Exam structure and content
Overview
The examination consists of 16 Objective Structured Clinical Examination (OSCE) stations in total and covers four components (question types). Each component is made up of four stations:
- Examination (four stations)
- Non-technical skills (four stations)
- Procedural skills (four stations)
- History taking (four stations)
Examples of stations include patient history taking and physical examination, demonstration of practical technical skills, the application of basic science knowledge, data acquisition and analysis, counselling and communication skills.
The examination is focused on assessing generic skills, not knowledge about particular clinical scenarios, although common clinical scenarios may be used to illustrate and demonstrate various skills. The clinical knowledge required for the Clinical Examination is targeted at the level assumed of a competent junior doctor.
Scenarios in the Clinical Examination may be based around any of the nine RACS specialties; Cardiothoracic Surgery; General Surgery; Neurosurgery; Orthopaedic Surgery; Otolaryngology, Head and Neck Surgery; Plastic and Reconstructive Surgery; Paediatric Surgery; Urology and Vascular Surgery.
Examination
"Perform a relevant physical examination..."
Candidates should perform a physical examination specific to the area of interest. Usually the region will be defined by the question.
For example: "Examine the right hip and other relevant features of the right lower limb".
The qualifier here serves to indicate that in addition to a hip examination, leg length and a brief neurovascular examination should be performed.
Occasionally you could be asked about the examination for a specific condition which may involve many regions. You will need to explain to the examiner what you are doing and why as you proceed.
You are not required to take a clinical history and ongoing dialogue with the surrogate should be confined to the physical examination (eg. "does it hurt?" or "please open your mouth").
You will not be required to examine genital, anus/rectum or female breast regions but if you think it could be relevant to the condition, you should tell the examiner that you would examine the region without doing so.
Non-technical skills
There are five possible categories in this station type.
- Counselling
- Obtain informed consent
- Breaking bad news
- Working in a team
- Post-operative information
Counselling
The candidate will be given information about a specific condition or the result of an investigation and will be expected to communicate this information to the surrogate patient in terms that the patient would understand. They may also be asked to discuss options available to the patient or implications of the information.
Obtaining informed consent
Candidates will be told the specific procedure the patient is to undergo. They should carry out an appropriate informed consent.
Breaking bad news
The candidate will be supplied with unpleasant news to convey to the surrogate patient and is expected to demonstrate not only knowledge of the subject, but also an ability to communicate in an appropriate manner with empathy.
Working in a team
The candidate will be expected to undertake a task with the surrogate who is acting as a member of the team (e.g. nurse, paramedic or colleague) providing appropriate information, undertake a checklist or trouble-shoot for the clinical scenario presented.
Post-operative information
Information about the postoperative status (a complication or new scenario) of a patient will be provided and the candidate asked to explain the problem and its implications to the surrogate patient. Simple terms should be used to convey the information and where appropriate, pen and paper may be used to provide a diagram for the patient. It is also important to allow the patient an opportunity to ask questions to make sure they understand. The surrogate may have specific questions to ask during the station.
Procedural skills
There are three categories of procedure you may be required to demonstrate.
- Generic surgical skills – such as gowning and gloving, suture technique and safe handling of instruments.
- Diagnostic procedures – such as FNA, biopsy, excision of lesion.
- Emergency procedures – such as airway management, IV access procedures.
The examiner at this station type will expect the candidate to demonstrate the method of performing the specified procedure on a surrogate patient, a mannequin or a model.
A running commentary is expected from the candidate describing the anatomical landmarks, the presence or absence of obvious complicating factors (e.g. previous surgical scar), and a complete step by step description of the procedure using the equipment provided.
The equipment may be physically present or a photograph may be used to identify pieces of equipment to be used. If equipment you need is not on display you should indicate to the examiner what you would use, how you would use it and why.
Invasive procedures should not be performed on surrogate patients but should usually be completed on mannequins or models. As well as a description of your actions to the examiner, some explanation to and interaction with the surrogate is expected.
In some questions you may be asked to do a number of short simple procedures.
History
"Take a history...."
The candidate will be required to interview a surrogate patient.
You will be given basic information about the presentation of a clinical problem and are required to take a formal structured and relevant clinical history from the surrogate patient who has been provided with basic responses to the appropriate questions.
Appropriate questions asked by the candidate will be marked on the examiner's checklist.
The marks awarded are not dependent on the answers given by the surrogate.
Charts
Several standardised charts have been developed and may be used in some stations.