MRCS Part B (OSCE) Examination Preparation Tips

Part B of the Intercollegiate MRCS is an objective structured clinical exam (OSCE).

It tests:

• Anatomy and surgical pathology
• Applied surgical science and critical care
• Clinical and procedural skills
• Communication skills

Examination Domains

Four domains have been identified which encompass the knowledge, skills, competencies and professional characteristics of the competent surgeon. These domains map to GMC’s Good Medical Practice (GMP) and are assessed in the OSCE. They are as follows:

Clinical knowledge and its application:

The clinical knowledge specified in the syllabus; the ability to understand, synthesise and apply knowledge in a clinical context.

Clinical and technical skill:

The capacity to apply sound clinical knowledge, skill and awareness to a full investigation of problems to reach a provisional diagnosis, the ability to perform manual tasks related to surgery which demands manual dexterity, hand/eye coordination and visual/spatial awareness.

Communication:

The ability to assimilate information, identify what is important and convey it to others clearly using a variety of methods; the capacity to adjust behaviour and language (written/spoken) as appropriate to the needs of differing situations; the ability actively and clearly to engage patient/carer/colleague(s) in open dialogue.

Professionalism:

The demonstration of effective judgement and decision making skills; the consideration of all appropriate facts before reaching a decision; the capacity to make the best use of information and think beyond the obvious; being alert to symptoms and signs suggesting conditions that might progress or destabilise; being aware of own strengths/limitations and knowing when to ask for help; the ability to accommodate new or changing information and use it to manage a clinical problem, to anticipate and plan in advance, to prioritise conflicting demands and build contingencies, to demonstrate effective time management; being aware of the need to put patient safety first.

COVID-19 Impact

There are many modifications made to the examination format and conduct due to challenges presented by COVID-19. Following is the summary how different aspects of the exam are affected along with our tip from successful candidates on how to prepare for the exam.

Salient changes to the format of the examination are summarised below:

• Reduced number of procedural skills stations from 2 to 1
• Reduced number of history taking stations from 2 to 1
• Reduced number of anatomy stations from 3 to 2
• Reduced number of pathology stations from 2 to 1
• Reduced overall number of stations from 17 to 13
• Reframed physical examination stations to allow them to be delivered without a patient/actor present by focusing on identification/discussion of signs/symptoms of described patients, followed by discussion of likely diagnoses, further investigations and management plan
• Reframed procedural skills stations to allow to be delivered without an actor present
• A single pass mark for the entire circuit rather than separate pass marks for knowledge and skills components
  • (this can work in favour of many candidates who would otherwise pass either the applied/practical or  knowledge part instead of both and hence failing the exam)

All four Surgical Royal Colleges run the examination socially-distanced in-person.

The four Surgical Royal Colleges reserve the right to change the method of delivery at short notice if restrictions change, and candidates should bear this in mind if booking travel. Candidates will be informed of the method of delivery when they receive their admission letters no later than four weeks prior to the examination.

General Tips for Exam Preparation

Here at traineeportal.co.uk we have teamed up with experts in clinical examination preparation and successful candidates to give you the best possible advice on how to prepare for your MRCS Part B (OSCE) Examination. We have team of experts and professionals to master you on all aspects of MRCS Part B (OSCE).

Successful clinical examination outcome requires sound preparation. It involves techniques along with knowledge of the subject. Knowing precisely the requirements and expectations at each station, and presenting them exactly what is needed is the secret to successful outcome. Here at traineeportal.co.uk we will tell you exactly how to prepare for your MRCS Part B (OSCE) Examination.

First of all, start early. Don’t leave anything for end as you will keep improving upon your preparation as you go along. Don’t forget to give thorough read to MRCS Content Guide by Intercollegiate Committee for Basic Surgical Examinations (ICBSE), a copy of this can be downloaded from following link.

General Tips for All Stations:

• Remain Calm
• Understand the questions before jumping on to answer
• Structure your answers
• Keep the answers to the point
• Examiners are also pressed for time as they need to complete the questions they have within given time, don’t take it negative if they stop you and ask next question. That would probably mean that they have got the answer they were looking for
• Look for hidden / obvious clues

Conduct of Examination:

• Always arrive at the examination site early as different sites have different ways of approaching examination area.
• Remember, it’s a 3/4-hour long exam and you really need to be comfortable in what you wear. Do not stress too much about wearing suits, obviously dress formal, but many candidates simply wear shirts (rolled sleeves) and chinos- No ties/Jackets!
• Exam is delivered by dividing candidate into 2 circuits, each with 8 stations, after finishing 8 stations; candidates swap over with a tea break in between.
• Time between stations has increased to 2 minutes (pre-covid this was only 1 minute)- 1 minute you will be cleaning your hands and move between stations (will take less than 10 seconds), and 1 minute you will be reading/preparing for the scenario. In the first 1 minute you are not allowed to look at the scenario (This is the perfect time for you to relax and forget the previous station and mentally prepare yourself for the next station)
• Remember- you are in covid times and not gelling your hands in between stations, or not adhering to COVID rules is generally not forgiven in this exam- DON’T shake hands your examiner/actor!
• Due to omission of actual patients from exam during covid times, you can now prepare for the exam with your friends online (Zoom, Skype etc), this is my most important tip to you all. DONOT PREPARE ALONE. Many times, you will find yourself knowing the answer but not being able to verbalise it, so it really pays to practice with your exam buddy. Join our MRCS Part B (OSCE) Facebook Group for fruitful discussions and to find your preparation buddy.

STATIONS

Each station is marked out of a total of 20. Rather than an itemised check list approach the marking scheme allocates a proportion of the marks at each station to one or more of the above domains which can be evaluated within the context of each scenario.

Anatomy And Surgical Pathology:

• As mentioned above there are two anatomy stations so worth revising your anatomy!
• All 20 marks are awarded for clinical knowledge
• Photos are used in these stations with pros being standardised photos and no more poorly prosected specimens and cons being poor quality images in certain cases, prepare yourself well for both.
• There are roughly 10-15 quick fire questions in these stations so if you do not know the answer, you can politely ask to return to these later and go for the rest of the marks for grab.
• In all parts of the examination if the candidate gets a question wrong and this may affect their performance in subsequent questions then they will be given the correct answer.

Applied Surgical Science and Critical Care (Physiology/Critical care/Trauma)

• Fairly straightforward stations where you can easily prepare for them
• No excuse for not being swift in talking through you’re A to E-
• Try and book yourself into CCRISP and ATLS courses, but if you haven’t done these, make sure you go through their textbooks.
• There are some niche topics in physiology that keep coming out in every sitting which we will go through with you.
• You will be assessed for
  • Ability to sift peripheral information to detect a root cause
  • Ability to explain and justify decisions
  • Alertness to symptoms and signs suggesting a condition may deteriorate
• In addition to clinical knowledge and skills, Professionalism is also assessed at this station
  • Makes the best use of information and is able to think beyond the obvious.
  • Anticipates and plans in advance.
  • Aware of need to put patient safety first.

Pathology

• Been reduced from 2 to 1 station but due to frequently repeated scenarios and microscopic slides, very easy to revise and prepare for.
• Examiners look for concise responses in this station so ask the examiner to skip the question if you genuinely do not know the answer.

Procedural Skills (Practical station)

• Again, the numbers reduced to only one station, which most candidates pass
• Know your suture material, specially what is commonly used for skin closure.
• Normally you are asked to perform some interrupted stitching, then quizzed on local anaesthetics. In some occasions you might be asked to tie at depth and do figure of 8 stitch.
• Marks are awarded for confidence, answering questions while performing the procedure and sharp safety.
• One of the two examiners will normally assist you to cut stitches for example.
• They may also include patient safety-related issues such as correct ordering of theatre lists or discussing the dangers of diathermy.

Communication stations

• Two stations:

• Information giving: you will be delivering information to an actor regarding various topics, same stations repeated every year so very easy to prepare for. You really need to ace your jargon free language and be kind to the actor. One examiner is medical(who will judge the content) and one examiner is a lay person(who will judge your communication skills)

• Information receiving: in this station, you will discuss a patient with a consultant over the phone. Really important to go through SBAR handover technique, be concise and not miss important information. You really need to work hard in your prep station to write out all the details you want to go through over the phone. One important point is that almost always they will ask for an investigation which has not been performed- DO NOT LIE! As obvious as it is, many people have failed this station for lying about an investigation under the exam stress.

History taking

• Fairly straightforward station, again, a lay person is present to judge your communication skills
• 6 minutes of history taking and 3 minutes of presenting and questioning.
• 6 minutes go very quick so important to get to point and only ask one or two open questions, however, actors have been trained to give you concise answers- no more calculating pack years!
• Always include ICE and respond to patient cues.
• They may also ask you to discuss any particular physical signs you would look for on examination
• You will be assess:
  •  To summarise the history.
  • To give the differential diagnosis and explain how you would justify your answer.
  • To explain how the diagnosis would be confirmed
  • To specify what management you would recommend  
• You will also be assessed about Communication Skills and Professionalism at this stations
• Communication
  • Ability to assimilate information, identify what is important and convey it to others clearly using a variety of methods.
  • Ability to adjust behaviour and language as appropriate to needs of differing situations.
  • Ability to actively and clearly engage patient/carer/colleague(s) in open dialogue.
• Professionalism
  • Ability to accommodate new or changing information and use it to manage a clinical problem.
  • Ability to anticipate and plan in advance.
  • Ability to Prioritise conflicting demands and build contingencies.
  • Ability to demonstrates effective management of time and resources.

Physical Examination

• This station caught many people out following Covid modification. This is because not many people are used to talk through their examination without actually doing it. It however can be easily prepared for.
• Practice with a colleague talking through every examination including- respiratory, cardiovascular, arterial/venous, orthopaedics and one common station… Submandibular gland.
• Examiners will give you the signs as you talk through your history taking- very similar to ATLS end of course exam.
• Candidates should not take a history or undertake a general examination if instructions clear say about a specific examination e.g. Knee Examination.However, at all stations candidates will be expected to introduce themselves, outline the purpose of the task, confirm the patient’s identity and check that they consent to the required task. Candidates should always clean their hands before and after patient contact with the alcohol-based hand gel provided.
• Some stations will clarify whether the candidate should describe what they are doing as they proceed with physical examination but typically a dialogue with the examiner is not required as the purpose of the examination of these stations is for the examiner to observe the candidate perform the task and for the candidate to report their findings at the appropriate time.
• Know the differentials and management of common conditions in each examination category eg. Submandibular gland stone, joint arthritis, frozen shoulder, aortic stenosis etc.
• You will be assessed for communication and professionalism also at this station
• Communication
  • Use of technical language appropriately and correctly.
  • Establishing relationship of respect with others without being patronising or domineering.
  • Demonstrating clarity and focus in communication.
  • Demonstrating active listening towards others.
  • Ability to express ideas clearly to others.
  • Ability to Introduce and establish rapport with patient.
  • Ability to respond appropriately to the patient if causing pain/distress.
• Professionalism
  • Consider all the facts before reaching a decision.
  • Respond flexibly, redirecting thinking when the situation demands.
  • Show awareness of wider needs of situation. Attempt to think ‘around’ issue.
  • Ability to explain and justify decisions.
  • Alertness to symptoms and signs suggesting conditions that might progress or destabilize.
  • Ability to accommodate new or changing information.
  • Demonstration of strategic and tactical planning ability.
  • Ability to recognize and manage complex and competing needs.
  • Management of time and resources effectively.
  • Put patient safety foremost when planning.

Rest station

• If you are lucky, you will get this in the middle of your circuits, but you may start on this station. It is really tricky to keep calm and sit for 9 minutes the heat of exam, but also a perfect time for some relaxation technique of your own.
• Try and use the toilet at this point in exam or in the rest break in between of the two circuits.

Finally, best of luck to you