I’m Dr Laura White and I’m currently an internal medicine trainee based in the North West of England.

Medical education has always been a passion of mine and I’ve been involved in teaching since my clinical years of medical school. During those years we were sometimes left to our own devices to not only develop the skills needed to become a doctor but also to pass our clinical exams.

This motivated me to get involved in medical education – initially by directly observing students to help them develop these skills. Since then, I’ve become one of the lead clinical lecturers for One2One Medicine and have recently written the new SBA Masterclass course and its accompanying textbook.

Why are OSCEs so important?

Objective structure clinical examinations (OSCEs) are clinical exams that aim to simulate real-life situations we face as doctors in a variety of settings. While a lot of it feels like acting, it’s not until you start practising medicine that you realise how ‘real-life’ some of those OSCE scenarios become.

The key to preparing for your OSCEs is therefore clinical exposure: being on the wards, observing doctors doing those same skills you’ll be tested on in these exams. Unfortunately, the COVID-19 pandemic has really disrupted this. Many students have lost months of clinical placements and less clinical exposure can result in reduced confidence among students during OSCEs.

Whenever we think about OSCEs, the first thing that tends to spring to students’ minds are the clinical system examinations. Students often spend a lot of time preparing for these – making the effort to attend the ward out-of-hours to examine patients with clinical signs. But there’s one very important area that can become neglected during these preparations: communication.

Communication skills: essential but often forgotten

We use communication every day to communicate with colleagues, patients and families. Communication is one of the most important skills in clinical practice and examiners can tell when these skills haven’t been practised. This can mean students unintentionally losing these communication marks.

Having helped students prepare for OSCEs for several years, I’ve certainly witnessed an increased focus on communication skills (especially as it’s possible to run these stations in a socially distanced manner), which is why it’s worth spending time on these skills.

The importance of effective communication is emphasised even further when you look at NHS complaints. Communication was the largest subject of written complaints to the NHS in 2020-2021 (NHS England). The pandemic has also highlighted the challenges of communication and the need for trainees to take on more of those often difficult conversations.

Prepping for OSCEs

There are several things you can do to prepare for communication stations and optimise your marks.

• Know what to expect: be prepared for the communication stations that may come up. Common communication-specific stations include: SBAR handovers between colleagues, speaking with the angry patient or relative, breaking bad news to patients and discussing important ethical dilemmas (for example, confidentiality and the patient who lacks capacity).
• Learning through observation: observing doctors handling these conversations in real life and, where appropriate, asking to practise these skills under direct supervision is a valuable part of learning. This is particularly the case for SBAR handovers – many doctors would be more than happy for you to hand over a patient to a colleague with their supervision!
• Practise: create scenarios with your colleagues or use pre-created scenarios from a variety of resources, including any ‘mock’ stations your own university may have created.

Approaching the communication stations

While different scenarios will employ different skill sets, we can use some generic principles in all communication stations.

First, listen to your patient. As a consultant once said to me: ‘listen to your patient, they are telling you the answer’.

The next is to be empathetic, using phrases such as ‘I’m sorry you feel that way’ or ‘I can see that this has been really difficult for you’ and when asking sensitive questions try to normalise them – for example, ‘lots of people experience voices when they’re feeling low, is that something you’ve experienced?’ in those challenging psychiatry history stations.

And finally, be aware of your non-verbal communication. Non-verbal communication makes up a big part of communicating and keeping this ‘open’ by leaning in, uncrossing your arms and legs and reflecting your patient’s non-verbal cues to them is key – unless of course that non-verbal communication is aggressive in nature.

Communication is going to be vital in whatever career you choose to pursue in medicine. Optimising these skills early and practising them for OSCEs can really help you to secure more marks on exam day.

Good luck!