What Is An OSCE (Objective Structured Clinical Examination)?

GP Nurse, Claire Carmichael, outlines the Objective Structured Clinical Examination or ‘OSCE’, detailing what they are, how long they take and her proven tips for a successful OSCE.

Introduction

Hi, everyone, welcome back to the vlog.

My name's Claire Carmichael, and I'm here to talk to you all about OSCE in nursing. So firstly, what does OSCE stand for?

What Is An OSCE?

So OSCE stands for objective structured clinical examination, OSCE.

The very first OSCE started in the 1970s, is very widely used, especially in medicine and the general medical council with the doctors, medical students, but it's also used in nursing as well.

And this was brought in as a safe way to practice your clinical skills or not practice, but be assessed in your clinical skills, in a safe environment where you're going to be monitored by people, and you're not going to be a danger to anybody, pretty much.

So basically when you are at university, you'll learn the theory behind something, you'll do the anatomy and physiology, you'll do all of the skill sessions and things like that to get practicing on particular skills, something like for Rosa, it was observations, for example, so doing the blood pressure, temperature, the heart rate, respiratory rate, those sorts of things.

But then before you're released out onto placement to sort of be released and get practice in on live patients where it could be very, very dangerous if you're not competent at something.

This is just a safe environment for somebody to practice those skills, to make sure you're confident, make sure you're competent at what you're doing and make sure that knowledge that you've learned at university has really set in to be able to practice safely out there.

So there's something called Miller's pyramid that was developed in 1990, and this is like a pyramid of confidence.

I'm going to put it right here, so you can have a look at it and see.

And this was developed as a way of ranking confidence and assessments.

So at the bottom, as you can see is about, what you know in your knowledge, and then it goes up a rank, which is knowing how, and that you understand that knowledge and then it goes up another rank, so then you're showing that knowledge.

This is probably the section where OSCE sits because you're showing that in the OSCE and you're showing that you're competent at doing something before you go out there in the real world.

And then at the very, very top, you've got the expert level so then you're going to be going out and doing it in practice.

And OSCE's can be provided in two different ways so they can be summarative OSCE's or they can be formative OSCE's.

So summarative OSCE's is normally at the end of a module or the end of a program, and this will test your knowledge on the learning and the outcomes that the module has set for you.

So this could be in the way of exams and things like that.

And then there's formative assessments, which are the ones that help you prepare for placements and hopefully help you achieve the learning outcomes needed.

How Long Do OSCEs Take?

So how long did OSCE's take?

Well, at Birmingham City University we had one OSCE in our first year, and that was just again, like I said, just to ensure we were getting the observations right.

We know how to do blood pressures and temperatures, AT assessments, that sort of thing and this was only a 20 minute assessment.

So you would go into the room, I had two examiners, one examiner was your patient where you do the observations on them, and the other examiner would stand in the background with their clipboard, marking you and seeing how you interact with the patient, make sure you're doing everything right, make sure the ranges are right on what you're saying and things like that.

And then the patient themselves, I'm assuming will speak to the examiner after and say, oh yeah, she was really gentle or she was a bit harsh.

I don't know whatever they say afterwards, I don't know.

But that's the way that we were examined at Birmingham City University.

We have to go into this room, we were on our own, we have two examiners and then you would just go in, pretend that you're a student nurse going onto placement and just do some observations on your patient.

But every university is different and the timings will be different and varied between every single university.

There's no set rule that the NMC have stated for timings of OSCE's or length of OSCE's, that sort of thing.

They just state that you have to be assessed and monitored before you go out there in clinical practice.

Another type of OSCE that I've heard of is some students will have more of a spoken OSCE.

So you will go into the room, the examiner will be there and they will ask you a series of questions and you respond to the questions.

It's like that sort of an OSCE rather than a physical, you're doing something OSCE, if that makes sense.

That's the other type of OSCE I've heard of.

However, again, every university is different in how they develop these OSCE's and how they assess you and all of that.

So just have a look at your own university guidelines for more information.

Do You Need To Study For An OSCE?

Absolutely.

Depending on what your OSCE is on, so for example, like I said about the spoken OSCE where they ask you a series of questions, so this could be anatomy and physiology, for example.

They might ask you how the heart works and how blood pressure works, so you would need to respond to that.

So those are the little things that you would have to revise, make sure you're really sound and competent on how the body works, what the different ranges are for the observations, for the blood pressure, the ranges for respiratory rate, heart rate, that sort of thing.

You really need to know that because it's really important when you're out there in practice, because it could be a life-or-death situation with a real patient.

So it's really important that you do know those skills.

So I would say yes, absolutely, you should be revising and studying and just preparing yourself for an OSCE.

How Difficult Is An OSCE?

I think I've said this in previous videos, but I'm going to say it again, just in case you just miss the memo, but exams, assignments, things like OSCE's are only really difficult if you haven't prepared for it, if you haven't put in the work, if you haven't revised for it.

So the amount of effort and time you spend on the revision and the studying and really preparing for something like this, you're going to find it a breeze.

I feel like I was really well prepared for mine, and I think that's why I got into that really good mindset.

So it's really important that you do the revision, you do the study and you practice, practice, practice, so then on the day you feel a lot more comfortable.

Like I said, is this not nice?

You are going to feel anxious on the day and it's going to be a lot of pressure, but if you've done all of the work, you're going to breeze through it.

If you mess up a little bit because you're nervous or sweating, or maybe you shed a tear, as long as you're going in there and you're doing all right, I think you'll be okay.

Do All Universities Have OSCEs?

So not every university does like a proper, big OSCE where you physically go in and you pretend to be a patient, and all of that.

Everyone will have a different way of providing an OSCE. So as part of the NMC pre-registration standards that were set in 2019, they set out a whole load of criteria that universities have to meet and obviously assessments and things like that are absolutely in there.

So then each university puts in the curriculum basically, so they set their new curriculum and they show the NMC and the NMC have to approve it.

So if it's been approved and set in stone, then it's absolutely mandatory that they have to do that.

But again, every university is different in how the OSCE will look, how it presents.

It's really up to the university that you're going to and how they deliver that OSCE, but as long as universities are assessing your competence, making sure you're confident and competent to go out there on placement, and making sure you're safe to handle patients basically, that's the main thing that the NMC want.

They want safety for everybody.

Do You Have An OSCE Once Qualified?

Absolutely, maybe not. It depends, actually. I say, absolutely, it depends.

So we will all have clinical supervisions, we'll all have an NMC revalidation where you have to sit down with your mentors or someone that's a registered nurse or registered person to do these supervisions and things like that.

So you would have to sit down and do like a reflection sort of piece.

You could kind of class that as an OSCE in a way, because that other person is assessing you and assessing your competence to make sure that you're okay to nurse still.

And this all come about when we had to do reevaluation every three years and this all come about from the Mid Staffordshire scandal.

So there was a lot of things missing.

So this is why revalidation came in, to make sure everyone's safe to practice, make sure you're updating your skills and your knowledge and that you're safe to work with patients still.

Every single three years, you've got to do it.

So technically you are sort of assessed in a way of an OSCE kind of, but how it looks will be completely different to where you work.

Also, if you wanted to do something like your nurse prescribing course, advanced nurse practitioner course after you've qualified, they will absolutely have OSCE's as part of that, I'm sure, where you have to be assessed to do medications and clinically diagnosed patients and things like that.

So 100% you'll be doing OSCE's then as well.

What Are OSCE Stations?

So an OSCE's station, it very much again depends on which university and how they run this.

But I have heard of universities where they have different stations.

So one station might be a set of observations, I keep using that because that's what we did.

A set of observations, and then you might have another station the other side of the room.

So that'd be your first station, you'll have your patients sitting there with your equipment and you have to go through the observations.

And then once your time's up on that station, you would move to a different station, so that could be to do medications, for example.

So you're going through medications with your mentor or mentor, which is the examiner, and they might test you on medications, for example.

It runs like that, so you have three separate stations to assess you, if that makes sense.

We didn't have that where I was, we just had the one set station for us so that was the room that you were in, you had your patient and things like that, that I've already spoke about.

We're not going to much to it again, otherwise this video is going to be hours long, but that's what an OSCE station is.

You'll have different tables with different things that you have to do.

Tips For OSCE

Try And Forget It’s An Exam

Some other things that you might not have thought about to how to prepare for your OSCE, your mental health.

The OSCE's are absolutely terrifying for some people.

I was very, very lucky where I was able to change my mindset, I don't know how, but I managed to change my mindset and imagine that I was in a real room, I was on real placement and I had a real patient and I just went in and I was myself.

And I've got no idea how that happened, but I managed to get into that state of mind, and that is my biggest advice for you.

If you can just try, forget it's an exam, forget it's been assessed, forget you've got someone in the corner marking you and just say, do you know what?

This is me, this is my real life, this is me as a student nurse and this is my real patient.

What would I do in this situation?

Just try and get into that mindset and you'll be absolutely amazing.

Stay Calm

But like I said, OSCE's can be terrifying and please don't let the nerves get the better of you.

So just try use different breathing techniques, anything that's going to help reduce your anxiety.

I used things like lavender on my pulse points to help calm.

There's actually some research on that as well and it does help to a certain extent.

So things like that, doing something that's going to help you relax before your OSCE and just try and calm yourself.

Because the last thing you want to get do is let the nerves get the better of you, and then you just completely mess everything up.

And yeah, I've heard of people having breakdowns in the middle of their OSCE's and things 'cause they're just so anxious and overwhelmed with it.

So just please take some time out for yourself, take some self care and get the support you need.

Make Sure You’re Familiar With The Equipment

Also make sure that you're familiar with the equipment.

So like I said, if you've got a whole lot of vital signs/observations to do, make sure you know how to do a manual blood pressure, how the thermometer works, how to check pulse rate, how to look for the respiratory rate and all of that.

Just know how the equipment works before you go in there.

So get practicing is my biggest tip as well.

Practice on your friends, practice on your family, practice on your dogs, anyone you can practice on just go and practice, practice, practice, because that's going to help you feel way more comfortable on the day as well.

Make Sure You Know The Procedures

Make sure you know all of the procedures, the guidelines and your marking criteria for your OSCE.

I know Birmingham City University were very, very good so they give us a whole marking criteria and everything that they would be assessing us on.

So the only thing that I could think of that you would get wrong there is if the nerves got the better of you, because you know what you're being assessed on, you know the marking criteria, so you know what points you need to hit to pass.

So, yeah, so I hope that your university support you in giving you the mark and criteria in advance, giving you the policies, the guidelines to look out and everything.

So it's just getting in there and getting practicing, and just knowing that stuff.

Time It Right

Timing of your OSCE as well.

So again, with practice, practice, practice, do a whole set of range of observations or speak through whatever you've got coming up for your OSCE, practice with somebody and time it, just make sure that you're not going over, you're not going under.

I don't think it matters so much if you're under so much, it's if you're going over, 'cause then that's it your cutoff then.

And they'll be like, well, you didn't do the respiratory rate.

So yeah, just make sure your timings are right.

And lastly, make sure you know if you've got to wear your uniform to your OSCE, make sure you know the time, the date, the place, you know where you're going.

Don't be late, get there in advance.

All these little things really, really help, so just make sure that you've got everything in place and you feel comfortable and confident when you're going in there. Click here to learn about the Blood Borne Virus.

If You Don’t Get It Right, Ask For Feedback

So I think that's everything about OSCE's.

If I've missed anything, if you want to know anything more, put a comment below and I'll reply to your comment, but I just, I hope that this reassures you a little bit and doesn't put you off and makes you terrified of OSCE's.

It is okay, guys, it's just a way of being assessed and making sure that you're safe, the patient's safe and that you're comfortable in what you're doing.

If by, for whatever reason, you didn't get through an OSCE, you missed a mark somewhere, please ask the marker to give you as much feedback as possible and just see where you can improve the next time and hit those marks to pass.

Like I said, it's about being safe, it's not about putting anyone down or anything like that, so please don't beat yourself up if you don't pass first time, it's okay.

Just take on board all of that feedback, practice, practice, practice, and then smash it next time and you'll be absolutely fine, I'm sure.

But that's it from me, if you've got any OSCE coming up, massive, massive, good luck to you.

You have absolutely got this.

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