Objective structured clinical examination

Or OSCE for short. The most barbaric examination ever invented since Madame Guillotine had her apprentices testing the equipment on each other to check their technique. I hate OSCEs. I hate them. Words have not been invented to express the depth of my loathing for this type of assessment. There is not a cell in my body that does not detest OSCEs. Even the 14 mites on each of my eyelashes sigh with relief at the ending of another OSCE ordeal. Is the theme of this article becoming clear?

For those of you yet to experience the delights offered by an OSCE, let me explain. The standard format consists of a circuit of a number of stations, each comprising a task to be attempted in a set period of time, usually about five minutes. So you find yourself trying to counsel someone about future contraceptive needs, then a bell sounds and you rush off to take a history from a man with diarrhoea, then mid-sentence, you are sent hurriedly on to defibrillate the ever present Resussi-Annie. By this time, however, your brain is functioning at a level equivalent to a cerebrally compromised shrimp, the only answers you can think of are to the questions you got wrong three stations back, and your hands are shaking so much that if you're asked to demonstrate venepuncture, the examiner may lose an eye. Faced with an unconscious plastic patient in ventricular fibrillation, the overwhelming temptation is to turn the defibrillator on yourself to see if that would jump start enough neurones for you to make it through to the end. Or at least, that's what happens to me.

I have also experienced life on the other side of the table, and believe me, it isn't much better. Forget adrenaline surges, as a mock patient the biggest challenge is remaining conscious. In my second year, I volunteered to participate in the exam students were doing at the end of their third year and was given the delightful role of "woman with premenstrual migraines." There are no Academy Awards in the offing, you will be surprised to hear. I repeated the same history 43 times. By half time I was experiencing difficulty in remembering my name. By the end I had become so fed up with saying the same thing over and over again that some candidates thought I was supposed to be aphasic. That night, my dreams consisted of endless questions about aggravating and relieving factors and my menstrual history. It could, however, have been much worse. Some people were allocated to be subjects for fundoscopy and blood pressure. They swapped over half way through. After 20 people had stared at each of their retinas for two minutes at a time, then another 20 had taken a blood pressure measurement, doing it a couple of times to check, they left the exam blind in both eyes and unable to move from the shoulder down.

I have been trying to decide on a new meaning for the abbreviation OSCE. Suggestions so far are an "obligatory sweepingly crushing experience," a collection of "overwhelmingly significant clinical errors" or an "obnoxiously stupefying celebration of evil." I'm sure some of you out there can do better, and I would welcome any suggestions you have. I do, however, take no responsibility if your inspiration hits you while trying to remember how to examine the elbow of an unconscious patient with three and a half minutes to go.

Vicky Mottram, fourth year medical student, University of Newcastle upon Tyne


studentBMJ 2000;08:45-88 March ISSN 0966-6494