The PCC-OSCE (Patient-Centered Care Objective Structured Clinical Examination) is typically held in early April and is posted on the academic calendar as a weeklong process, but you are assigned to a specific day for a 2 hours block. The rest of that week is off, so you can use it to travel, relax, or study for Step 2. Students are “randomly” assigned to exam dates/times, but it went by last name for our class. The SOM does not accommodate requests to change exam time/date and switching your exam times is not allowed. The OME sends out your schedule sometime in January.
From our experience, we had very little instruction before entering the OSCE exam, so this blog entry is aimed to alleviate stress and explain the process. We will also recommend some tips at the end.
4 exams:
“Clinical Skills Cases” – 2 simulations focused on history, focused physical exam, and assessment and plan (+SOAP note after visit)
- 15 minutes for encounter
- 10 minutes for writing the note (done in LearningSpace)
“Patient-centered care cases” – 2 simulations focused on motivational interviewing and difficult conversations/patients
- 5 minutes to prepare
- 20 minutes for encounter
Structure of exams/tips:
Before:
- Make sure to arrive at least 15 minutes early so you give yourself some time to decompress before starting because they will run through the order of your four visits.
- You are not allowed to bring anything with you into the exam room, so know how you are going to structure your history and physical, and how to write/structure a SOAP (subjective, objective, assessment/plan) note.
- Outside of each room, there is a piece of paper with the pertinent information for the visit.
- It will include information on the setting of the visit, patient demographics, and clinical information.
- Make sure to read this closely because it will tell you what setting you are in and tell you your role (attending physician, resident, medical student, etc.).
Patient-centered care cases
- Do not require physical exam
- If you suspect depression, ask about suicide ideation
- If you suspect abuse, ask about safety at home, etc.
Clinical skill cases
- Keep track of time and give yourself enough time to conduct:
- HPI, PMH, Current Meds, PSH, Allergies, Family hx, Social hx, quick focused ROS
- Focused physical exam
- Diagnosis + Treatment options/Next steps
- Give the pt a diagnosis and treatment options/plan during the visit
Necessary items for exam
- White coat
- Name badge
- Stethoscope
- Laptop for notes
Tips
- Review history and physical exam components particular to the core 7 clerkships
- Patient-centered care cases were psych/family medicine heavy
- Clinical cases were more big organ systems (pulm, GI, CV, neuro, etc.)
- When collecting an HPI remember to ask: “OLD CARTS”
- Onset, Location, Duration, Characteristics, Aggravating factors, Relieving factors, Treatments (and response), Severity
- Review how to do a focused physical exam for some general chief concerns
- If you haven’t had a clerkship yet, study those parts of the history and patient exam (recommend talking to your friends who have had other rotations)
- Review how you would structure your SOAP note if you had to write it
- Our year the note writing portion was poorly constructed, so we are hoping they made changes for you.
How are you evaluated?
- Communication, interpersonal skills, and integrated clinical skills
- Faculty graders will evaluate your performance based on a rubric
- OME doesn’t release the rubric
- Each encounter is either satisfactory or unsatisfactory
- Successful completion is a graduation requirement, so can re-do any encounter graded unsatisfactory
What happens if I fail?
No big deal. You will be called back the following week to take the portion of the exam that you failed again, and will have to complete all of the required elements of the history and physical to pass.