OSCE: experience as a simulated candidate

Philip Seager's letter (Psychiatric Bulletin, August 2007, 31, ) about performing as a simulated patient reminded me of a recent experience as a simulated candidate in the Royal College of Psychiatrists’ pilot objective structured clinical examination (OSCE).

Significant changes to the College Membership examinations are imminent. One of these is the introduction of an OSCE in Spring 2008 as the sole clinical component. This inevitably required training for consultants in both the theory and practice of examining an OSCE. Specialist registrars were invited to attend as mock candidates and I arrived to find I was the only one who had done so. Luckily several of the consultants also agreed to act as candidates.

I have experienced OSCEs at first hand, both at medical school and as part of the MRCPsych part I examinations. I am familiar with the structure and have fine-tuned my style in the hope of improving my performance. This was not the case for many of the consultants present at the pilot.

We rotated through six linked stations, involving assessment of self-harm, schizophrenia, depression following a myocardial infarct and dementia with paranoid delusions, and preparing a court report. I was surprised by the level of anxiety I experienced but felt able to cope with this and was pleased to hear that I performed at a standard sufficient to ‘pass’. What was interesting was that some of the consultants struggled to reach this standard, despite having much more clinical experience, but without any personal OSCE experience. Therefore, I feel that future candidates need to consider several factors when seeking examination practice, not least the training and actual experiences of senior clinicians.