The OSCE – what does it involve?

Guidance on the OSCE

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The final assessment (OSCE) checks a sample of the knowledge and skills you’ll need to register and practice independently. It usually takes place four times a year, in January, March, July and September. The latest dates are published on our website.

OSCE format

The OSCE consists of 16 short tasks or stations. Each station lasts five minutes and you will have one minute outside each station to read the instructions. There is also a five minute rest station.

You could be tested on any of the 75 competencies you were assessed on at Stage One. Examiners are looking for evidence that you understand the theory behind each element of competence, and can apply it in a practical clinical setting. 

OSCE content

You will be tested several times on the skills outlined below. A sample OSCE station can be found in the OSCE download section. These tasks may take longer than five minutes in practice, but stations have been designed to make sure you can demonstrate competence in five minutes.

Patient conditions will be drawn from the experience requirements outlined in the GOC elements of competence and have been categorised as:

•    neurological/developmental
•    neurological/acquired
•    refractive
•    pathological anterior segment
•    pathological posterior segment
•    psychological.

History taking, including diagnosis

You must take an accurate and relevant history from the patient or patient’s relative (played by an actor).

You might be required to give a diagnosis, either to the patient or examiner, and explain your reasoning or suggest further tests. Presentations might include, but are not limited to:

•    blurred vision,
•    reduced vision,
•    sudden visual loss,
•    diplopia,
•    red eye,
•    headache,
•    systemic disease with ocular manifestations.

Make sure you perform a thorough history and symptoms, even if you have an early idea of the diagnosis. 

Tailor your questions to the responses offered by the patient and make sure you explore the responses to effectively exclude other differentials.

The criteria for referrals are different in different parts of the UK. Standard definitions for the purposes of the OSCE are below and will be in each station. Use these terms during the exam, as the examiner may not be familiar with the referral criteria in your area.

Emergency = same or next day
Urgent = within one week       
Routine = in due course

If you are asked to write a written referral in an OSCE station, you will be provided with a template to complete. A copy of this template is in the OSCE downloads section.

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Communication

You will be observed interacting with a patient, patient’s relative, or other health professional (played by actors). You might be required to:

•    explain how a condition will be treated,
•    explain a diagnosis,
•    explain a prescription,
•    request a referral,
•    decide on appropriate management with a patient,
•    give advice on the most appropriate optical appliances,
•    break bad news,
•    write a referral letter.

Although communication skills are the main skill tested in some stations, you will be marked on communication in all stations involving a patient. The types of issues the examiners will assess are:

•    ability to relate to the patient,
•    ability to explain and advise appropriately,
•    ability to listen and question,
•    ability to be fluent, logical, confident and professional.

When marking communication, examiners will take into account both what you say and how you say it. Communicating incorrect information well or communicating correct information poorly will both be penalised.

Performance indicators relating specifically to communication objectives can be found in the OSCE downloads section.

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Data interpretation

You will need to interpret a variety of clinical data – these may include visual field plots, charts, results of clinical examinations and clinical signs (via photographs or videos).

You may have to discuss your conclusions and diagnoses with another health professional or with the patient, patient’s relative (played by actors). You might also be given a dataset and asked to answer a series of questions about it. If this is the case, you will be given the questions before you enter the station.

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Clinical examination and practical skills

You will need to demonstrate the ability to undertake a clinical examination or perform a practical procedure. This might be conducted on an anatomical model if the procedure is invasive or could harm a patient.

Every exam will include a station that requires you to demonstrate your ability to perform indirect ophthalmoscopy. For this station, you will be asked to identify a set of symbols on the back of a model eye. Other stations may include, but are not limited to:

•    direct ophthalmoscopy (suspended during COVID-19),
•    cover test,
•    focimetry,
•    motility,
•    retinoscopy.

The OSCE will assess your ability in a range of clinical decision-making and management situations. The patients (played by actors) will range in age and have a variety of conditions. No young children will be present, but you may have to interact with an actor playing the child’s parent or guardian.

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