused history, then you will only get credit for taking a history in a clinically
appropriate manner. You will not get credit for educating the patient or advising him or her when the assigned
task is to take a history.
If the task is “assess and advise” OR “discuss” OR “counsel”, then will get credit for tasks like eliciting key
information about the patient’s problem, understanding how the patient perceives the problem, AND for actions
like advising the patient, providing information and recommending follow-up, depending on the nature of the
presenting problem.
If the task is “assess and manage”, then you will get credit for assessing the patient (e.g., relevant history and/or
physical exam) AND for managing the problem, which may include ordering investigations and making immediate
treatment decisions.
In each station, you must decide what information and actions are the most clinically relevant, given the patient
information provided in the instructions AND the time allowed. Ensure that you have a list of priorities.
Asking too many questions
Asking as many questions as you can, especially if done in a rapid- re, disorganized fashion, in hopes of asking
enough of the right questions, is not a good strategy. The relatively short amount of time allowed for each task
requires that you organize your approach, preferably around a differential diagnosis or around generating a
differential diagnosis.
Misinterpreting the instructions
Sometimes candidates approach a station by trying to
gure out “what is on the test”, rather than basing their
actions on a clinically appropriate approach to the patient problem. For example, the patient information describes a
belly pain problem and you are asked to conduct a focused physical examination. Even if a complete basic
abdominal exam is performed (inspection, auscultation and palpation of the four quadrants) it is generally not
suf cient to achieve a good rating on the station. You may have conducted some maneuvers that were irrelevant to
identifying the most likely diagnosis.
The emphasis in a focused physical examination should be making a diagnosis and ruling out differential diagnoses.
In the preceding example, an abdominal examination is certainly important but based on the patient information
given to you and whatever
ndings (or lack of
ndings) you discover, there are other maneuvers and/or systems
you will need to assess to rule in or rule out your differential diagnoses.
Using too many directed questions
Using open questions is helpful in this exam, just as it is in clinical practice. While the broad question “Tell me why
you are here” may not lead patients to share all the information you need, it will certainly provide a starting point.
Questions such as “Can you describe the pain for me?” or “Have you noticed any other changes?” are helpful. You
will likely have to follow up with more directed questions to get the full picture from the patient but it is easier to
start with their initial comments than to run through endless “yes/no” questions that limit the patients to saying yes
or no.
Remember that, as in real life, patients cannot report what they do not have and may not report changes that do not
relate to the presenting problem. However, your score is based on eliciting critical information, not only on eliciting
speci c pertinent positives. If a patient says he or she has no other symptoms but you need to know whether there
has been any weight loss or speci c neurological changes to determine the diagnosis, then you should ask
speci cally about these points.
Not listening to patients
Patients often report that candidates do not listen to them and therefore miss crucial information. If a patient’s
answer is not clear AND the issue is important, then explore further. For instance, you ask the patient if he or she
has ever had this problem before and the patient responds with “not like this”. You may want to know what was
meant by this statement.
If you appear indifferent to their concerns, the patients are expected to react accordingly – you will get less
information from them. They are not required to give everyone their whole story. You are expected to elicit their
story. And as in clinical practice, patients will be reluctant to con de their underlying fears or embarrassing
information if they feel you are indifferent, judgmental or hostile to them.
Not explaining what you are doing in physical examination
stations
stations
Please note that you cannot receive credit for genital, rectal or vaginal examinations unless you indicate to the
examiner that you would do such an exam. In most cases, the examiner is given
ndings to report to you, but he or
she can only do so after you state which examination you would do.
In a physical examination station, you must greet the patient brie
ndings are, including pertinent negative
y, explain what you are doing and what your
ndings. This way the examiner can accurately assess your skills.
Explaining yourself to the patient is suf cient for credit – you do not need to repeat yourself to the examiner if you
feel you have adequately identi ed what you are doing, as well as, what you are
nding. You must demonstrate your
clinical skills. You will only get credit for tasks completed to the examiner’s satisfaction.
To
nd out more about the examination, please visit Preparing for the OSCE stations and OSCE orientation.
Not providing enough direction in management stations
In management stations where a nurse is present, remember that he or she is there to help you. However, you must
provide clear directions. If the nurse asks for more direction, answer as best you can, as clarifying what you want
will likely improve your performance.
Missing the urgency of a patient problem
With urgent patient problems where an acute problem or trauma must be managed, set clinical priorities. Do the
most important things
rst, then go back and get more information, if you need it, or make further orders. Beware of
ordering investigations or treatments by rote before you understand a particular patient’s situation. This can be
dangerous in practice and will be
agged as such on your examination sheet.
Talking too much
Sometimes candidates talk so much while with the patient that they lose valuable time and miss information.
Ef ciency does not exclude the professional courtesies of introducing yourself or explaining brie
y why you need to
ask a dif cult question or conduct a painful maneuver; however, it is not necessary to talk incessantly. You are
expected to speak to the patient in language that he or she will understand, not to quote textbooks to the examiner.
Your manner tells both the patient and the examiner a lot about your attitude to the patient; you do not need to do it
all with words. Avoid lecturing and showing off.
Giving generic information
In some stations, you are expected to provide the patient with information or advice relevant to his or her problem.
Some candidates seem to miss the purpose of these stations and only offer very general statements like “There are
risks associated with X and you should really do Y.” If you are expected to advise a patient then you are expected to
provide him or her with the quality of information that re
ects your abilities as a physician, assisting in informed
decision-making by the patient and going beyond what is available in the public domain.