Warrington & Halton NHS Foundation Trust
Barts and the London School of Medicine and
East Kent Hospitals University NHS Foundation
St George’s Hospital Medical School
Institute of Sport, Exercise and Health (UCL)
Barts and the London School of Medicine and
Brighton and Sussex Medical School
NIHR Academic Clinical Fellow in Cardiothoracic
Imperial College Healthcare NHS Trust
North East London NHS Foundation Trust &
Barts and the London School of Medicine and
notes together with a few contributions from my then housemates. At the time, OSCEs had suddenly
become very big, but medical publishing lagged behind, leaving our generation of medical students
to scramble for preparation materials.
been through no less than three publishers and five editions.
Back in 2003, I could not have dreamt that in 12 years’ time I would be working alongside a team of
hugely indebted to each and every student contributor and to the student editor, John Allen, for
if you would like to form part of the team for the next edition.
• Don’t panic. Be philosophical about your exams. Put them into perspective. And remember
Greek island starting on the day after your exams to help focus your attention.
• Read the instructions carefully and stick to them. Sometimes it’s just possible to have
revised so much that you no longer ‘see’ the instructions and just fire out the bullet points like
expression of the actor or examiner. Just as an ECG monitor provides live indirect feedback
on the heart’s performance, so the actor or examiner’s facial expression provides live indirect
feedback on your performance, the only difference being – I’m sure you’ll agree – that facial
expressions are far easier to read than ECG monitors.
• Quickly survey the cubicle for the equipment and materials provided. You can be sure that
items such as hand disinfectant, a tendon hammer, a sharps bin, or a box of tissues are not just
random objects that the examiner later plans to take home.
• First impressions count. You never get a second chance to make a good first impression. As
much of your future career depends on it, make sure that you get off to an early start. And who
knows? You might even fool yourself.
• Prefer breadth to depth. Marks are normally distributed across a number of relevant domains,
such that you score more marks for touching upon a large number of domains than for
exploring any one domain in great depth. Do this only if you have time, if it seems particularly
relevant, or if you are specifically asked. Perhaps ironically, touching upon a large number of
domains makes you look more focused, and thereby safer and more competent.
• Don’t let the examiners put you off or hold you back. If they are being difficult, that’s their
problem, not yours. Or at least, it’s everyone’s problem, not yours. And remember that all that
is gold does not glitter; a difficult examiner may be a hidden gem.
the actors, if only by ‘remembering’ to treat them like real patients. This may hand you a merit
over a pass and, in borderline situations, a pass over a fail. Although they never seem to think
so, students usually fail OSCEs through poor communications skills and lack of empathy, not
through lack of studying and poor memory.
• Enjoy yourself. After all, you did choose to be there, and you probably chose wisely. If you
do badly in one station, try to put it behind you. It’s not for nothing that psychiatrists refer to
‘repression’ as a ‘defence mechanism’, and a selectively bad memory will do you no end of
• Keep to time but do not appear rushed. If you don’t finish by the first bell, simply tell the
examiner what else needs to be said or done, or tell him indirectly by telling the patient,
for example, “Can we make another appointment to give us more time to go through your
treatment options?” Then summarise and conclude. Students often think that tight protocols
impress examiners, but looking slick and natural and handing over some control to the patient