OSCE Prep

One of the major tests in medical school is the dreaded OSCE. It stands for something, but I've honestly forgotten what. The basics of an OSCE involves simulating patient interactions in a short amount of time. This can be interviewing, doing a physical exam, maybe a combination of both, and then answering some questions on that fake patient's case.

I would argue it's one of the higher-yield activities we do, at least in pre-clerkship. They're great learning tools - they reinforce a lot of the book-learning we do and force us to think about that knowledge practically. They might be the only training we get in doing the simple things for patients, like introducing ourselves, draping patients appropriately for exams, and washing our hands. These elements to medicine matter as much as the memorization of small textbooks worth of medical information that we seem to do on a regular basis.

We had a practice session for our first real OSCE held by the graduating class at my school. They were great, giving excellent advise and tips along with the opportunity for extra OSCE practice. I can't say how much I appreciate the support from people who are basically done and have no real further obligations to the school.

However, one thing that was emphasized for me during these practice sessions was that I need to talk more. Not to the patient - apparently I'm great on that front. No, I need to talk more to the examiner. I need to say everything I'm doing, why I'm doing it, and I need to use the big doctors words too. That annoys me. It saddens me. It disappoints me. Not because the graduating class told me that, not at all. In terms of helping me pass my OSCEs, it's probably the best piece of advice I got and I'm glad they were willing to be upfront with me about it.

What troubles me about this recommendation is that to pass the OSCEs, you need to behave in a way that really isn't optimal or even appropriate for real interactions with patients. Since the OSCE is the major way in which medical students prepare their interviewing and physical examination skills, it encourages some habits which are far from ideal and may not be broken later down the line. I think most of my colleagues recognize the big things that you do in an OSCE but you shouldn't do in real life (like not explaining everything you're doing in complex medical terms), but there are some subtleties as well which may not get picked up by a decent number of medical students (like briefly explaining what you're doing in simple, non-medical terms).

Maybe it comes from working in healthcare before medical school, but I've learned that how you do something with patients matters almost as much as what you're doing with them. Granted, there are marks for patient care and rapport on most OSCEs, since schools recognize their importance. The problem is, as long as you aren't being an overt @#$hole to the standardized patient during an OSCE, you're not going to fail because of missed patient care marks. You are going to fail if you don't talk to the examiner enough, which is why my graduating colleagues were so consistent about emphasizing that to me.

I realize this is somewhat unavoidable - to accurately evaluate someone, you need to know what they're doing and why they're doing it, so they ask students to verbalize their actions. I don't really have a good suggestion around this. All I'll say is that this situation gets back to the fundamental divergence in goals between teaching and testing. Testing should evaluate teaching and adapt the evaluation to what is being taught, but in many cases, including the OSCE, teaching tends to adapt to the testing.

It may be worth spending some more time working on our patient interactions without a marking scheme to worry about.