Having spent a number of years teaching and examining medical student OSCEs I regularly get asked what are my top tips for Surgical OSCEs. Try to focus your attention on these tips in order to boost your score in upcoming exams.
1. Always remember red flag symptoms
When taking a history in general surgery stations it’s always important to ask about red flag symptoms. It can be really common to forget about these symptoms when under pressure but often there’s a lot of marks allocated to asking about them. I recommend reviewing the NICE guidelines for suspected cancer referrals (www.nice.org.uk/guidance/ng12) for each type of cancer. There is usually only 3 to 4 to remember for each cancer site but these will gain you lots of marks in a history taking station. We’d recommend on looking at the lower gastrointestinal tract cancers and upper gastrointestinal tract cancers for surgical osces first!
2. Don’t waste time examining the hands
Students commonly spend a long time examining the hand and neck in an abdominal examination. It’s really important to examine these areas quickly and efficiently to get to the abdomen where most of the marks are available. For example, students can spend a long time naming numerous signs in the hand where often two or three would be sufficient. I would recommend spending no more than 2 minutes before you reach the abdominal examination. It’s worth practising this initial 2 minutes with your friends, tutors or even in the mirror to yourself as it’s very obvious to examiners when you haven’t.
3. Commit to your findings
This is especially important for final year students but applies to all years. As an examiner its incredibly frustrating when students constantly say “there appears to be” or “there seems to be” in OSCE stations. It makes the examiner doubt that you’ve identified a sign, or worse, they may think you’re making something up. It’s always important to stand by your findings so, if you can identify mass, you should say” I can palpate a mass” or, if you can see a surgical scar, you should say “I can see a surgical scar on the abdomen”. Of course, if you’re not sure you should state this but clarify to the examiner that in real clinical practice you would seek clarification from a senior doctor. In most undergraduate OSCE stations however the clinical signs will be really obvious because the exam isn’t designed to trick and fail you.
4. Don’t order a CT scan straightaway
It’s common during OSCE stations to be asked what your initial management would be in a given scenario. Whenever this is asked you should start by suggesting simple bedside tests, e.g. Urine dipstick, blood glucose or clinical observations. Following this it is reasonable to arrange simple blood tests then simple radiology tests, e.g. Chest X-Ray. Undergraduate OSCE stations are only ever expecting you to be at the level of a foundation year one doctor. Doctors at this level would not be arranging CT or MRI scans independently so, although it’s good to understand the role of these scans you shouldn’t order these as a first line test, especially not before consulting a senior doctor. It would therefore be reasonable for you to say “following these tests and review by a senior doctor this patient may require a CT to look for …”
5. Practice, practice, practice…
As I’ve said before it’s really obvious to an examiner when a student either simply hasn’t practised a station or, worse, this is their first exposure to it. I can’t emphasise enough the importance of practising your history taking and examination skills. Not only will this make it clear to the examiner that you know what you’re doing it means you can reach the maximum possible marks as you will have practised covering all aspects of the station.