OSCEs in GP Training
The art of being watched while looking completely calm. (You can practise that too.)
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Quick Summary — If You Only Read One Thing
⚡ OSCE at a Glance
Objective — every candidate is assessed against the same checklist. No examiner bias.
Structured — every candidate faces the same scenario and the same tasks.
Clinical — each station mimics a real clinical situation in practice.
Examination — can be formative (learning) or summative (grading). In GP training, usually formative.
OSCEs are the closest thing to the SCA that GP trainers can run in-house.
They test history-taking, examination, communication, data interpretation, and clinical reasoning — all in one format.
Stations typically last 5–15 minutes. A full OSCE circuit usually has 8–15 stations.
Simulated patients don't need to be professional actors. Anyone trained well can do it — even colleagues.
What is an OSCE?
An OSCE is a method of assessing clinical competence in a structured, fair, and reproducible way. Instead of one examiner watching one student for a long time (which is very subjective), you have multiple short stations — each testing a different skill — with a different examiner at each one.
Traditional examinations relied heavily on written tests and one-examiner assessments — both of which carry significant bias and fail to test real-world clinical skills. OSCEs were introduced to address this. They present trainees with simulated or real clinical scenarios that represent the kind of work they will do in practice, and objectively evaluate how they respond.
Importantly, OSCEs go beyond knowledge. They test domains that written exams cannot: communication skills, clinical reasoning, problem-solving, ethical judgement, and the ability to manage real human situations with professionalism and empathy.
The structured feedback after each station is one of the most valuable parts of the OSCE process. Trainees hear not just what they did, but how it felt to be on the receiving end — something that changes behaviour in a way that reading a textbook never can.
OSCEs are resource-intensive to run, but when done well they are reliable, valid, and educationally transformative. Ronald Harden first described the format in the British Medical Journal in 1975, and it has been widely adopted across postgraduate medical education ever since.
In GP training, OSCEs bridge the gap between clinical knowledge and the performance of that knowledge in a consultation. The SCA exam is essentially a high-stakes OSCE — 12 remote consultations, each marked by an examiner against set criteria. Running regular in-house OSCEs during training is one of the best ways to prepare trainees for the SCA without waiting until the exam itself.
Educational Benefits of OSCEs
✅ What OSCEs Do Well
- Safe learning without risk to real patients
- Objective, reproducible assessment
- Tests multiple domains in one session
- Immediate, structured feedback
- Trainees can rehearse difficult situations (breaking bad news, angry patients)
- Instructors can explore clinical reasoning directly
- Levels the playing field — everyone faces the same scenario
- Less intimidating than working with real patients under assessment
⚠️ Limitations to Be Aware Of
- Resource-intensive to set up and run
- Risk of "fragmenting" the clinical encounter into artificial tasks
- Poorly designed stations can introduce their own bias
- Simulated patients need consistent, careful training
- Short stations may not allow for complex reasoning
- Trainees can "game" OSCEs if they know the checklist structure
- The debrief is often more valuable than the station itself — and is often rushed
The most common complaint from trainees about OSCEs? Not the stations themselves — it's the feedback. When feedback is rushed, vague, or delivered by someone who didn't watch the station properly, the whole exercise loses its value. The most memorable OSCEs are those where the simulated patient gives honest, human feedback: "When you leaned forward and made eye contact, I felt genuinely listened to." That sticks.
What Sorts of Things Are Examined?
History Taking
Take a focused, relevant history within the time allowed. Good flow and open questions matter more than perfect detail.
Physical Examination
Usually targeted (e.g. examine the knee). You are unlikely to be asked for a full head-to-toe. Know your systems.
Data Interpretation
Blood tests, ECGs, spirometry, peak flow charts. You will be expected to interpret — not just identify — findings.
Communication
Breaking bad news, explaining a diagnosis, managing an upset patient. ICE and empathy are central here.
Equipment Use
Demonstrate safe use of clinical equipment — ophthalmoscope, peak flow meter, BP cuff, inhaler technique.
Clinical Reasoning
Given a scenario, what is your differential? What would you do next? Show your thinking out loud.
The following types of data are commonly used in OSCE stations:
- Spirometry / peak flow / vitalograph measurements
- ECGs (12-lead — know your basics: AF, MI, heart block, LVH)
- Radiology — simple chest X-rays and plain films only (not CT)
- Blood tests: FBC, U&Es, LFTs, TFTs, coagulation
- Urine dipstick results
- Audiograms (especially in ENT stations)
This is not a trick exam. You will be given material that any competent GP is expected to interpret — not specialist-level diagnostics.
Simulated Patients
A simulated patient (SP) is someone who has been carefully trained to portray the emotional, physical, and symptomatic characteristics of a real patient. They follow a detailed script that ensures every trainee experiences exactly the same encounter.
Who Can Be a Simulated Patient?
- Professional actors (ideal but expensive)
- Trained volunteers from the community
- Colleagues, receptionists, practice managers
- Other healthcare professionals
- Real patients who are willing and trained
Acting experience is NOT required. What matters is training, consistency, and the ability to give honest, structured feedback. A well-trained bank teller can be a better simulated patient than an untrained actor.
What Do Simulated Patients Do?
- Portray the same symptoms and emotional state every time
- Follow a detailed script — including what not to reveal unless asked
- Observe the trainee's verbal and non-verbal communication
- Provide feedback at the end: how the encounter felt from the patient's perspective
- Stay in role throughout, even if the trainee goes off track
SP feedback is different from examiner feedback. The SP tells you how you made them feel. This is often more impactful than any checklist.
How Is It Marked & How Are OSCEs Run?
The Marking System
Every clinical behaviour you demonstrate is ticked against a pre-designed checklist. Collect enough ticks at a station and you pass it. Pass enough stations and you pass the OSCE overall.
At the end of each station you receive feedback — typically 3–5 minutes. You are asked first: what did you feel you did well? Then: what might you do differently? Then the SP and examiner each give their observations. This structured reflective loop is where most of the learning actually happens.
Running an OSCE — A Step-by-Step Overview for Organisers
- Venue: You need one room (or cubicle) per station, plus a waiting area for candidates.
- Timing: Agree station length in advance. 10 minutes per station + 3 minutes transition is a good starting point for GP training OSCEs.
- Assessors: One assessor per station — do not share assessors between two stations, as this introduces variability.
- SP training: If you have multiple assessors, record the SP training session so latecomers can watch it.
- Errors in scripts: A factual error in a station brief can ruin the entire station and make trainees doubt all other stations. Double-check everything before going live.
- Refreshments: Build in adequate breaks. A tired trainee is not being fairly assessed.
- Payment: If using external SPs or facilitators, arrange payment in advance. Nothing undermines enthusiasm like an unpaid actor.
- Evaluation forms: Collect feedback from trainees, SPs, and assessors after the event. This is how you improve the next one.
Before the station:
- Read the candidate instructions carefully — note the task and the time available.
- Take a breath. Each station is fresh. What happened in the last one doesn't follow you into this one.
During the station:
- Welcome and identify the patient. Introduce yourself. Make them comfortable first.
- Establish the chief complaint — do not jump straight into a system review.
- Use open-ended questions early: "Tell me more about what's been going on."
- Establish a personal focus: "That sounds exhausting. How has it been affecting you day to day?"
- Summarise what you've heard. Prioritise the most important concern.
- Move to focused, closed questions once you have the picture.
- The specific details you gather matter less than the quality of the interaction. Examiners are watching your approach, not just your data collection.
- Listen actively — simulated patients are much more consistent than real ones, so their answers genuinely guide your next question.
After the station:
- When asked for self-reflection, be honest rather than defensive. "I felt I rushed the opening" lands better than "I think I did everything well."
- Take one learning point from each station and write it down within 24 hours.
Bradford VTS OSCE Video Database
Click a specialty below to access the video OSCE station collection for that area. For written OSCE past papers and templates, use the Downloads section at the top of this page.
A Note for International Medical Graduates (IMGs)
If you trained outside the UK, you may not have encountered OSCEs during your medical education. Here are the things that commonly surprise IMGs:
- The patient is always in charge of their care. In the UK, shared decision-making is fundamental. You propose options; the patient chooses. Telling patients what to do — even if you are clinically correct — will lose you marks.
- ICE is central, not optional. UK GP training places huge emphasis on exploring the patient's Ideas, Concerns, and Expectations. This is not a soft extra — it is a core marking domain in the SCA.
- Silence is a clinical skill. It can feel uncomfortable to pause, but allowing a patient a moment to think or to become emotional is a sign of professional skill, not awkwardness.
- Safety-netting is mandatory. Every consultation in UK GP should end with clear guidance on what to do if things get worse. This is a patient safety requirement, not a tick-box.
- Do not over-investigate. UK GP practice follows NICE guidelines closely. Ordering expensive investigations for reassurance or without clear clinical indication will lose marks — and is not appropriate practice.
Common Pitfalls — Trainee Traps
- Rushing the opening — jumping straight into closed questions without establishing rapport. You lose marks and the patient's trust simultaneously.
- Forgetting ICE — trainees who neglect Ideas, Concerns, and Expectations consistently lose marks in the Interpersonal Skills domain. ICE is not a tick-box; it changes your management.
- Ignoring emotional cues — when a patient hesitates, avoids eye contact, or becomes tearful, trainees often push on with their history. Examiners notice when you miss the human moment.
- Over-talking the explanation — dumping everything you know about a diagnosis on the patient without pausing or checking understanding. Chunk and check — always.
- Forgetting to safety-net — many trainees end the consultation without specific safety-netting. "Come back if it gets worse" is not good enough. Name the red flags. Give a timeframe.
- Treating the OSCE like an exam to "pass" — trainees who focus on ticking boxes often come across as robotic. The checklist is an output of a good consultation, not a script to follow.
- Not taking feedback seriously — the 3–5 minutes of feedback is more valuable than the station itself if you engage with it honestly. Defensive candidates learn nothing.
If you consistently lose marks in the same domain across multiple OSCE stations — particularly Interpersonal Skills — this is an early warning sign for the SCA. Interpersonal Skills failures in the SCA are the most common reason for failing. Target this domain deliberately in your practice.
OSCEs in GP training are almost always formative. They are designed to give you feedback and help you grow — not to pass or fail you in any consequential way. If a station goes badly, that is the point. Learn from it, write it up, and try it differently next time.
Insider Pearls — What Trainees Say
Most trainees say the station itself taught them very little. The feedback conversation afterwards — especially from the SP — is where the real learning happened. Don't skip it, rush it, or be defensive in it.
When a patient becomes emotional and you pause to acknowledge it, it feels like forever. On replay, it is usually 3–4 seconds. Examiners notice the pause. They notice you did not push on. That pause gets marks.
The most common thing trainees miss in OSCEs: the "real reason" the patient came. In most well-designed stations, the presenting complaint is not the most important thing. Ask what's worrying them. Keep listening. The real concern is usually in the second half of the history.
Trainees who score highest in Interpersonal Skills are not always the most technically polished. They are the ones who seem genuinely interested in the patient as a person. That quality cannot be taught from a textbook — but it can be practised in OSCEs.
Voices from the Trenches
🎓 What Examiners Actually Say — Direct from the Examiner's Chair
The following insights come from examiner guidance published by NHS deaneries — these are the people who mark the SCA and who design OSCEs. This is as close to reading their minds as you will legally get.
These are the specific behaviours that SCA examiners have explicitly named as the things that frustrate them. Every single one is avoidable with practice.
Asking the next question while the patient is still answering the previous one. Examiners call it "not responding to the patient." The patient has just told you something important — and you moved on.
Asking "What do you think this is?" and moving on regardless of the answer. ICE is not a tick-box. The answer must change what you do next — otherwise you haven't used it.
Phrases that sound rehearsed and robotic — "I hear what you're saying" repeated three times, "That must be really difficult for you" said in a flat tone. Examiners can tell the difference between genuine empathy and a script.
Running out of time before reaching a management plan is one of the most common reasons for failing the Clinical Management domain. Use the 6-minute rule: history first half, management second half.
"I'll get the nurse to sort that" or "the pharmacist can advise you" — without making any clinical decision yourself. Examiners want to see you manage the case, not pass it on.
"Come back if you're worried" is not safety-netting. Name the specific symptoms. Give a specific timeframe. Tell them exactly which route to use (GP, 111, A&E). Inappropriate safety-netting — too early or too late — can be dangerous.
- Efficient, focused history. You do not need to ask every possible question. Target your questions to the differentials you are actively considering. Quality over quantity.
- Managing uncertainty well. Saying "I'm not entirely sure yet, and here's what I'd like to do to find out" is a strength — not a weakness. Examiners want to see you handle uncertainty honestly rather than pretend certainty you don't have.
- Sharing probability with the patient. "The most likely thing here is X, but I want to make sure we're not missing Y, which is less likely but important to rule out." This shows clinical reasoning in real time.
- Agreeing a plan and committing to a decision. Examiners do not want to see endless deferral. They want to see you think, decide, and explain your reasoning. Shared decision-making is not the same as having no opinion.
- Sensible follow-up. This doesn't mean booking a follow-up for everything. Sometimes the right plan is clear, with good safety-netting, and no follow-up needed. Appropriate judgment impresses examiners.
- Adapting to what the patient says. If the patient reveals something unexpected mid-consultation, responding to it — even if it disrupts your plan — shows genuine listening and clinical flexibility.
This comes directly from trainees who have sat and passed the SCA, and is endorsed by deanery guidance. In a 12-minute SCA consultation:
- First 6 minutes: history, ICE, red flags, psychosocial context.
- Second 6 minutes: explain your thinking, discuss management options, reach a shared plan, safety-net.
- "Relating to Others" (empathy, communication, rapport) is not a separate phase — it runs through every minute of the consultation.
- Clinical Management carries more weighting than the other two domains. Rushing your management section is the single most costly timing error.
- Use a whiteboard to jot brief notes during the SCA. Have a strategy ready before you go in — trainees who wing this under pressure make it worse.
Practise with a kitchen timer from the very first revision session. Twelve minutes sounds like a lot. It isn't. If you haven't talked about management by minute seven, you are already behind. Once this becomes automatic in practice, it becomes automatic in the exam.
💡 The "Transparent Consulting" Concept — A Game-Changer for OSCEs and SCA
This idea comes from a GP trainer and TPD in Hertfordshire, published in the BJGP in 2021. It has been widely shared among GP training communities because it solves a problem that many trainees recognise instantly.
The Problem — Your Questions Feel Random to the Patient
Imagine watching a trainee's consultation from the patient's point of view. The doctor asks about weight loss. Then blood in the stool. Then fatigue. Then a family history of cancer. All individually reasonable questions — but from the patient's perspective, they arrive like random blows. Nobody explains why.
Then, at the end, the doctor says "I need to rule out something more serious" — and the patient is shocked. But the information was already there, scattered through the consultation. It just wasn't woven together.
The Solution — Be Transparent About Your Thinking
Transparent consulting means you tell the patient why you are asking what you are asking. You make your clinical reasoning visible. You treat the patient as a partner in the process — not a passive subject being interrogated.
❌ Traditional approach
"Have you noticed any blood in your stool?"
The patient doesn't know why you're asking. The question arrives out of nowhere. It feels alarming without context. And if the answer is no, the opportunity to reassure them has been missed.
✅ Transparent approach
"I want to make sure we rule out anything more serious — so can I ask: have you noticed any blood in your stool, or any unexpected weight loss?"
The patient understands the reason. They feel part of the process. And your safety-netting at the end now reminds them of something they already know — rather than shocking them with new information.
Transparent consulting naturally improves your Relating to Others score — because you are visibly involving the patient. It also makes your safety-netting more coherent — because the "red flags" you mention at the end are things the patient already heard during the history, framed in context. It also helps with time: when the patient understands what you're looking for, they give better, more focused answers.
How Transparent Consulting Flows Through the Whole Consultation
Notice how one thread — started during data gathering — runs all the way through to safety-netting. Nothing lands as a shock.
📣 Trainee Accounts — What Worked and What Didn't
These are patterns drawn from real trainee accounts — including trainees who failed first and then passed, and trainees who sat the very first SCA diet in November 2023. Their honest reflections are more useful than any generic revision tip.
- Study groups of 3–5. The sweet spot. Bigger groups mean less time as the "doctor." Smaller groups mean less variety of feedback. Being observer, patient, and doctor in rotation is all useful — not just being the doctor.
- Back-to-back cases without feedback in between. The SCA has 12 consecutive consultations. Your brain gets tired. If you only ever practise with feedback breaks, you are not preparing for the real thing.
- Practising on video platforms from early on. Teams, Zoom, whatever. Remote consulting feels different. Looking at the camera instead of your own face is a learnable skill — but you need time to unlearn the bad habit first.
- One new phrase per couple of consultations. Don't try to change everything at once. Pick one thing — how you open, how you ask about concerns, how you close — and practise just that until it feels natural. Then move to the next.
- Refreshing NICE guidelines in the weeks before the exam. The SCA is not primarily a knowledge test — but you still need working knowledge of first-line management. Trainees who had sat the AKT much earlier found it helpful to do a quick guideline review before the SCA.
- Watching trainee consultation videos critically. Not to see the perfect consultation — but to spot the mistakes. Recognising errors in others is the fastest way to spot those same errors in yourself.
- Positive-only feedback from your study group. If everyone is telling you your consultation was great from day one, someone is being kind — not honest. The best study groups are comfortable giving hard feedback.
- Memorising scripts. Several trainees who failed reported they had tried to learn set phrases for every situation. Under the pressure of an unexpected scenario, the script crumbled — and they had nothing underneath it.
- Over-focusing on data gathering and forgetting management. It is much easier to fill 12 minutes with history-taking than with management. This feels thorough. It isn't. You need to practise stopping yourself and switching gears at the midpoint.
- Practising only easy, typical cases. Deanery guidance specifically advises candidates to practise "awkward" scenarios — patients who push back, demand something inappropriate, or have complex emotional needs. These are exactly the cases that separate passing from failing.
- Neglecting the "expectations" part of ICE. Trainees consistently report asking "what do you think is wrong?" and "what are you worried about?" — but forgetting "what were you hoping I could do for you today?" All three matter. Expectations often contain the most important agenda item.
- Ignoring the BNF in the 3-minute prep time. You are allowed to use the BNF in the 3 minutes before each SCA case. Practising opening the BNF efficiently — not reading it cover to cover but checking a specific drug or dose quickly — is a skill worth developing.
📊 The 8 Habits of a High-Scoring OSCE/SCA Consultation
Based on patterns from examiner guidance, deanery toolkit advice, and trainee accounts — these are the eight habits that consistently separate strong performers from the rest. They are not equally weighted in real marking, but they all matter.
🌍 Specific Advice for International Medical Graduates (IMGs)
This section draws on examiner feedback and deanery guidance specifically noting patterns in IMG trainees. These are not criticisms — they are practical differences between UK and international clinical training that are worth knowing about before you walk into an OSCE or SCA.
The doctor-knows-best trap
In many healthcare systems, patients are expected to follow the doctor's advice without question. UK patients are different. They have opinions, preferences, and the legal right to refuse treatment. Shared decision-making is not a soft skill — it is a core clinical competency here.
Language and fluency
If English is not your first language, start working on fluency in ST1 — not ST3. Listening to English podcasts, reading aloud, and speaking in English outside work hours are all evidence-based ways to build fluency. The SCA is 12 minutes of real-time verbal consultation. Fluency is part of the exam.
Less OSCE practice before UK
Many IMGs have had far less OSCE-based clinical assessment than UK graduates. This means the format itself — timed, structured, observed — can feel very unfamiliar. Start early. Run more practice OSCEs than your UK colleagues. The skill is learnable; you just need more repetition to close the gap.
Being open to feedback
Trainees who improve fastest are those who treat feedback as information — not as personal criticism. One RCGP-trained GP who passed the SCA after failing the RCA reflected that her single biggest change was learning to hear critical feedback without feeling defensive. This is a learnable skill too.
UK-specific clinical knowledge
UK GP practice follows NICE guidelines. Drug choices, referral thresholds, and management pathways differ from those you trained with. Use NICE CKS during practice sessions. When you find a gap — a case where you'd manage something differently from UK guidance — that gap is a study priority.
Cultural nuance in consultations
SCA cases reflect the diversity of UK general practice — including LGBTQ+ health, religious practices (fasting, blood transfusion refusal), and health inequalities. Respond non-judgementally and with curiosity. A case centred on cultural or religious context is testing your respect for patient autonomy — not your knowledge of that religion.
If you are studying in a group of colleagues from the same country, consider switching to English for the whole session — including the feedback conversation. It feels harder at first. But by the time you are in the SCA, you need your clinical thinking to happen naturally in English, not be translated in your head before you speak.
🗂 The Consultation Hierarchy — Where Marks Actually Come From
This is a visual distillation of what examiners, deaneries, and trainee accounts all say — consistently — about where marks are won and lost in OSCE-style assessments.
Using OSCEs to Prepare for the AKT
What AKT-OSCE Stations Look Like
Unlike clinical OSCE stations, AKT-focused stations are not consultant-simulated. They typically involve written materials, data sets, or structured viva-style discussions. They can be run in groups without simulated patients.
| Station Type | What It Tests | Format |
|---|---|---|
| Data interpretation hotseats | ECG, spirometry, blood test interpretation under time pressure | Candidate reads data, verbalises interpretation, assessor marks against checklist |
| Guidelines quiz stations | Threshold knowledge (e.g. BP targets, lipid targets, antibiotic choices) | Written or verbal Q&A — timed, single-best-answer format |
| Evidence-based medicine station | Critical appraisal — NNT, sensitivity/specificity, odds ratios | Short paper or abstract provided. Questions follow. |
| Clinical reasoning viva | Differential diagnosis, investigation choice, management sequences | Short clinical vignette presented. Candidate talks through their thinking. |
| Prescribing station | Drug interactions, contraindications, first-line vs second-line choices | Written prescription task or verbal explanation to assessor |
| Organisational knowledge | NHS structure, GP contract, referral pathways, QOF | Scenario-based discussion |
Trainees who do well in written practice questions often freeze when asked to explain their reasoning out loud. If you cannot say it, you probably haven't fully understood it. Running AKT knowledge stations verbally is a brilliant way to identify gaps that written practice misses.
Using OSCEs to Prepare for the SCA
Each SCA case is marked in three domains: Data Gathering & Interpretation, Clinical Management, and Interpersonal Skills. Most candidates who fail lose marks in Interpersonal Skills — specifically in ICE, empathy, shared decision-making, and safety-netting. OSCE stations can target each of these domains individually.
Microskill OSCE Stations — Target One Domain at a Time
Rather than running a full 10-minute consultation every time, consider shorter targeted stations that isolate specific SCA skills. These are especially useful for trainees who keep failing the same domain.
| Microskill Station | Duration | What It Isolates | Marking Focus |
|---|---|---|---|
| ICE Only | 4 min | Exploring Ideas, Concerns & Expectations without clinical questioning | Did they ask all three? Did they respond to the answers? Did ICE change the management? |
| Empathy Moment | 4 min | Responding to a single emotionally charged moment (e.g. patient bursts into tears) | Tone, pace, non-verbal cues, what they said, what they did next |
| Explanation Station | 5 min | Explaining a diagnosis or result clearly to a patient | Plain language, chunking, checking understanding, no jargon overload |
| Shared Decision-Making | 5 min | Presenting two clinical options and reaching a shared decision | Both options presented fairly, patient preference sought, autonomy respected |
| Safety-Netting | 3 min | Ending a consultation with specific safety-netting advice | Was it specific? Did they mention red flags? Did they give a timeframe? Did they check understanding? |
| Difficult Patient | 6 min | Managing an angry, resistant, or tearful patient | De-escalation, maintaining rapport, staying professional, not capitulating or becoming defensive |
| Agenda-Setting | 4 min | Opening the consultation and setting an agenda when the patient has multiple concerns | Did they uncover the full agenda? Did they prioritise collaboratively? |
| Breaking Bad News | 8 min | Delivering an unwelcome result or diagnosis (e.g. new cancer diagnosis) | Warning shot, pace, pauses, checking what the patient already knows, allowing silence |
🗣 Useful Consultation Phrases for SCA OSCE Stations
These are the phrases that sound natural, human, and confident. Not robotic. Not scripted. Just how a good doctor actually speaks.
Designing Your Own OSCE Station
The Anatomy of a Well-Designed Station
Every station needs five documents. Never run a station without all five.
What the candidate reads immediately before entering the station. Must include:
- The clinical scenario (brief — 2–3 sentences)
- The patient's name, age, and presenting complaint
- Exactly what you are being asked to do (e.g. "take a focused history", "explain the diagnosis to the patient")
- The time available
- Any relevant background (e.g. "you have previously seen this patient for hypertension")
Do not include more clinical detail than the candidate would realistically have in a real GP consultation. Over-informing removes the challenge of the station.
The script for the SP is the most important document. A poorly written or ambiguous SP script will make the station unreliable — and unfair. It must include:
- Background: who the patient is, their social context, their medical history
- Opening statement: the first thing they say when the candidate enters
- Volunteer information: what they tell unprompted
- Withheld information: what they only reveal if asked the right questions
- Emotional cues: e.g. "become tearful when discussing your mother"
- Agenda items: e.g. "you are really worried this is cancer — reveal this if asked about concerns"
- Feedback guide: what the SP should comment on in the feedback conversation
A standardised list of behaviours, actions, or statements the candidate is expected to demonstrate. Each item is marked as present or absent.
Good checklist items are:
- Observable and concrete — not "showed empathy" but "paused when patient became upset and acknowledged their distress"
- Clearly either done or not done — no ambiguity
- Matched to the station's learning objective — irrelevant items inflate the checklist without improving reliability
Consider including a global rating scale alongside the checklist — a single item asking the examiner to rate overall performance (e.g. 1–5). This captures holistic impression that checklists miss.
Instructions for the assessor running this station. Should include:
- What to say when the candidate enters
- Whether the assessor should intervene if the candidate goes completely off track
- Any props or materials to hand to the candidate (e.g. blood test result, X-ray)
- The feedback structure to follow at the end
- Common issues to watch for with this scenario
Used for assessor training and post-OSCE feedback. Describes what an excellent performance looks like for this station — including key phrases, key clinical content, and key consultation behaviours. This document is not shared with candidates before the OSCE.
Tip: write the model answer before you write the marking checklist. If you cannot write what a good answer looks like, you haven't yet designed the station clearly enough.
📌 Example Station — Fully Written Up
- Introduces self and confirms patient identity
- Uses plain language — avoids unexplained jargon
- Explores ICE — elicits concern about injections and family history
- Acknowledges and addresses the concern about injections (most T2DM does not require insulin initially)
- Addresses the question about reversibility honestly (remission possible with lifestyle change)
- Explains lifestyle management as first step
- Mentions referral to diabetes nurse/dietitian
- Safety-nets — tells patient when to return, mentions symptoms of hypoglycaemia
- Checks understanding before closing
- One learning objective per station. Do not try to test everything in 10 minutes.
- Write the model answer before you write the checklist.
- Test your station on a colleague before running it with real trainees.
- Include factual clinical content only if you are 100% sure it is correct — errors in station briefs destroy validity.
- Train your SP at least once, with feedback, before the event.
- Include a space on the marking sheet for qualitative comments — checklists alone miss a lot.
Trainer & TPD Guide
What Trainees Find Hardest
- Staying calm under observation — they know this is being watched
- Genuinely listening to the SP's answers rather than running through a list in their head
- Managing time — starting too broadly or going too deep on one symptom
- Giving explanation without jargon
- Handling unexpected emotional content without losing structure
- Truly integrating ICE into clinical management (not just asking the questions)
What You Can Do as a Trainer
- Run short 4–6 minute microskill stations rather than always doing full consultations
- Use video review — watching yourself is uncomfortable but profoundly educational
- Ask the SP to feed back first — the patient perspective carries more emotional weight
- Normalise imperfect performance — trainees learn more from safe failure than safe mediocrity
- Debrief in a group when appropriate — collective learning from one trainee's station benefits everyone
- Map each OSCE station to SCA domains explicitly so trainees see the relevance
- "What would the patient's experience of that consultation have been?"
- "At what point did you notice your instinct and your training were in conflict?"
- "If you had done that consultation again, what single thing would you change first?"
- "What was the patient's ICE in that scenario — and did it change what you did?"
- "Where were the moments of uncertainty? How did you manage them?"
Using OSCEs at Different Stages of Training
| Stage | Focus | Suggested Station Types |
|---|---|---|
| ST1 | Establishing consultation structure, basic history taking, introducing ICE | History-only stations, short data interpretation, basic communication |
| ST2 | Managing uncertainty, deeper ICE, targeted examination | Communication stations, combined history + management, breaking bad news |
| ST3 | SCA-focused preparation, complex communication, multimorbidity | Full SCA-style stations, microskill refinement, difficult patient management |
Final Take-Home Points
- An OSCE assesses clinical competence in a fair, structured, reproducible way — with the same scenario and same checklist for every candidate.
- OSCEs can test history-taking, examination, data interpretation, communication, equipment use, and clinical reasoning — all in the same session.
- Simulated patients do not need to be professional actors. They need to be trained, consistent, and willing to give honest feedback.
- The feedback conversation after each station is more educationally valuable than the station itself — invest in it.
- The SCA is essentially a high-stakes OSCE. Every in-house OSCE station you run is direct SCA preparation.
- Microskill stations — targeting one consultation domain at a time — are often more useful than full-consultation stations, especially for trainees who keep failing the same domain.
- ICE, empathy, safety-netting, and shared decision-making are the domains that most trainees lose SCA marks in. Target these deliberately.
- For trainers: run OSCEs at every stage of training, adapt complexity to the trainee's stage, and always use structured debriefs.
- For IMGs: UK GP places shared decision-making and patient autonomy at the heart of every consultation. This is not optional.
- A well-run OSCE is one of the most memorable learning experiences a trainee can have. Done badly, it is merely stressful. The difference is in the preparation — and the feedback.