CANDIDATE ORIENTATION

© NAC / MCC Pre-Exam Orientation 2013

NAC OSCE Examination The National Assessment Collaboration (NAC) Objective

Structured Clinical Examination (OSCE) assesses the competence of candidates — specifically the knowledge, skills and aptitudes essential for entrance into postgraduate training in Canada.

The NAC OSCE examination may include problems in: Medicine Pediatrics Obstetrics and Gynecology Preventive Medicine and Community Health Psychiatry Surgery

In addition, the candidates will be assessed on their basic knowledge of therapeutic management of common clinical problems.

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Duration][ The examination duration is approximately 4

hours.

Plan to be at the examination site for a minimum of 6.5 to 7 hours.

No external contact will be permitted during the examination and sequestering period.

Candidates will not be dismissed until the specified time on the information sheet.

Items to Bring ][ Reflex hammer

Stethoscope

White lab coat

Items that are NOT permitted: Cell phone, pager, iPod,

or any PDA (Palm, Blackberry, etc.)

Pens, pencils, pen lights

Paper, books, notebooks

Bags, briefcases

Candidate Notebook ][

Do not open your notebook until the examination begins.

Inside, you will find a sheet of bar code ID labels and some blank paper for your use during the examination.

Never rip out any pages; your notebook must be returned intact at the end of the examination.

Organization of the Examination ][

TWO PARTS: Written:

Therapeutic Management Examination A series of questions unrelated to any of the

patients in the OSCE portion of the examination.

Then a short break, followed by the: OSCE

12 clinical stations with standardized patient encounters.

][ A written examination component

based on the knowledge of therapeutic content. Multiple- choice questions — approximately

24 in total.

The session will last 45 minutes.

Introduction to the Therapeutic Knowledge Component

][ WrittenTherapeutic Knowledge Session

Wait for the signal from staff before beginning.

Questions DO NOT relate to any patient that you will see in the OSCE portion of the examination.

These questions test your ability to recognize common therapeutic approaches including the prescription of medications for common clinical problems.

Read the questions carefully.

Record your answer to each question by filling in the corresponding bubble with a pencil ().

To change an answer, completely erase the bubble you do not want counted.

Only clearly filled bubbles will be scored. – The following marks will NOT be recognized:

,,. If you fill in more than one bubble for a

question, you will be scored ZERO for that question.

WrittenTherapeutic Knowledge Session[ ]

Introduction to the OSCE][ What is an OSCE?

Objective Structured Clinical Examination A form of performance-based testing used to measure

candidates’ clinical competence.  During an OSCE, candidates are observed and

evaluated as they go through a series of stations in which they interview, examine and treat standardized patients (SPs) who present various types of medical problems.

NAC OSCE: 12 stations of 11 minutes

Candidate Instructions][ At each clinical station there is a written

statement (candidate instructions) that: Introduces a clinical problem

Directs the candidate to appropriately interact with a patient (standardized patient)

Specifies the task, such as obtaining a focused history, conducting a focused physical examination, or assessing and addressing the patient’s issues

Indicates whether there are examiner oral questions at the 8-minute signal

Read the instructions carefully If the task is “take a focused history” – that is what you

will get credit for. You will not get credit for advising or educating if the assigned task is focused history taking.

Use closed-ended AND open-ended questions Use open-ended questions such as: “Can you describe

the pain for me?” or “What other changes have you noticed?”

Limiting yourself to yes/no questions also limits what the patient can answer.

[ Important Reminders ]

Listen to the patient

If the patient’s answer is not clear and the issue is important, explore the point further.

You are expected to elicit the patient’s story; if the patient feels you are indifferent, judgmental or hostile, he or she will be reluctant to confide underlying fears or embarrassing information.

[ Important Reminders ]

Get full scores on physical examination stations You cannot receive scores for rectal, genital or

vaginal exams unless you indicate to the examiner that you would like to do such an exam.

State what you are doing and report your findings — both positive and normal.

Give specific information Avoid giving generic information. Advise the patient with information or advice specific

to their problem.

[ Important Reminders ]

Do not talk too much or too little By talking too much, you may lose valuable time

and miss information.

Use professional courtesies of introducing yourself or explaining briefly why you must ask a difficult question.

Speak in a language that the patient will understand — do not use medical jargon.

Avoid lecturing the patient — engage them instead.

[ Important Reminders ]

Your badge has a station number that indicates your start station.

Candidate instructions are posted outside each station.

READ everything carefully. Pay attention to the statement, which explains

your task. A copy of the instructions will be available inside

the room for your reference.

[ Important Reminders ]

Physical Examinations Examiners may intervene by:

Asking you to reread the instructions The intent is to remind you to refocus on the task and to

save you time. Stopping genital, rectal or vaginal examinations

If such examinations are appropriate, all you need to do is clearly inform the examiner.

Help the examiner score by: Telling the examiner what you are doing

(e.g., inspection) Describing any findings

Include findings that are normal.

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Physical Examinations]

Carry out any maneuvers necessary for assessing the presenting problem.

Examiners only give credit for tasks completed satisfactorily!

[ You will be expected to use the hand sanitizer that

will be available in every physical examination station. You may be prompted by the examiner.

Be sure to drape the simulated patients appropriately.

] The 8-minute warning signal will indicate:

EITHER that your time with the patient is over and the physician examiner will begin to ask you questions

OR if there are no questions (as indicated on the candidate instructions), that you still have 3 minutes remaining with the patient.

A signal also indicates the beginning and the end of each station.

After each final signal, you will have 2 minutes to move to the next station and read your instructions.

[ Signals

] Physician examiner oral questions may follow the warning

signal in the OSCE stations. They: Are related to the patient you just saw Ask about matters like diagnosis, management

decisions, and/or your response to an ethical issue

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Candidate instructions on station doors will indicate whether there are oral questions at the 8-minute signal.

If there are no oral questions, you will have the full 11 minutes with the patient.

Oral Questions at 8 minutes

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Standardized patients are trained to simulate patients’ signs and symptoms in a reliable and consistent manner.

Treat them as you would real patients.

Hand 1 bar code label to the examiner as you walk into the room (instructions on the door).

Examiners observe and assess your performance with preset rating sheets.

]Physician Examiners, SPs and Labels

[ Before leaving, you must follow the sign-out procedure.

When it is your turn, hand in your: Candidate notebook (all pages intact) ID badge Unused bar code labels

Signing Out]

Congratulations! At this point, the examination is over!

Sign out on the sheet.

Read your instructions carefully.

Complete the specified task.

Demonstrate your clinical skills.

You receive credit for tasks completed satisfactorily.

Treat the standardized patients as real patients.

Do not provide more answers than specified in the question.

DO NOT LEAVE without signing out.

Final Review of Important Points

Your group leader and the support staff are there to answer your questions and guide you from station to station.

Try to relax and stay focused on the examination.

The purpose of the examination is a fair and accurate assessment of your clinical skills.

Focus on the Examination

Results will be made available to you in your online account at the MCC 6 to 8 weeks after the exam date.

RESULTS

Through your online account, you will be able to: view your results documents. share them with other organizations.

[ Questions?]

© NAC / MCC Pre-Exam Orientation 2013