OSCEs Explained: Guide to the Objective Structured Clinical Examination

The Objective Structured Clinical Examination (OSCE) is a performance-based test designed to assess the clinical competence of aspiring physicians. It’s a cornerstone of healthcare education and essential to your success in medical school and beyond.

This comprehensive guide will delve into what the OSCE entails, its format, why it’s so widely used in medical education, and how you can master this essential examination.

What Is the OSCE?

The Objective Structured Clinical Examination (OSCE) is a performance-based test commonly used in healthcare education to assess clinical competence. It assesses a student’s ability to apply medical knowledge, communicate effectively with patients, perform physical examinations, and demonstrate clinical reasoning in a standardized setting.

The goal is to simulate real-life medical scenarios. Students interact with standardized patients (actors trained to portray clinical cases) or mannequins across multiple timed stations.

The OSCE was developed in the 1970s by Dr. Ronald Harden at the University of Dundee in Scotland ****to address limitations in traditional oral and written exams, which often failed to assess real-world clinical skills. It ensures readiness for clinical practice, especially in disciplines where safety and precision are critical.

The OSCE format generally offers:

• Objectivity: Standardized scenarios reduce examiner bias.
• Structure: All students face the same multiple tasks in timed stations.
• Realism: Simulated patient interactions mimic clinical environments.

Since its inception, OSCEs have gained global acceptance and are now a cornerstone of assessment in medical schools and for professional licensure in some specialities. Studies have shown that they significantly improved the validity and reliability of clinical skills assessment, providing a more equitable and comprehensive evaluation of medical students.

OSCE in Medical Education: Who Has to Take the Exam?

Nearly all medical schools worldwide incorporate OSCEs into their curricula, particularly in preclinical or clinical skills courses. They are often required for promotion (i.e., going from pre-clinicals to clinicals) or graduation and are sometimes part of national licensing (e.g., MCCQE Part II in Canada and previously Step 2 CS in the US).

This means that every medical student must take the OSCE at least once, with the vast majority taking it multiple times throughout their medical school education. So, it’s in your best interest to master OSCEs as soon as possible.

OSCEs have become so ubiquitous within the field of medicine that even physician assistant students, nursing students, pharmacy students, and many more roles are beginning to implement them into their curricula.

It’s crucial for medical students to understand that OSCEs are not standardized national exams, meaning each medical school designs and grades its own. This leads to considerable variability in everything from the number and length of stations to the specific clinical scenarios presented, and most importantly, the scoring rubrics and pass/fail criteria.

Some schools may emphasize specific communication skills more heavily, while others may focus on procedural precision or use a combination of numerical scores and global ratings with varying weights.

Therefore, to maximize your success, proactively familiarize yourself with your institution’s unique OSCE structure, expectations, and grading system. Often, this can be done by attending practice sessions, reviewing provided materials, and seeking feedback from faculty and senior students.

Objective Structured Clinical Examination Format

An OSCE is typically composed of stations, each lasting between 10 and 30 minutes. The time will vary depending on your medical school.

At each station, candidates will encounter a new task, such as:

• Taking a patient history
• Performing a focused physical exam
• Interpreting lab results
• Counseling/comforting the standardized patient
• Writing the clinical SOAP note
• Generating a differential diagnosis
• Oral Patient Presentation

Each task is standardized, utilizing standardized patients (actors) and a checklist used by the examiner to assess performance. The more checklist boxes you fulfill, the better your overall grade.

OSCE Example Scenarios

Let’s explore OSCE scenarios.

Here are ten sample scenarios simulating real-world clinical encounters. They test knowledge, skills, communication, and clinical reasoning. Each scenario offers a unique challenge, including focused history taking, physical exams, ethical dilemmas, and emergencies.

• Scenario 1: A geriatric patient with chest pain.
• Scenario 2: A child with a sore throat.
• Scenario 3: Breaking bad news.
• Scenario 4: Diabetic (or any chronic condition) patient follow-up.
• Scenario 5: Annual physical exam.
• Scenario 6: Abdominal pain in a young woman.
• Scenario 7: Post-operative pain management.
• Scenario 8: Smoking cessation counseling.
• Scenario 9: Mental health assessment.
• Scenario 10: Medication reconciliation (“polypharmacy”).

What makes many of these scenarios so practical is that there are multiple differential diagnoses based on the vague scenario intro. For example, Scenario 6 includes a differential diagnosis that should include everything from constipation/diarrhea, Celiac’s disease, pregnancy, trauma, cancer, and many, many other reasonable potential diagnoses.

Note: not all of those components will be necessary for each scenario. For example, in Scenario 2, where a child presents with a sore throat, you are unlikely to face an ethical dilemma.

How to Succeed at the OSCE

OSCEs aren’t only about what you know, but how you apply that knowledge in real-time under pressure. Success comes down to preparation, structure, and strong interpersonal skills. The following five tips will help you walk into your exam calm, confident, and ready to perform at your best.

1 | Practice, Practice, Practice!

The OSCE is a performance, and like any performance, you improve by doing it repeatedly.

Practice with classmates using real-time simulations and give each other honest feedback. Rehearsing under timed conditions will help build your confidence and improve your pacing. The more you simulate the exam environment, the more automatic and natural your responses will feel on test day.

2 | Use a Framework

Using clinical frameworks like SOAP (Subjective, Objective, Assessment, Plan) or the Calgary-Cambridge communication model provides a structured approach. These frameworks ensure you don’t miss essential components of the history or exam.

It also helps reduce anxiety, since you always know what comes next. Consistent use of frameworks makes your thinking clearer to both yourself and your examiner.

3 | Know the Rubric

Every OSCE station is graded using a checklist or rubric, and knowing what’s expected can earn you easy points. For example, knocking on the door and washing your hands is almost always worth a couple of points.

If you have access to your school’s OSCE rubric, memorize it. Then, every single time you practice, mark the items you miss to find patterns in your performance. This will ensure you can address your deficiencies before exam day.

It’s not enough to be thorough; you must also be strategic.

4 | Focus on Communication

Clinical knowledge means little if you can’t connect with your patient. Maintain good eye contact, use open body language, and actively listen without interrupting. Show empathy and validate patient concerns by using phrases like “I understand this must be difficult.”

Clear and compassionate communication is often the deciding factor between a good performance and an excellent one.

5 | Master Transitional Phrases

Smooth transitions help stations feel natural and professional. Use phrases like “Now I’d like to examine your abdomen, is that alright?” or “To summarize what we’ve discussed…” to signal changes in the conversation or task.

These phrases show the examiner that you’re organized and considerate. They also help reassure the standardized patient and keep the interaction flowing naturally.

OSCE Frequently Asked Questions

What Does OSCE Stand For?

The OSCE abbreviation stands for Objective Structured Clinical Examination.

How Are OSCEs Graded?

OSCEs are not standardized national exams, meaning each medical school designs and grades its own. Some schools might emphasize specific communication skills more heavily, while others might focus on procedural precision, or use a combination of numerical scores and global ratings with different weighting.

Therefore, to maximize your success, you should proactively familiarize yourself with your institution’s unique OSCE rubric.

Can You Fail the OSCE Exam?

Yes, you can.

The criteria to pass will depend on each school’s approach to OSCEs. This also means that each school will determine what qualifies as a failing grade. If you do fail, you can expect a short refresher course reviewing proper history-taking and physical exam skills.

How Many Times Can You Take the OSCE?

Most schools offer only one attempt per station as each scenario is highly rehearsed.

Are There Breaks Between OSCE Stations?

There are typically breaks between OSCE stations, especially if there are many stations or each station is designed to take a long time.

Ace Every Test

OSCEs are far from the only test you’ll face in your medical education.

We’ll show you how to score higher on every test with our free Test-Taking Tactics Cheat Sheet, which distills key tactics and reveals secrets to overcome test-taking anxiety, guess more accurately, and more.