Zu-hua Gao - Clinical Skills Review: Scenarios Based on Standardized Patients

Clinical skills examssometimes called objective structured clinical examinations or OSCEsare a rite of passage for all physicians in training. These exams include the MCCQE II and the Certification Examination in Family Medicine in Canada, and equivalent exams in other countries such as the USMLE Step 2 CS in the United States.

This book is designed to help you prepare for these exams. Although simply reading through the cases in this book will be useful, the best way to study for a clinical skills exam is to practice. Groups of 3 or 4 work best, assigned to the following roles:

Candidate: reads aloud a case from the list of cases at the back of the book. Reading aloud ensures that everyone knows the boundaries of the task. The candidate should then perform the task by formulating questions to ask the patient, or describing other procedures such as physical examinations or investigations, as required.

Examiner: uses the notes for the case to formulate one or two pertinent questions to ask the candidate and to remind the candidate of any crucial steps they may have missed.

Observers: help debrief the task. We recommend that observers pay particular attention to skills such as: communicating clearly and respectfully; setting appropriate priorities; engaging issues of medical ethics as needed; and resolving clinical situations that require the expertise of specialists.

Work through all the cases in the book in this way, changing roles each time. Each case has time limiteither 5 minutes or 10 minutesin keeping with the protocols for the Canadian clinical skills exams. In some instances, in an effort to be comprehensive, the cases set up more tasks than a candidate could realistically accomplish within the assigned time. It is still useful, however, to set a timer or stopwatch for the assigned time, to get a feel for how long you have.

Take the time to work through all the cases thoroughly and thoughtfully, so start at least a few months in advance of the exam. This will allow you to use each case to its fullestexploring different issues and questions that each could containand allow you to gain some level of comfort and confidence in the face of an otherwise stressful exam.

We have tried to avoid the use of jargon as much as possible. However, in the interests of space we have used a number of abbreviations, and we have listed these in the abbreviations section at the back of the book.

Medicine is famous for the number of mnemonics that students have developed over the years to remember certain aspects of history or management, and we have given these as appropriate throughout the book. Memorizing the most important of these should prove useful in situations where you need to think on your feet.

No book of this nature can ever be complete. We encourage you to draw from other sources in preparing for your clinical skills exam. In particular, you should be familiar with advanced lifesaving (ALS) protocols, and should review general textbooks in each of the areas in which you will be tested.