OSCE

A Comprehensive Guide for MBBS Students in India 

Introduction to OSCE in Surgery

The Objective Structured Clinical Examination (OSCE) is a modern, widely adopted method
for assessing clinical competence in medical education. It provides a standardized and
objective way to evaluate a student’s practical skills, knowledge application,
communication abilities, and professionalism in a simulated clinical environment. For
MBBS students in India, particularly in the context of the Competency-Based Medical
Education (CBME) curriculum, OSCEs are becoming increasingly crucial in surgical
assessments.
Unlike traditional viva voce or long-case examinations, OSCEs break down the assessment
into multiple short, focused stations. Each station tests a specific skill or competency,
ensuring a comprehensive and fair evaluation across a range of clinical scenarios. In
surgery, OSCEs are particularly effective because they can assess not just theoretical
knowledge of surgical conditions, but also the practical skills required for patient care, from
history taking and physical examination to basic surgical procedures and effective patient
communication.

Components of an OSCE Station
A typical OSCE station is a self-contained unit designed to assess a specific competency.
While the exact setup can vary, common components include:

The Scenario/Task: A brief written instruction or clinical vignette describing the
patient’s situation and the task you need to perform (e.g.,
history taking, physical examination, explaining a procedure, performing a skill).

The Patient/Mannequin/Simulator: This could be a real patient (standardized patient
or actor), a high-fidelity mannequin, or a part-task trainer (e.g., for suturing,
catheterization).

The Examiner/Assessor: A faculty member or trained assessor who observes your
performance and marks it against a pre-defined checklist.

Equipment/Resources: All necessary instruments, forms, or information required to
complete the task.

Time Limit: Each station has a strict time limit, usually ranging from 5 to 10 minutes,
followed by a short transition period.

Types of OSCE Stations in Surgery

OSCEs in surgery can broadly be categorized into several types, each designed to assess different facets of a student’s clinical competence:

1. History Taking Stations: These stations assess your ability to elicit a comprehensive
and relevant medical history from a patient (often a standardized patient). You’ll need
to demonstrate active listening, focused questioning, and empathy.

Example: Taking a history from a patient presenting with abdominal pain, focusing
on surgical causes.
2. Physical Examination Stations: Here, you’ll be required to perform a focused physical
examination on a standardized patient or a mannequin. This assesses your clinical
examination skills, including inspection, palpation, percussion, and auscultation, as
well as your ability to identify relevant signs.

Example: Performing an abdominal examination, or a focused examination of a
lump/swelling.
3. Procedural Skills Stations: These are hands-on stations where you perform a specific
medical or surgical procedure on a mannequin or simulator. This evaluates your
technical proficiency, adherence to aseptic techniques, and understanding of the steps
involved.

Examples: Basic suturing, wound dressing, venepuncture, urinary catheterization,
nasogastric tube insertion.
4. Communication and Counseling Stations: These stations assess your ability to
communicate effectively with patients, their families, or colleagues. This includes
explaining diagnoses, discussing treatment options, obtaining informed consent,
breaking bad news, or counseling on lifestyle modifications.

Example: Explaining the risks and benefits of a surgical procedure to a patient, or
counseling a patient on post-operative care.
5. Interpretation Stations: In these stations, you’ll be presented with clinical data such as
X-rays, CT scans, ECGs, blood reports, or pathology slides, and asked to interpret them,
discuss findings, and suggest further management.

Example: Interpreting an X-ray of a fractured bone, or a CT scan of the abdomen.
6. Resuscitation/Emergency Stations: These stations simulate emergency scenarios
where you need to demonstrate your ability to assess, prioritize, and manage a critically
ill patient, often involving teamwork and rapid decision-making.

Example: Initial assessment and management of a trauma patient, or a patient in
shock.
7. Prescription/Management Planning Stations: You might be asked to write a
prescription, formulate a management plan for a given clinical scenario, or discuss drug
interactions and dosages.

Example: Writing a post-operative prescription for pain management and antibiotics.

The OSCE Marking Scheme: How You Are Evaluated

OSCEs are designed to be objective, and this is achieved through detailed marking

checklists. For each station, examiners use a pre-defined checklist that outlines the
essential steps or actions required to successfully complete the task. Each item on the
checklist is typically assigned a specific mark. This ensures consistency across examiners
and reduces subjectivity.
Marking schemes often include:

Critical Steps: Certain steps are considered critical, and failure to perform them (or
performing them incorrectly) might lead to a significant loss of marks or even a fail for
the station. These often relate to patient safety or ethical considerations.

Global Rating Scales: In addition to checklists, some stations might include a global
rating scale where the examiner assesses your overall performance, professionalism,
communication, and confidence.

Time Management: While not always explicitly marked, efficient time management is
crucial. Running out of time before completing essential steps will impact your score.
Let’s take the example of Urinary Catheterization to illustrate how an OSCE station is
structured and marked in a surgical context.

Detailed Example: Urinary Catheterization OSCE Station

Scenario: You are a final year MBBS student in the surgical ward. The patient, Mr. Rakesh,

requires urinary catheterization due to acute urinary retention. Perform the procedure on
the mannequin and explain the post-procedure care to the patient.

Total Marks: 10 (This is a hypothetical breakdown, actual marks may vary by institution)
Breakdown of Marks:
1. Introduction and Consent (2 Marks)
• 1 Mark: Introduces self to the patient (Mr. Rakesh) and confirms patient identity
(name, age, hospital ID). (Critical Step: Patient Safety*)_
• 1 Mark: Explains the procedure clearly, including the reason, steps involved,
potential discomfort, and obtains verbal consent. Addresses any patient concerns.
(e.g.,
“Mr. Rakesh, I am Dr. [Your Name], a medical student. I understand you are experiencing
difficulty passing urine. We need to insert a urinary catheter to help drain your bladder. This
involves inserting a thin, flexible tube into your urethra. You might feel some discomfort, but
I will try to be as gentle as possible. Do I have your permission to proceed?”)

2. Preparation (2 Marks)
• 0.5 Mark: Performs hand hygiene (washing/sanitizing hands).
• 0.5 Mark: Gathers all necessary equipment (catheterization tray, appropriate size
catheter, sterile gloves, antiseptic solution, lubricant, sterile water for balloon
inflation, drainage bag, sterile drapes, waste bin).
• 0.5 Mark: Ensures patient privacy (draws curtains/closes door).
• 0.5 Mark: Positions the patient appropriately (supine position with legs slightly
abducted for male, or frog-leg position for female).

3. Procedure (4 Marks)
• 0.5 Mark: Dons sterile gloves correctly.
• 0.5 Mark: Prepares the sterile field (drapes the patient appropriately, ensuring
sterility).
• 1 Mark: Cleans the urethral meatus thoroughly with antiseptic solution using correct
technique (e.g., for male, retracts foreskin if uncircumcised, cleans in a circular
motion from meatus outwards; for female, separates labia and cleans from anterior
to posterior). (Critical Step: Aseptic Technique*)_
• 0.5 Mark: Applies lubricant to the catheter tip.
• 1 Mark: Inserts the catheter gently and smoothly into the urethra until urine flows.
(Critical Step: Patient Safety/Skill*)_
• 0.5 Mark: Inflates the balloon with the correct amount of sterile water (as per
catheter specifications) and gently retracts until resistance is felt.

4. Post-Procedure Care and Documentation (2 Marks)
• 0.5 Mark: Connects the catheter to the drainage bag, ensuring a closed system.
• 0.5 Mark: Secures the catheter to the patient’s thigh (for male) or inner thigh (for
female) to prevent traction.
• 0.5 Mark: Explains post-procedure precautions to the patient (e.g., maintaining
hygiene, reporting pain/fever, ensuring drainage bag is below bladder level,
adequate fluid intake). (e.g., “Mr. Sharma, the catheter is now in place. Please let us
know if you experience any pain or discomfort. It’s important to keep the area clean
and ensure the bag is always below your bladder level to prevent infections.”)
• 0.5 Mark: Disposes of waste appropriately and performs hand hygiene.

How to Prepare for OSCEs in Surgery
Preparing for OSCEs requires a systematic and hands-on approach. Here’s a
comprehensive guide for MBBS students:
1. Understand the Blueprint: Try to get information about the OSCE blueprint from your
faculty or seniors. This includes the number of stations, types of stations, time allocated
per station, and the marking scheme. Knowing what to expect is half the battle.
2. Master Your Basics: OSCEs test foundational clinical skills. Ensure you are proficient in:

History Taking: Practice a systematic approach for common surgical complaints
(e.g., abdominal pain, lumps, trauma). Focus on open-ended questions, active
listening, and summarizing.

Physical Examination: Know the steps for all major system examinations (e.g.,
abdominal, cardiovascular, respiratory, neurological, peripheral vascular) and
specific surgical examinations (e.g., breast, hernia, thyroid, per rectal/vaginal).

Communication Skills: Practice explaining procedures, breaking bad news,
obtaining consent, and counseling. Focus on empathy, clear language, and
addressing patient concerns.

3. Hands-on Practice is Crucial:

Skill Labs: Utilize your college’s skill lab facilities. Practice procedures like suturing,
knot tying, catheterization, Ryle’s tube insertion, and IV cannulation on
mannequins or simulators repeatedly until you are confident and smooth.

Peer Practice: Practice with your friends. One can act as the patient, another as the
examiner, and the third as the student. Provide constructive feedback to each other.

Clinical Postings: Make the most of your clinical rotations. Observe senior residents
and consultants, and actively participate in patient care. Ask for opportunities to
perform procedures under supervision.

4. Utilize Checklists and Mark Schemes:

Create Your Own Checklists: For each common surgical procedure or examination,
create a step-by-step checklist based on standard protocols. This helps you
internalize the sequence of actions.

Review Sample Mark Schemes: Look for sample OSCE mark schemes (like the
catheterization example above) to understand how marks are allocated. This helps
you identify critical steps and areas where you might lose marks.

5. Time Management:

Practice with a Timer: During your practice sessions, always use a timer to simulate
exam conditions. This helps you learn to perform tasks efficiently within the given
time limit.

Prioritize: In the exam, quickly read the scenario and identify the core task. Prioritize
critical steps and essential components to ensure you complete the most important
parts of the station.

6. Simulated OSCEs/Mock Exams: If your institution offers mock OSCEs, participate in
them. This is the best way to experience the exam environment, identify your
weaknesses, and get feedback from examiners.

7. Professionalism and Etiquette:

Dress Appropriately: Always dress professionally for the exam.

Be Courteous: Greet the patient/standardized patient and examiner politely.

Maintain Eye Contact: Show confidence and engagement.

Hand Hygiene: Always perform hand hygiene at appropriate steps.

Patient Privacy: Ensure patient privacy and dignity are maintained throughout the
procedure.

8. Reflect and Learn from Feedback: After each practice session or mock exam, reflect on
your performance. What went well? What could be improved? Pay close attention to the
feedback provided by your peers or examiners.

Conclusion
OSCEs in surgery are designed to assess your practical competence in a structured and fair
manner. While they can seem daunting, a systematic approach to preparation, focusing on
hands-on practice, understanding the marking criteria, and refining your communication
skills, will equip you to excel. Remember, the goal is not just to pass an exam, but to become
a safe, skilled, and compassionate surgeon. Good luck!