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The Australian College of Emergency Medicine (ACEM) training program has an exit examination process that is rapidly evolving. From a candidate point of view, the level of uncertainty of expectation and the need to perform relatively routine tasks under direct observation has led to very high levels of stress.
Recently, the exam has been plagued with swirls of controversy regarding sharing of stations by candidates and drawn out delays in results due to complex statistical standardising process.
No doubt this is a challenging implementation issue for the college. We hope for everyone’s sake that things are ironed out over the coming months and years.
We may gripe but the exam has to change… The FACEM ‘OSCE’ has lots of theoretical advantages over the old “SCEs, Shorts and Longs”.
The main advantage is the ability to standardise the exam so you compare candidates on a equal footing. Short and Long cases, while offering a glimpse of professionalism and communication, could be ‘gamed’ for a pass by well rehearsed candidates. The old exam was also subject to a variation between patients and in the “the standard” set for a pass by hawk and dove examiners.
A good example of the old exam’s Short Case failings:
- One Candidate gets Paediatric Development, Cerebellar Signs, Cranial Nerves and HOCM (not to mention two Dinosaur Examiners).
- Meanwhile, another equally able candidate gets a short case exam with no Paediatrics, a straight forward aortic murmur, Pulmonary Fibrosis, Rheumatoid Hands and Liver Disease.
In summary, the old exam did not test what a FACEM ‘actually did’ day to day and asked the candidate to say “what they would do”. The new OSCE asks the candidate to “do what they would do everyday” in exam conditions…
- The ACEM Fellowship Examination: Fit for purpose? – PDF File
- Does the new Fellowship Examination format ensure a sufficient standard for FACEMs? Yes – PDF File
- Does the new Fellowship Examination format ensure a sufficient standard for FACEMs? No – PDF File
The aim of this page is to help answer the above questions.
The first point is that the exam is structured, and allegedly objective. Therefore, like any exam you can prepare and improve with practice and feedback.
Avoiding group practice for your comfort of long nights with a textbook may seem logical but is probably the road to the wrong result.
As a candidate, there are some general rules that you should follow in any OSCE assessment. A good preparation for a candidate or mentor is to attend your local medical school’s OSCE exams either as an observer or an examiner.
Marking 20-30 students in a row gives a great insight into the exam from the assessors perspective. Things that have jumped out to me as an OSCE examiner as as follows:
- Wash your hands and smile on entering
- Body language is very important in all OSCE stations – therefore practice your non-verbals (use video of yourself to obtain feedback)
- Watch Amy Cuddy’s famous insight into body language:
- Avoid the common errors outlined here
- Think about your ‘scripting‘ where you can. The following would be examples of where you can write down and repetitively practice the best way you can communicate:
- Simulation introduction
- LIPS: Label Case, Issues List, Priority Setting, Send for help
- Closed loop communication
- Breaking bad news
- Dealing with difficult situations
- Simulation introduction
- Allow the actor to talk and treat the exam ‘patients’ like a real patient
- Find a mentor or two and a good study group of 3-4 members
- Given the alleged 2016 events around postponing the OSCE results it is a prudent reminder to look after “yourself” first. By all means share your resources and energy but don’t suffer a fellow candidate who is “take take take”. You can’t afford the stress of supporting other candidates or being pressured to give away details about your exam experience.
- Look, sound and smell your best on the day
- gentle exercise up and until the exam day
- iron your scrubs
- industrial strength deodorant prior to entering the exam.
The following resources and links should help you prepare:
External Resource Collection
ACEM college example questions:
- Samples – All Sample OSCE stations
- Airway – Airway Management
- History – History Taking
- Simulation – Asthma Management
Common Clinical Examinations
Medical Education Solutions
- Simulation – How to Pass?
- OSCE Podcast (Simulation) – Podcast