MRCEM OSCE (Part C) – preparation, revision, resources and courses
April 09, 2020
The MRCEM OSCE exam requires a considerable amount of revision and preparation....
And we are often asked by Emergency Medicine doctors where they should look for MRCEM OSCE resources, online revision materials, mock stations and preparation courses.
Here we compile the best advice, tips, courses and resources available for the Membership of the Royal College of Emergency Medicine (MRCEM) OSCE exam whilst also address some understandable concerns about the effect of COVID-19 on availability of test centres and upcoming exams.
What is the MRCEM OSCE?
The MRCEM OSCE consists of 18 stations (16 patient encounters & 2 rest stations), each one lasting for about 7 minutes. The MRCEM OSCE exam will not only test your theoretical knowledge, but also your resus skills and communication skills. Even candidates who are working in an emergency medicine department (ED or ER) often find these OSCEs difficult. Even if you have a strong background knowledge in Emergency Medicine the exams can still be tricky due to a heavy reliance on testing your communication skills and etiquette.
Preparation is therefore vital for all doctors who intend to take the MRCEM OSCE (part C) exam. This can be broken down into the following:
Practical day-to-day work (colleague observations & feedback, peer groups, study groups)
In general, emergency medicine course tutors advise setting aside at least 2-3 months preparation in addition to your Emergency Medicine experience.
How has the COVID-19 coronavirus afffected MRCEM exam centres & dates?
The Royal College of Emergency Medicine took the difficult decision to cancel all events for the months of April, May and June following the escalation of the virus. As the UK and most of the world remain in some form of lockdown, the Royal College has not announced when it is expecting to open up it's centres again. Understandably this will be tied into government advice and that of the WHO whilst most examiners involved in the OSCE examinations will be tied into urgent clinical duties.
IMG Connect is keeping a very close eye on the examination schedule and will keep all our IMGs informed as soon as the College publishes some updates. You can find the updated exam schedule here.
However, this does not mean you cannot use the time to prepare for your OSCE!
Take a look through Mastering Emergency Medicine – a practical guide to re-enforce your solid background in Emergency Medicine knowledge before you start approaching the stations. Note that this book was first published in 2009, and some aspects may be slightly outdated.
Familiarise yourself with the stations, techniques and format by watching online videos and tutorials - you can find both free and paid tutorials online.
YouTube has many great videos available to get you started, covering basics of examination and OSCE guides through to mock OSCE scenarios:
General advice is to use a variety of resources, including reading materials, online subscriptions to videos and tutorials, podcasts and videos. The following have helped IMGs on their journey to successful completion of the MRCEM OSCE:
Practical work - peer groups and senior colleague observations
The best way to practice and solidify what you have learnt from your studies is to organise group sessions and observations at work.
Observations at work
Ask senior colleagues to observe and offer feedback to you on a regular basis on the EM ward. Receiving quality feedback in a formal setting is widely regarded as fundamental to your advances in emergency medicine practice.
When organising a peer group of Emergency Medicine OSCE aspirants, advice is to have a maximum of three/four persons per group. Three works very well because you can each play a role during role play sessions.
When conducting role plays, you may want to organise yourselves as follows:
Patient (use instructions for the actor provided in the textbooks, remember each patient has a back story and there are many aspects the actor must show, including emotion)
Examiner (takes notes, observes, marks the checklist and gives immediate and detailed feedback on all aspects of the marking sheet)
Remember to take turns and swap roles, work as the patient, exam candidate and the examiner. Stick to the exam format, for example set a time limit of about 7 minutes which will allow you to get a clear understanding of how to pace yourself and finish before 7 minutes. Remember not to be too fast, or too slow, helping you to make every second count.
Feedback is crucial to improving your practice. As you practice together, look at the checklists after you perform each station and find out if you are missing anything.
When taking up the examiner role ensure to give detailed feedback covering all marking criteria (intro, examination, body language and winding up - the four key areas that can improve your score). Once the examiner has delivered their feedback, discuss as a group, considering how to improve in all aspects of the exam criteria.
Once you have a routine in place for peer group practical OSCE simulations, build up towards completing a full set of stations. This should be done for each member of your group. The exam can be tiring, which can in turn affect your performance on the day of the exam. For example, if exhausted at the final stations, it can be hard to maintain your clear communication and positive body language, so a full run through will help you to understand what it will be like on the day and what you need to do to ensure that you are consistently performing.
Try recording your group scenarios. IMGs who have done this repeatedly informed us that this was one of the single most important methods for seeing first-hand how to improve. We are after all our own worst critics! Take notes on the way you enter the room, move, talk, express yourself, your non-verbal cues, body language and interactions.
Take a course
There are various workshops organised by expert course tutors in Emergency Medicine designed to help you pass. You can find these online and anecdotal evidence suggests that taking a face to face course improves your chances of passing the MRCEM OSCE exam.
Speak to an IMG Consultant to check what courses might be suitable for you, if there is not a course where you live, it may be possible for us to organise one for you and your peers.
Is a course necessary?
Many overseas doctors preparing for their FRCEM or MRCEM Emergency Medicine examinations wonder if they should take a course as part of their preparation. In short, we advise that all IMGs should attend as many courses as possible. The knowledge gained on an MRCEM or FRCEM course goes well beyond the exam.
One issue is of course that courses cost a considerable amount of money, but if you consider that taking a course increases your chances exponentially of passing the examinations first time, the cost is offset by not having to pay to re-sit and all the additional costs that come with it (i.e. flights & accommodation).
Finding courses can be tricky
So take some time to work out what you specifically need help with and the stage you are at in the process. Search online to find the course that will suit your needs the most.
Speak to your peers, some may have attended a course that they felt had a positive impact on the learning and preparation.
Once you think you have found a course that suits your needs, such as an MRCEM OSCE course, check reviews posted by other IMGs to be sure of the quality of the tutoring.
If you have found a course that suits your needs, has good reviews recommendations from your peers, then it will likely be worth the investment. As a direct result you will likely pass the exams much quicker, helping you to secure the Emergency Medicine job that you want in the NHS.
On the day of exam - tips from IMGs
Passing any exam is not easy, passing the Membership of the Royal College of Emergency Medicine (MRCEM) OSCE examination even more so. In speaking with IMGs about their journey through the MRCEM OSCE exams, we have heard many thoughts about what it takes to pass. To help IMGs preparing to take the test, here we share some tips from past examinees and OSCE course tutors.
Firstly, it is good to know that every IMG taking the test is in the same position as you, perhaps anxious about how to prepare and worried about the exam day. We are told that the exam is just an ordinary day on the ward, so why then do so many excellent practicing EM physicians struggle to pass at first attempt?
It is perhaps important to say that the advice below is not just from not just those IMGs who passed first time, but from those who had to learn from their mistakes and take the test a second or even third time.
The most common thing that we hear is that IMGs must adapt their skill set to the requirements of the NHS system as well as changing their mindset to be able to work under intense observation.
Further reasons they struggle are:
Experiencing anxiety during exams is completely natural and the fact that the OSCE stations are only 7 minutes adds to this in the Part C. The only way to combat exam anxiety is to accept thatis both natural and inevitable. The best way to prepare and suppress the adrenergic surge is with practice, practice and more practice. The best way to practice is under exam conditions and if possible, this should be timed and observed by different examiners.
We are not of the opinion that this practice should be done last minute in the week before the exam, instead, your practice should start long before this point. Ask your senior colleagues in the ED to observe and comment upon your history taking and examination skills. If you can get into a routine of doing this with 3 to 5 patients per day you will be able to run through nearly all of the most likely scenarios in only 12 shifts. Another great strategy is to teach OSCEs to the more junior doctors within the department. Teaching can be a powerful learning tool and has helped many aspirants with their revision.
2. Lack of practice
Make no mistake – the exam is very tough. Over 50% of candidates failed the 2016 sitting. Unless you are freakishly good at cramming you will need to set aside at least 3 months to prepare. IMGs will all study in different ways. Remember you have been through many exams all on your own. Whatever revision method works for you, stick to it. Once you know that you are going to study, make a revision plan and stick to it.
Practice in any way that you can. As above, be sure to ask senior colleagues to observe and offer feedback to you on a regular basis on the EM ward.
To practice out of work, form a small group of colleagues who are also taking the test and run through role plays, taking turns to be patient, doctor or examiner.
Pay careful attention to time keeping as it is very common for candidates to run out of time, particularly in history taking and communication skills stations.
3. Lack of familiarisation with curriculum
If you don’t know what you could be tested on, you won’t know what to prepare. The MRCEM OSCE is mapped to the competences of Year 1-3 of the Emergency Medicine 2015 Curriculum which is available on the 2015 Curriculum page. You should familiarise yourself with the Year 1-3 competences in preparation for sitting this examination.
4. Not being able to communicate effectively
Many IMGs have made the mistake of thinking that communication is only about what you say, not considering how you say it, and what you look like when you are saying it. Of course, you may be anxious, which can make you behave differently and say things in a different way. So, if you have practiced as above, make sure you incorporate practicing communicating not just focusing on what you say, but also your body language when saying it. Remember that between 70% of our communication is non-verbal!
Try to speak audibly and clearly and if at all possible, sit at the same level as the patient with an open posture. Attempt to make a connection with the patient, maintain good eye contact and give them your undivided attention. Treat actors and mannequins as if they are real patients, interact with them in the same way that you would on the EM ward.
Be direct and to the point but deliver any bad news in a sensitive and empathetic manner. Always check whether the patient has understood what you have said and ask if they have any questions.
5. Reading and deciphering the instructions
It is vitally important to read the instructions very carefully before entering a station. Easy marks are frequently lost by nervous or over-confident candidates that have overlooked key information or made assumptions by misreading. This is a mistake many IMGs have made, so learn from their mistakes and be sure to read everything carefully. Once read, make a plan of how you will approach the scenario. Once your minute is up… deep breath and smile!
If you have any questions about how to prepare for the MRCEM OSCE exam, including advice on courses, resources, mock scenarios, online materials and revision books, then don’t hesitate to get in touch with an IMG Consultant.
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