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OSCE Structure for Nurses in the UK

The OSCE is made up of 10 stations (15 minutes each) and is divided into two components:

A. APIE Stations (4 Stations)

Assessment: The candidate must complete a patient assessment, gathering relevant data about their condition.
Planning: Based on the assessment, the candidate must create a care plan addressing the patient’s needs.
Implementation: The candidate is required to demonstrate a nursing intervention, such as administering medication or performing a wound dressing.
Evaluation: The candidate reflects on the care provided, discussing whether the goals were met and any necessary adjustments.

B. Skills Stations (6 Stations)

These stations test practical nursing skills. Examples include:

Vital signs measurement (e.g., blood pressure, temperature)
Administration of medications
Catheterization
Wound dressing
Basic life support (BLS)

What to Expect in Each Station

Each station typically lasts 15 minutes.
The candidate is expected to interact with a standardized patient (an actor playing the role of a patient) or demonstrate procedures on mannequins or equipment.
Stations are objective, meaning they follow specific checklists to assess performance.

Key Areas Assessed

Communication: Explaining procedures, obtaining consent, and providing patient-centered care.
Clinical Skills: Demonstrating competency in tasks such as medication administration, catheter insertion, or wound care.
Decision-Making: Using clinical judgment to assess, plan, and implement care.
Documentation: Recording findings and care plans accurately.

Scenarios

1. History-Taking

Similar to the example you saw, these stations require the student to obtain a detailed medical history from a patient. This could involve:
- Presenting complaints (e.g., chest pain, headache, fatigue)
- Past medical history
- Family or social history

2. Physical Examination

These stations assess a student’s ability to perform a structured physical exam. Examples include:
- Cardiovascular examination: Listening for heart murmurs, checking for edema
- Respiratory examination: Auscultating lung sounds, checking respiratory effort
- Abdominal examination: Palpation of the abdomen, listening for bowel sounds

3. Procedural Skills

Students are expected to demonstrate proficiency in performing specific clinical procedures. Examples include:
- Venipuncture (drawing blood)
- Urinary catheter insertion
- Suturing a wound
These stations often use mannequins or simulation devices, and the student must explain the procedure to the patient (simulated or real).

4. Communication and Counseling

These stations assess the student’s ability to communicate medical information effectively. Common tasks include:
- Breaking bad news: Telling a patient they have cancer
- Informed consent: Explaining risks and benefits of surgery or treatment
- Lifestyle counseling: Discussing smoking cessation or dietary changes for diabetes management

5. Clinical Reasoning

These stations test the student’s ability to interpret clinical information, make a diagnosis, and develop a management plan. Examples include:
- Diagnostic reasoning: Given a case with lab results or images, students must make a diagnosis.
- Next steps: Identifying appropriate investigations or treatments based on a patient’s symptoms.

6. Emergency Management

Some OSCE stations simulate acute situations where students must demonstrate the ability to manage medical emergencies. Examples include:
- Cardiopulmonary resuscitation (CPR)
- Managing an anaphylactic reaction
- Treating a patient in shock

7. Ethical and Legal Scenarios

These assess the student’s understanding of medical ethics or legal obligations. Examples include:
- Dealing with patient confidentiality
- Informed consent issues
- Reporting unsafe practices or negligence

Station 1 Samples

Here are 10 examples of scenarios that might be used in the first station of an Objective Structured Clinical Examination (OSCE) focused on assessment skills:

Chest Pain Assessment: A patient presents with chest pain radiating to the left arm. The candidate must take a detailed history, including the onset, duration, and characteristics of the pain, and conduct a physical examination.
Abdominal Pain Assessment: A patient complains of acute abdominal pain. The candidate should ask about the location, nature, and associated symptoms, followed by a focused abdominal examination.
Headache Evaluation: A patient reports persistent headaches. The candidate needs to gather information about the headache’s frequency, intensity, triggers, and any neurological symptoms.
Shortness of Breath Assessment: A patient is experiencing difficulty breathing. The candidate must assess the patient’s respiratory rate, oxygen saturation, and relevant medical history to identify possible causes.
Mental Health Assessment: A patient presents with anxiety and depression symptoms. The candidate should conduct a mental health assessment, including screening for suicidal ideation and evaluating coping mechanisms.
Skin Rash Evaluation: A patient has a new skin rash. The candidate must assess the rash’s appearance, location, duration, and associated symptoms, and may need to perform a skin examination.
Diabetes Management Review: A diabetic patient seeks advice on managing their condition. The candidate should evaluate the patient’s blood glucose logs, medication adherence, and lifestyle choices.
Elderly Fall Risk Assessment: An elderly patient reports having fallen recently. The candidate should assess the patient’s fall history, home environment, and any medications that may contribute to fall risk.
Pediatric Assessment for Fever: A parent brings in their child with a high fever. The candidate must take a detailed history of the fever, any associated symptoms, and perform a physical examination on the child.
Post-Operative Recovery Assessment: A patient is one day post-operative from abdominal surgery. The candidate should assess the patient’s pain levels, wound site, and any signs of complications.

Sample Test with Answer

OSCE Station 1: Chest Pain AssessmentExaminer: “Hello, welcome to this station. My name is [Examiner’s Name], and I will be your examiner today.”

Candidate: “Hi, nice to meet you.”

Examiner: “This station will last for 15 minutes. You will first have 2 minutes to read the instructions and prepare, followed by 13 minutes to demonstrate your skills. In this scenario, you will be assessing a patient presenting with chest pain that radiates to the left arm. Please gather a detailed history and perform a physical examination.”

Candidate: “Understood. I will get started.”

Candidate: [Reads the provided instructions and mentally prepares for the assessment.]

Candidate: “Hello, my name is [Candidate’s Name], and I will be your nurse today. Can I have your name, please?”

Standardized Patient (SP): “My name is John.”

Candidate: “Nice to meet you, John. What brings you in today?”

SP: “I’ve been having chest pain that radiates to my left arm.”

Candidate: “I’m sorry to hear that. When did this pain start?”

SP: “It started about two hours ago.”

Candidate: “Can you describe the pain for me? Is it sharp, dull, or something else?”

SP: “It feels like a tight pressure.”

Candidate: “Has the pain been constant, or does it come and go?”

SP: “It comes and goes, but it’s been pretty intense.”

Candidate: “Are you experiencing any other symptoms, like shortness of breath, sweating, or nausea?”

SP: “Yes, I feel a bit short of breath and a little dizzy.”

Permission for Examination

Candidate: “Thank you for sharing that with me. I would like to check your vital signs and perform a brief physical examination. Is that alright with you?”

SP: “Yes, that’s fine.”

Candidate: [Checks blood pressure, heart rate, and respiratory rate.] “Your blood pressure is [XXX], your heart rate is [XXX], and your respiratory rate is [XXX].”

Auscultation

Candidate: “I’m going to listen to your heart and lungs now.” [Proceeds to auscultate the chest.] “Take a deep breath for me… and out.”

Candidate: “Now, I’m going to gently press on your chest to check for any tenderness.” [Palpates areas around the chest.]

Candidate: “Based on what you’ve told me and the examination, I’m concerned that your symptoms might indicate a cardiac issue. I recommend further tests, such as an ECG and possible blood tests.”

SP: “I understand. What does that involve?”

Candidate: “We will monitor your heart rhythm and check for any markers of a heart attack. I’ll ensure you’re comfortable during this process. Do you have any questions or concerns?”

SP: “No, thank you. I appreciate your help.”

Examiner: “Thank you, [Candidate’s Name]. That concludes your assessment. You demonstrated good communication and assessment skills.”

Candidate: “Thank you for the feedback.”

Examiner: “Do you have any questions about your performance today?”

Candidate: “No, I feel good about it. Thank you!”

Examiner: “You can now proceed to the next station. Good luck!”

Candidate: “Thank you!”