OSCE Objective

To assess applied knowledge, clinical reasoning, clinical skills, communication skills and professional attitudes in the context of consultations and patient examinations.

Examination Format

This OSCE is comprised of 14 stations. A station is the basic unit of an OSCE and is comprised of a simulated patient and an examiner in the setting of an examining room. Each station will be 12 minutes in duration.

Halfway through the exam there will be a 20-minute rest period. It will take approximately 3.5 hours to complete the stations. Clear instructions will be provided to the candidates before entering each station. It is critical that candidates read and follow the Candidate Instructions carefully.

The 14 stations will require candidates to focus on a number of tasks (e.g. history taking, physical examination, investigations (selection or interpretation), making a diagnosis or a clinical decision, management aspects and counseling). The clinical cases may focus on any aspect of general practice/family medicine, from obstetrics/pediatrics to geriatrics. For example, candidates may be required to consult with an emotional patient, a patient with multiple clinical problems, a new patient, or a patient with diagnostic and management dilemmas. Candidates may also be required to answer oral questions from the examiner in a station.

Simulated Patients

Simulated patients (SP's) are an integral part of this exam. SP's are healthy people who have been carefully trained to portray, in a standardized way, particular social, emotional and physical findings for the purpose of this assessment. Throughout the exam, candidates must treat these SP's as they would real patients.

Candidate Procedure

Candidates are asked to bring a lab coat. If the name of the school or hospital is indicated on the lab coat, it must be covered with non-transparent tape. Candidates must also bring a reflex hammer and stethoscope. This equipment must be carried within lab coat pockets. Handbags, knapsacks, medical bags, etc. are NOT permitted. All other necessary equipment will be provided at the exam site.

For security reasons, candidates will NOT have access to telephones during their time at the exam site. Cell phones, palm pilots and all other electronic devices will NOT be allowed on site, as storing these items securely during the exam will be problematic. Please note that only a coat rack will be available.

Senior exam staff and examiners may inspect anything that a candidate brings to the exam site and may at their sole discretion, forbid the admission to the exam of any materials that they deem unsuitable.

Candidates will have 3 minutes to read the candidate Instructions before entering each of the 14 stations. They should read the instructions carefully and identify what is expected in each station. A copy of the Candidate Instructions will be in each station if the candidate needs to re-read them during the simulated patient encounter.

This exam has been designed to assess candidates' clinical skills; there are no ‘tricks'.

Throughout the exam, candidates may make notes in a blank booklet that they will receive at exam day registration. This can be done when reading the Candidate Instructions or when meeting with the simulated patient. This booklet MUST be returned, completely intact, during de-registration at the end of the exam. Exam staff will be there to assist at de-registration.

For security reasons, the morning administration of candidates will be required to remain on site until the pre-designated exam finish time. The College will provide candidates with this time prior to the exam. A light lunch will be provided. No outside contact will be permitted until candidates are dismissed at this designated time.

Central Timing

Candidates will hear a standardized pattern of buzzers throughout the exam, which will indicate the timing of the stations. The pattern is as follows:

One Long Buzzer Signal – Having read the Candidate Instructions on the door, the candidate enters the station.

Two Short Buzzer Signals – Indicates that the candidate either has 4 minutes remaining with the simulated patient, OR that it is time to disengage with the patient, as the examiner will be asking some focused questions*.

One Long Buzzer Signal – The candidate must leave the station and move to the next station to read the Candidate Instructions. Candidates must wait for this final 12-minute buzzer signal before moving to the next station.

* Candidates will know from the Candidate Instructions, before entering the station, whether there will be examiner questions at the nine-minute mark.

Exam site staff will be available to guide candidates throughout the exam process, from registration at the beginning, to de-registration at the end of the exam. CAPP aims to make the OSCE process as straightforward as possible, so that candidates can focus on the content of the exam and demonstrating their skills.

Physical examination findings, test and investigation results may be:

• Detailed in the candidate Instructions (with a copy in the station)
• Given verbally by the examiner in response to the candidate's questions
• On a printed sheet to be handed to the candidate by the examiner
• Given as printed or photographic material (e.g. photos, ECGs, pathology, imaging)

Assessment Focus and Individual Station Scoring Checklists

Each of the 14 stations will have different scoring checklists: a station which calls for a focus on history taking will have its scoring weighted towards this aspect; whereas a station which calls primarily for a physical examination will have its scoring weighted to reflect this focus.

Furthermore, if a station presents a diagnostic problem where the candidate has been instructed to take a history to demonstrate his/her problem solving skills and discuss his/her differential diagnoses with the patient, simply arriving at the “right” diagnosis may not be sufficient for a satisfactory rating. Other important elements such as taking the relevant history in a systematic approach and demonstrating good communication skills with the patient may also contribute to the candidate's score in this station.

The assessment focus of each station will be comprised of a combination of the areas listed below.

(Note that these examples are not exclusive and there may be more in the actual list.)

Communication and Rapport

Competence in this area demonstrates genuine respect, rapport and empathy. It allows the patient to talk freely and to feel at ease in a non-judgmental atmosphere. It includes active listening, appropriate maintenance of eye contact, recognition of verbal and nonverbal cues and body language. It demonstrates the effective use of silence and suitable language with appropriate mix of open and closed questions. It enables the exploration of concerns and expectations and allows recognition of the significance of the patient's words.

(See Communication Skills Program: Dalhousie University Faculty of Medicine and Calgary Cambridge : Teaching and Learning Communication Skills in Medicine. Links on this website)

Interprofessional Communication Skills

Candidates are rated on their communication skills at an interprofessional level with colleagues in other health professions.

History Taking

Candidates are rated on their ability to take a relevant and organized history; following appropriate cues and eliciting both positive and negative details important to the assessment and management of the patient.

Physical Examination

Candidates are rated in their ability to perform an appropriate and systematic examination, which is focused and not overly inclusive. Relevant and specific findings should be elicited. Note: All physical exams may not elicit positive findings.

Physical Examination Technique

Candidates are rated on their physical examination technique. Systematic and appropriate examination techniques should be employed and explained to the patient. Candidates should demonstrate respect for the patient and concern for the patient's safety, comfort and modesty. Candidates should clean their hands at the beginning and end of each physical examination with the antiseptic hand cleaner provided in each station.

Investigations

Candidates are rated on their ability to select relevant, cost effective investigations in an appropriate sequence, displaying consideration for the safety and comfort of the patient.

Diagnosis

Candidates are rated on their ability to make an accurate diagnosis based on interpretation of the patient's history, physical examination and investigations.

Problem Definition

Candidates are rated on their ability to identify, define and prioritize the physical, psychological and social issues involved for the patient, the family and the community.

Medical Knowledge

Candidates are rated on their medical knowledge of the physical, psychological and social issues involved in some cases.

Public Health Issues

Candidates are rated on their awareness of, and ability to deal with the public health and social issues raised by some cases.

Management

Candidates are rated on their ability to manage the issues raised in some of the cases, both now and in the future. Candidates should offer effective explanations, education and choice to patients, and involve the patient, family and relevant community resources in their immediate and ongoing management plans, as appropriate. Candidates should demonstrate responsibility for the immediate and ongoing management of the patient.

Ethical and Medico-Legal Issues

Candidates are rated on their ability to deal with the ethical, medico-legal and professional issues raised by some of the cases.

PLEASE READ THE FOLLOWING CAREFULLY:

The CAPP examinations assess candidates' competence to perform satisfactorily in actual practice. PLEASE NOTE THAT THIS IS NOT A "PASS OR FAIL" EXAM, BUT AN ASSESSMENT OF YOUR STRENGTHS AND WEAKNESSES. It is the licensing authority's decision as to what constitutes a result that is “satisfactory” to justify granting a licence to practice medicine.

All decisions regarding licensure are the sole jurisdiction of the licensing authorities. The Report of Assessment supplied by CAPP to the licensing authority will be one factor considered in the decision to offer the Physician-Candidate a license to practice medicine. A decision to grant a licence is the exclusive prerogative of the licensing authority and a favorable Report of Assessment does NOT guarantee licensure.

Acceptance into the CAPP does not guarantee a license from the medical licensing authority as each authority has other regulatory requirements beyond those required by the CAPP.