The National Assessment Collaboration (NAC) Objective Structured Clinical Examination (OSCE) consists of a series of stations based on presentations of clinical scenarios. For a given administration, each candidate rotates through the same series of stations including pilot stations that do not count towards a candidate's final score. Each station is 11 minutes in length with two minutes between stations.
At each station, a brief written statement introduces a clinical problem and outlines the candidate’s tasks (e.g. take a history, perform a physical examination, etc.). In each station, there is at least one standardized patient and a physician examiner. A standardized patient is either a healthy person or a person with chronic stable findings who has been trained to present a real patient's signs and/or symptoms in a reliable and consistent manner. Candidates should interact with standardized patients as they would with their own patients. This includes draping a patient as appropriate for different elements of a physical examination (regardless of their gender). Most standardized patients that are to be physically examined are already in hospital gowns, but the gowns may be removed as part of the examination. Interacting with standardized patients also includes questioning them and responding to their problems, as you would with a real patient. Your interaction with the standardized patient is part of what the physician examiner is assessing.
In general, you will not interact with the physician examiner. An examiner may prompt you once if they believe that you have misunderstood the directions; e.g., you are pursuing a history during the physical examination station. They may also intervene if they believe there is a problem for the standardized patient.
The physician examiner observes the patient encounter. For most stations, the candidate will be asked to respond to a series of standardized oral questions asked by the physician examiner after eight minutes with the standardized patient. The candidate instructions (posted on the door and in the room) will indicate whether there are physician examiner oral questions at the eight-minute mark or not.
It is not your ability to do and be all things at each station that contributes to a good assessment; it is your ability to focus on the assigned task, as well as the given patient problem. For example, if you are asked to conduct a focused physical examination on a patient with acute onset of shortness of breath, the challenge is to prioritize, organize and conduct a physical examination that is appropriate to the degree of respiratory distress presented by the standardized patient in the time allowed for the station. The ability to decide what is necessary for a patient problem, given limited information and time, is critical to success on the examination.
Physician examiners may intervene to provide you with information or results. For instance, in a physical examination station, a physician examiner may be directed to give a blood pressure reading or results of an ophthalmoscopic examination. They can only do this if they are so instructed by the scoring instruments and only if you have initiated the examination manoeuver. The intention is to save you time by allowing you to move on to other sections of the physical examination.
Similarly, physician examiners may provide results for some tests. This only occurs at those stations where you are expected to order tests or investigations. However, results are not given for all the tests or investigations that are ordered. This point is important, as ordering a certain laboratory investigation may be a correct procedure, even if no results are forthcoming.
In some administrations there may be observers or second examiners. These individuals are introduced as part of the quality assurance process and for ongoing assessment.
The examination includes a separate written test of candidates’ therapeutics knowledge. You will answer the questions directly into the therapeutics answer sheet which will be collected at the end of the session. This component lasts 45 minutes and consists of single best answer multiple-choice questions testing the candidate's knowledge of therapeutics for patients across the age spectrum and related to pharmacotherapy, adverse effects, disease prevention and health promotion. Click here to see examples of NAC therapeutics questions.