Make sure you don’t trip at the final OSCE hurdle

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You know that I like analogies to running – so here’s another – the taper week.   Tapering is what you do in the weeks prior to a long run – half or full marathon.   It is a deliberate reduction in your training to enable you to be physically fit and mentally hungry to perform when required.   This technique is useful in preparation for the OSCE too, and with two weeks to go you might be looking for some direction with regards to managing the week before the exam.   You have already been training hard for 6-12 months, sometimes longer, and you should have confidence that if you have learnt deeply, you will have a solid base on which to launch yourself into the exam.   Taking the time to make sure that you are well rested and prepared is important – there is nothing worse than tripping on your shoe-laces just before you get to the finish line.

So what should you do in ‘taper week’? – here are some ideas starting the Saturday prior to the exam.

Synthesis Saturday:

  • Mindmap the key curriculum topics, presentations and populations – against each other and against the domains – this well help remind you how everything fits together.
  • Consider the ‘bread and butter’ consultations and make sure that you know them well, e.g. Diabetes, sick kids, MSK presentations, dermatology.
  • Think about topics that lend themselves to particular domains and proformas, e.g.  Adolescents – confidentiality, HEADSS; Paediatrics – NAI, immunisations, development, growth, diet; Aged Care – competence, preventive activities, support and safety.

Self-care (Sunny) Sunday:

  • Have a break – you deserve it.  Refresh, revitalise, restore and get ready for your week.
  • You are not likely to learn anything extra today that will be the difference between a pass and a fail – but lack of concentration because you are tired and not refreshed can impair performance.

Mundane Monday:

  • Check the guidelines – make sure your answers are evidence-based.

Cue-day Tuesday:

  • Today you should think about your consultation style and timing.  The OSCE is the only exam that tests this so it’s worth spending time on.
  • Think about signposting, summarising, non-verbal communication and empathy in the consultation.
  • Recognise the key cues:
    • “What do you think is wrong with me, doctor?” = You need to state a provisional diagnosis.
    • “What ELSE could it be?” = You’ve missed an important possible diagnosis or you need to list a few more differentials.
    • “Yes I understand about that disease, I don’t need you to tell me any more about it” = You’ve explained the diagnosis enough, move on now.
    • “So what can be done about it?” = Talk about management plan.
    • “Is there anything ELSE I can do?” = More detail required. Think about medications / lifestyle / biopsychosocial management.
    • “Is this serious? Am I going to die?” = I need more counselling or reassurance.
    • “Can you tell me more about that?” = I need more explanation.
    • “You’ve said I have <diagnosis X> but what about <symptoms Y & Z> ?” = Maybe think again, you might be on the wrong track.

Walk-in Wednesday:

  • GP Emergencies – these come up in the exam too.  Review common emergency algorithms.

Tricky Thursday:

  • Think about the presentations that you don’t see often, don’t like dealing with, or fear being behind the OSCE door.  Make sure you have an approach for these to improve your confidence.

Finesse and Focus Friday:

  • Remember that examiners can’t guess what you’re thinking – we can only mark you on what we can see or hear, not what out ‘gut’ is telling us.  Demonstrate the depth and breadth of your knowledge (but don’t explain everything you’re doing unless you’re asked to!)
  • Practice the common examinations to make sure that you can do them with finesse.
  • Remind yourself of the areas that you often forget when you’ve been practising, e.g. office tests, vital signs, follow-up.
  • Finish early – stop studying at lunchtime.  Nobody goes for a run the night before a big running race!

Settle-down Saturday.

It’s likely the nerves will set in today (if they haven’t already).  Remember that the physiological responses to anxiety are the same as those for excitement – tell yourself that this is excitement that you’re feeling – the big day is nearly here.  Spend the day with positive distractions like exercise that will also help to use up some of that excess adrenaline and help to clear your mind.   Go over how you will spend the time just before the exam – what will you have for brekkie, how will you get there, what you will wear to make you feel like the confident, competent professional that you want to show off to the examiners!  Visualise a great performance in a curriculum area that you feel confident with.  Look forward to what you have planned after you walk out of that exam centre.

Spectacular Sunday!Adobe Spark (1)

It’s exam day – you have revised, are refreshed, and ready to run a good race.   Remember, you don’t have to win, just know that you’ve prepared well, be confident, and you will do a Personal Best!

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