Preparing for the MRCEM (Membership of the Royal College of Emergency

Medicine) International OSCE, particularly in the South Asia context, involves

mastering the art of structuring consultations effectively within the time
constraints. Here is a structured approach to help you navigate the OSCE
stations successfully:
Consultation Structure
A well-organized consultation typically follows a systematic approach. Here's a
step-by-step guide to structuring your consultation:
1. Introduction and Preparation:
o Introduce Yourself:

 Start by greeting the patient and introducing yourself clearly.

 Confirm the patient’s identity (name, age) to ensure you are
speaking to the correct person.
o Explain Your Role:

 Briefly explain your role and what you will be doing in the
consultation.
 Obtain consent to proceed with the examination or
discussion.
2. Gather Information:
o Chief Complaint:

 Ask open-ended questions to elicit the patient's main

concerns or symptoms.
 Encourage the patient to describe their symptoms in their
own words.
o History of Present Illness:

 Use the SOCRATES method for pain (Site, Onset, Character,

Radiation, Associations, Time, Exacerbating/Relieving factors,
Severity).
 For other symptoms, inquire about duration, severity, and
any associated factors.
o Past Medical History:

 Ask about previous illnesses, surgeries, or hospital

admissions.
 Inquire about any ongoing treatments or chronic conditions.
o Medication History:

 Obtain details of current medications, including over-the-

counter and herbal remedies.
  Check for any allergies to medications.
o Family History:

 Ask about significant illnesses in the family that might be

relevant.
o Social History:

 Gather information about the patient’s lifestyle, including

smoking, alcohol use, and occupation.
3. Physical Examination:
o Systematic Approach:

 Conduct a focused examination relevant to the presenting

complaint.
 Follow a head-to-toe or system-based approach, ensuring you
cover all critical areas.
o Explain Findings:

 Communicate what you are doing and why, ensuring patient

comfort and understanding.
4. Clinical Reasoning and Diagnosis:
o Formulate Differential Diagnoses:

 Based on the history and examination findings, consider

possible diagnoses.
 Discuss your reasoning with the patient, explaining why
certain conditions are more likely.
o Order Investigations:

 If appropriate, suggest necessary investigations to confirm

your diagnosis.
 Explain the purpose and implications of these tests to the
patient.
5. Management Plan:
o Discuss Treatment Options:

 Present possible treatment options, including benefits and

risks.
 Encourage shared decision-making by involving the patient in
the choice of treatment.
o Safety Netting:

 Provide clear instructions on what the patient should do if

symptoms worsen or new symptoms develop.
  Ensure the patient knows when and how to seek further
medical help.
6. Closing the Consultation:
o Summarize and Clarify:

 Recap the key points of the consultation, ensuring the patient

understands the plan.
 Ask if the patient has any questions or concerns.
o Follow-up Arrangements:

 Arrange any necessary follow-up appointments or referrals.

 Provide written information or resources if needed.
Tips for Effective Consultation
 Time Management:
o Practice completing each part of the consultation within the allotted
time, usually around 8-10 minutes per station.
o Prioritize critical information and interventions to ensure all
essential elements are covered.
 Communication Skills:
o Use clear, jargon-free language when explaining medical terms or
procedures.
o Demonstrate empathy and active listening to build rapport and trust
with the patient.
 Adaptability:
o Be prepared to adjust your approach based on the patient’s
responses and the specific requirements of each station.
 Practice:
o Engage in role-playing exercises with peers or mentors to simulate
the OSCE environment.
o Review feedback to identify areas for improvement.

By following this structured approach and practicing regularly, you can enhance
your consultation skills and increase your confidence for the MRCEM INT South
Asia OSCE exam.
The MRCGP (Membership of the Royal College of General Practitioners) OSCE
(Objective Structured Clinical Examination) is designed to assess a candidate's
ability to practice safely and effectively as a GP in the UK. Here’s how to
approach a case during the OSCE:
1. Understand the Case
 Read the Scenario Brief Carefully:
o You’ll be given a brief description of the case before you enter the
station. Take a moment to understand the key points.
 Identify the Main Issue:
o Focus on the patient's primary concern or the task you are required
to perform.
2. Establish Rapport
 Introduce Yourself:
o Begin with a clear introduction, stating your name and role.

 Ensure Patient Comfort:

o Use open body language, maintain eye contact, and show empathy.
Acknowledge any emotions or concerns the patient might express.
3. Gather Information (History Taking)
 Use Open and Closed Questions:
o Start with open-ended questions to gather broad information, then
use closed questions to clarify details.
 Explore the Patient's Ideas, Concerns, and Expectations (ICE):
o Ask about what the patient thinks might be wrong, any worries they
have, and what they hope to gain from the consultation.
 Cover Key Areas:
o Presenting complaint, past medical history, medications, allergies,
family history, social history, and relevant systems review.
4. Clinical Examination (if required)
 Explain the Examination:
 o Tell the patient what you are going to do and why.

 Be Systematic and Thorough:

o Perform the examination in a logical order, explaining your actions
and findings to the patient as you proceed.
 Respect Patient Dignity:
o Ensure privacy and comfort during the examination.

5. Management Plan
 Explain Your Findings:
o Clearly communicate your clinical findings and the diagnosis or
differential diagnosis.
 Involve the Patient in Decision-Making:
o Discuss the management options, considering the patient’s
preferences, and agree on a plan together.
 Provide Clear Advice:
o Give concise and relevant advice regarding treatment, follow-up,
and when to seek further help.
6. Communication and Empathy
 Be Empathetic:
o Acknowledge the patient’s feelings and concerns. Provide
reassurance when appropriate.
 Avoid Medical Jargon:
o Use layman's terms to ensure the patient understands the
information you’re providing.
 Summarize Key Points:
o Recap the important aspects of the consultation to ensure mutual
understanding.
7. Time Management
 Prioritize Key Tasks:
o Focus on the most important elements of the consultation, as you
have limited time.
 Keep Track of Time:
o Be aware of the clock but don’t rush. Manage your time effectively
to cover history, examination, and management.
8. Closing the Consultation
 Confirm Understanding:
 o Ask the patient if they have any questions or if they need any
clarification.
 Summarize the Next Steps:
o Clearly state what will happen next, whether it’s a prescription,
referral, or follow-up appointment.
 Thank the Patient:
o Conclude the consultation politely and professionally.

9. Reflect and Improve

 Self-Reflection:
o After each station, reflect on what went well and what could have
been done better. Use this to improve in subsequent stations.
10. Stay Calm and Professional
 Manage Stress:
o Take deep breaths before entering each station. Staying calm will
help you think more clearly and perform better.
 Maintain Professionalism:
o Even in challenging scenarios, remain composed, respectful, and
professional.
By following these steps, you can approach each OSCE case methodically,
ensuring that you cover all essential aspects of the consultation while
demonstrating your competence as a future GP.
Here are some common dialogues that you can use in the MRCGP OSCE
examination to effectively communicate with patients, demonstrate empathy,
and manage the consultation:
1. Introduction and Building Rapport
 Introduction:
o "Hello, my name is Dr. [Your Name], and I’m one of the GPs here.
How can I help you today?"
 Establishing Rapport:
o "I’m here to listen and help you with whatever is on your mind."

 Acknowledging the Patient's Emotions:

o "I can see that you’re feeling quite [worried/upset]. It’s completely
understandable. Let’s talk through what’s going on."
2. History Taking
 Open-Ended Questions:
o "Can you tell me a bit more about what’s been bothering you?"

o "How has this been affecting your daily life?"

 Clarifying Symptoms:
o "When did this symptom start, and how has it changed over time?"

o "Have you noticed anything else that might be related?"

 Exploring ICE (Ideas, Concerns, Expectations):

o "What do you think might be causing this problem?"

o "Is there anything in particular that’s worrying you about this?"

o "What were you hoping we could do for you today?"

3. Clinical Examination
 Explaining the Examination:
o "I’d like to examine you to get a better understanding of what might
be going on. I’ll explain each step as we go. Is that okay with you?"
 During the Examination:
 o "I’m going to check your [e.g., blood pressure/abdomen] now. Let
me know if you feel any discomfort."
 After the Examination:
o "The examination is complete. Let’s discuss what I’ve found."

4. Explaining a Diagnosis
 Breaking Bad News (SPIKES Model):
o Setting: "Would you like a family member to be here while we
discuss your results?"
o Perception: "Can you tell me what you understand about your
current situation?"
o Invitation: "Is it okay if I explain the results now?"

o Knowledge: "Unfortunately, the tests suggest that [briefly explain

the diagnosis]."
o Empathy: "I know this is not the news you were hoping for. I’m
here to support you through this."
o Summary: "Let’s go over what this means and the options we have
moving forward."
 Explaining a Diagnosis:
o "Based on what you’ve told me and the examination, it seems that
you might have [condition]. This is a condition where [brief
explanation]."
o "This condition is generally manageable, and we can work together
to develop a treatment plan."
5. Discussing Management Plans
 Involving the Patient in Decision-Making:
o "There are a few different ways we can manage this. I’d like to hear
your thoughts on what might work best for you."
 Explaining Treatment Options:
o "One option is to start on [medication]. It works by [brief
explanation of how it works], but there are some side effects we
should discuss."
o "Alternatively, we could consider [another option], which might be
more suitable if you prefer [lifestyle adjustments/less
medication/etc.]."
 Safety-Netting:
o "If you notice any new or worsening symptoms, or if you’re not
feeling better in a few days, please come back and see me."
6. Ending the Consultation
 Summarizing the Consultation:
o "To recap, we’ve discussed [diagnosis/treatment plan]. You’ll start
with [medication/lifestyle change], and we’ll review your progress in
[time frame]."
 Checking Understanding:
o "Does everything we’ve discussed make sense to you? Do you have
any questions?"
 Reassurance:
o "I’m confident we can manage this together, and I’m here to
support you through the process."
 Closing:
o "Thank you for coming in today. Please don’t hesitate to reach out if
you have any concerns before our next appointment."
7. Addressing Challenging Scenarios
 Dealing with an Angry Patient:
o "I can see that you’re upset, and I want to help resolve this. Can you
tell me what’s been bothering you the most?"
 Responding to a Patient Who Refuses Treatment:
o "I understand you’re not comfortable with this option. Can we
explore other ways to manage your condition?"
 Handling Uncertainty:
o "At this stage, we’re not entirely sure what’s causing your
symptoms. I’d like to arrange further tests to get a clearer picture."
These dialogues can help you navigate various scenarios in the MRCGP OSCE,
showing empathy, clarity, and professionalism throughout the consultation.