Radiology Masterclass OSCE presentation tips
Top 10 presentation tips.
- Pay attention to the clinical details
Learn your lines
- Comment on image quality - briefly
- Describe the 'obvious' abnormality first
- Continue systematically
- Describe things you are unsure of and come back to them only if you think they are relevant
- Check the review areas
- Summarise in one sentence linking the imaging findings to the clinical scenario
- Suggest immediate management
- Observe examination etiquette
An Objective Structured Clinical Examination (OSCE) is a common examination method for assessing skills in medical imaging at medical finals in the UK. A radiology OSCE 'station' usually involves the interpretation of a radiological image in the context of a specific clinical scenario.
For the perfect presentation of any X-ray there are several necessary elements.
1. Demonstrate a systematic approach
2. Describe and summarise the salient abnormalities
3. Link the abnormalities to the clinical scenario
4. Suggest appropriate management or further investigations
This is easier said than done, but good medical finals candidates will manage this fluently. Here's how...
Read the clinical information carefully
You are usually given some clinical information about a patient before you enter the OSCE station. This information should be kept at the forefront of your mind throughout the station. You will need it later when you summarise the radiological findings.
Be aware of the scoring system
Examiners are restricted by a check list and global scoring system. They are limited to asking specific questions. See these examples - OSCE socring and check lists .
You can't score points in a radiology OSCE unless you are talking. Coordinating a systematic approach and commenting as you go is difficult. The trick is to have lines prepared before you start.
The opening gambit
First, identify the patient and the type of X-ray image...
'This is a plain CHEST/ABDOMINAL radiograph of PATIENT'S NAME taken on DATE at TIME, it is a PA/AP/SUPINE/MOBILE image, and I note the side marker is correct...'
Ask to see any previous images. This will impress the examiner, even if none are available in the scenario.
Comment briefly on image quality
In the OSCE setting it would be unfair to give you an image that was technically inadequate, so don't spend too long assessing image quality. For example, if the case is a chest X-ray, don't spend too long deciding if the image is slightly rotated. This wastes valuable time. Instead you could say - 'The image is of adequate quality...' - unless it obviously isn't. If the examiner challenges the statement, you can then assess image quality more carefully. If you know you are expected to examine quality more fully, do so quickly.
Although you are unlikely to be given a chest X-ray with poor inspiration, you should always quickly note if the lungs are hyperexpanded. The quickest way to do this is to see if the hemidiaphragms are flattened, and if you are not sure, then count ribs.
Describe the obvious abnormality first
Some radiologists don't like the phrase 'obvious abnormality,' so it is best to say - 'The first abnormality to comment on is....' - and then describe it as best you can.
If you cannot see an obvious abnormality, say - 'I cannot see any abnormality at first glance...' - and then continue systematically, telling the examiner this is what you are doing - '... but looking at the image systematically...' .
Demonstrate your system
Once you have described the first abnormality, you must not assume you have finished. You should make it obvious to the examiner that you have a system for looking at the whole image by saying - 'I am now looking at the rest of the image systematically...' - and continue in an anatomical fashion.
Use appropriate 'normal' statements, such as...
'The trachea is central...'
'The hilar structures are normal...'
'The upper, middle and lower zones of the lungs are symmetrical and clear...'
'The costophrenic angles and hemidiaphragms are well-defined...'
'The heart size and contours are normal...'
'I can see no abnormality of the bones or soft tissues...'
Equivocal findings
If you are not sure whether something is abnormal, then describe what you see, saying - 'I am not sure if the... (anatomical structure)... is abnormal. It appears... (describe the structure)...' - and then move on. You can always return to an area of uncertainty if you still think it is important, once you have checked the rest of the image.
Review areas and summary
At the end, check the review areas saying - 'I am now checking the review areas...' - and, before being asked, say - 'In summary, this X-ray demonstrates evidence of...' - and in one sentence relate the imaging findings to the clinical scenario.
Clinical link and management
The clinical details you are given at the beginning are likely to be equally informative as the X-ray, if not more so. Don't forget that the OSCE is testing your ability as a day one doctor, not as a fully qualified radiologist. The best candidates will link the findings to the clinical features - 'These findings are consistent with the clinical suspicion of...' .
Good candidates will also suggest initial management or further investigations without prompting - 'In this situation I would manage the patient by...' - and suggest appropriate treatment. This step is particularly important if the findings suggest a medical emergency. Don't wait to be asked what you would do next.
The senior get out clause
Some candidates too readily defer management to seniors. Although this is entirely appropriate in many real life clinical scenarios, in the OSCE setting you should not do this too soon or, as some do, make this your only plan.
Although you will not lose marks for saying which other important people you would involve, you will be expected to know what to do yourself in the scenario given. Don't forget to mention nursing staff and other multi-disciplinary team members.
Exam etiquette
You should not ask too many questions about the image. Don't ask the examiner ...'Do you think this bit is abnormal?'... The exam is not a teaching session.
You can always ask to be reminded of the clinical scenario, and you may be given the opportunity to refer back to this before summarising your findings.
You will usually be allowed to point at the image, although it is polite to ask. Many examiners will encourage you to point, but never touch the film or monitor. Damaging precious film copies or marking a monitor with your sweaty finger will annoy the examiner. If you do touch the image by accident, apologise immediately and move on.
Your examiner
Always be polite to your examiner. Try and sound as professional as possible, and speak clearly. Introduce yourself as you enter, and say - 'Thank you'... - as you leave. If there are officials in attendance for quality assurance purposes, then remember to thank them too.
Occasionally an examiner may make a comment to lead you. This will almost certainly be helpful, and any leading comments should not be easily dismissed. Almost all examiners are on your side and want to pass you. They will have to account for any failures, and would rather not do the paper work. If they can, they will score you highly. Never argue with your examiner! If you do, the examiner may enjoy the paperwork.
An OSCE examiner should not ask questions that are not specified by the OSCE scenario, but many still do. If you are asked questions that do not refer to the scenario, keep calm and answer them as best as you can.
If things go wrong
Remember, if everything goes completely piriform, don't panic! The benefit of the OSCE exam is that you can put a bad performance behind you. Move on quickly to the next station and don't dwell on mistakes.
Listen to medical school advice
These OSCE presentation tips should only be used as a guide. Examination format varies in different medical schools, so you must be guided by information provided by your own college, and by the experience of your predecessors.
Page author: Dr Graham Lloyd-Jones BA MBBS MRCP FRCR - Consultant Radiologist - Salisbury NHS Foundation Trust UK ( Read bio )
Last reviewed: July 2023
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Nov 18, 2014
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OSCE. Kathy Boursicot Train the Trainer Assessment Workshop October 29, 2003. Hong Kong International Consortium. OSCE. Format Purpose Advantages Writing principles Training observers Scoring considerations. What is an OSCE?. O bjective S tructured C linical E xamination.
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OSCE Kathy Boursicot Train the Trainer Assessment Workshop October 29, 2003 Hong Kong International Consortium
OSCE • Format • Purpose • Advantages • Writing principles • Training observers • Scoring considerations
What is an OSCE? • Objective • Structured • Clinical • Examination Harden RG and Gleeson FA Assessment of clinical competence using an objective structured clinical examination (OSCE) Medical Education,1979, Vol 13: 41-54
Observed Stations: clinician examiners OSCE test design
…. Traditional OSCE …. SP-based test …. Station couplets …. Integral consultations Varieties of OSCEs Patient-based Clinical task Written task
Professional authenticity Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine (Supplement) 1990; 65: S63-S7. Simple model of competence Does Shows how Knows how Knows
Does Knows how Knows Shows how Testing formats Professional practice Behaviour~ attitude/skills OSCEs EMQs, SEQs Cognition~ knowledge MCQs
OSCE-Objective • All the candidates are presented with the same test • Specific skill modalities are tested at each station • History taking • Explanation • Clinical examination • Procedures
OSCE - Structured • The marking scheme for eachstation isstructured • Structured interaction between examiner and student
OSCE – Clinical Examination • Test of performance of clinical skills • candidates have to demonstrate their skills, not just describe the theory
Characteristics of assessment instruments • Utility = • Reliability • Validity • Educational impact • Acceptability • Feasibility Van der Vleuten, C. The assessment of professional competence: developments, research and practical implications, Advances in Health Science Education, 1996, Vol 1: 41-67
Test characteristics • Reliability of a test / measure • reproducibility of scores across raters, questions, cases, occasions • capability to differentiate consistently between good & poor students
Test Sample Test Sample Sampling Domain of Interest
Reliability • Competencies are highly domain-specific • Broad samplingis required to obtain adequate reliability • across content, i.e., range of cases/situations • across other potential factors that cause error variance, i.e., • testing time, number of cases, examiners, patients, settings, facilities
Test characteristics • Validity of a test / measure • The content is deemed appropriate by the relevant experts • The test measures the characteristic (e.g. knowledge, skills) that it is intended to measure • The performance of a particular task predicts future performance
Test characteristics • Validity of a test / measure
Advantages of using OSCEs in clinical assessment • Careful specification of content = Validity • Observation of wider sample of activities = Reliability • Structured interaction between examiner & student • Structured marking schedule • Each student has to perform the same tasks = Acceptability
OSCE Station Writing
How to start • Decide what tasks you • want to • can • should test in an OSCE format • OSCEs test performance, not knowledge
Constructive alignment • Need to know the learning objectives of your course / programme • Map these across : • Subject areas • Knowledge areas • Skill areas
Blueprinting • Content of the assessment should align with the learning objectives of the course • Blueprinting • allows mapping of test items to specific learning outcomes • ensures adequate sampling across subject area and skill domains
OSCE blueprint: systems-based
OSCE blueprint: discipline-based
Key features of success in designing OSCEs • Feasibility • Congruence
Feasibility • Is it a reasonable task to expect the candidates to perform? • Can the task be examined at an OSCE station? • Can the task be performed in the time allowed?
Feasibility • Is it a reasonable task to expect the candidates to perform? Is it authentic? • Can the task be examined at an OSCE station? • Match clinical situations as closely as possible • Some tasks may require simulated patients • Some tasks may require manikins • Some tasks simply cannot be examined in this format
Feasibility • Can task be performed in time allowed? • Pilot the stations to see if they are feasible • Check equipment /helpers/practicalities
Congruence • Is it testing what you want it to test? • Station construct: describe what station is testing
Congruence • Ensure that all parts of station coordinate • Candidate instructions • Marking schedule • Examiner instructions • Simulated patient instructions • Equipment
Station construct • This station tests the candidates ability to …………………………
Candidate instructions • State circumstances: e.g. outpatient clinic, ward, A & E, GP surgery • Specify the task required of the candidate: e.g. take a history, perform a neurological examination of the legs, explain a diagnosis • Specify tasks NOT required • Instruct on summing up: e.g. tell the patient, tell the examiner
Examiner instructions • Copy of candidate instructions • Specific instructions appropriate to the task: • e.g., do not prompt, explicit prompts, managing equipment
Simulated patient instructions • Give as much detail as possible so they can be consistent • try to leave as little as possible for them to ad lib! • Give enough information to enable them to answer questions consistently • Be specific about affect in each role • Specify patient demographics • i.e., gender, age, ethnicity, social class, etc.
Marking schedule • Ensure marks are allocated for tasks the candidates are asked to perform • Decide relative importance of diagnosis vs process (history taking, examination) • Separate checklist for process skills
Equipment • Be detailed • Think of • Chairs + table / couch / bench • Manikins - specify • Medical equipment • Stethoscope, ophthalmoscope, sphyg, suturing materials, etc
Designing stations • Use your blueprint • Be clear what you are testing: define the construct • Check for congruence • Pilot for feasibility
Training observers • Understand the principles of OSCEs • Enhance inter-rater consistency
Techniques • Examiners must train together • Videos • ‘live’ stations • Discussion of marking inconsistencies
Training observers • General training • Station-specific training
Scoring considerations • Global vs checklist scoring • Weighting • Standard setting
Checklist scoring • Advantages • Helps examiner know what the station setters are looking for • Helps the examiner be objective • Facilities the use of non-expert examiners • Disadvantages • Can just reward process/thoroughness • May not sufficiently reward the excellent candidate • Ignores the examiners expertise
Global scoring • Advantages • Utilises the expertise of the examiners • They are in a position to make a (global) judgement about the performance • Disadvantages • Examiners have to be expert examinersi.e. trained • Examiners must be familiar with expected standards for the level of the test
Weighting • In a checklist, some items may be weighted more than others • More complicated scoring system • Makes no difference to very good & very bad candidates • Can enhance discrimination at the cut score
Standard setting • No perfect method! • Should be criterion-referenced method • e.g. Angoff, Ebel, etc. But • are these suitable for performance based tests?
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