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Eligibility / Requirement

  • Part 2 of the test is a 14-station (plus a rest and pilot station) Objective Structured Clinical Examination (OSCE). It tests an individual's clinical and communication
    skills.
  • Before you apply to take Part 2 of the test you should consider the following:
  • Are there jobs available in the specialty of your choice Have you passed Part 1 of the test Have you considered living expenses while
    you are Preparing and taking Part 2 of the test
  • A candidate should book a place for Part 2 of the test only after he /she has passed part 1, that is within three years of having passed Part 1. A candidate is eligible to make up to four attempts
    at Part 2 of the test.
  • There is a strong demand for Part 2 test places. You may need to allow four to six months from the time of submitting an application to getting a test place in Part 2.

Pattern of Examination

  • Part 2 consists of an Objective Structured Clinical Examination (OSCE). It takes the form of 14 clinical scenarios or 'stations' as well as a rest station and a pilot station. Each station lasts five minutes.
  • The emphasis of Part 2 of the test is on clinical and communication skills relating to conditions commonly seen by SHOs, life-threatening situations, and rarer, but important, problems.
  • The main skills that would be tested in Part 2 of the test are - communication, history taking, clinical examination, practical skills, and emergency management - are defined in detail below. The examples are not exhaustive.
  • The candidate will also be assessed on their ability to conduct a physical examination of a standardised patient. A standardised patient will be an actor who has been trained to display signs as and when required by the station. In a limited number of stations, a real patient may be used. In certain circumstances, the examination will be carried out on a manikin or model.
  • The candidate is expected to be competent to carry out any basic physical examination. Examples are examination of the chest, heart, breast, hand, hip, knee and shoulder. They must also be able to perform a rectal or bimanual vaginal examination and also use the appropriate equipment in carrying out an examination .
  • The ability to maintain effective records may be tested through the writing-up of findings from a physical examination. The marking will focus on completeness (date, time, name of author), legibility and clarity.
  • Examination of the mental state is treated as a form of clinical examination for the purpose of this test.
  • Candidates will also be marked on their ability to treat a patient they are examining with respect for their privacy and dignity and attention to their comfort.
  • Assessment of the candidates ability to perform common practical procedures according to the nature of the procedure may be also observed . The practical skills may include:

  • - Taking blood pressure
    - Venipuncture
    - Inserting a cannula into a peripheral vein
    - Giving intravenous injections
    - Mixing and injecting drugs into an intravenous bag
    - Giving intramuscular and subcutaneous injections
    - Suturing
    - Interpreting an ECG, X-rays or results of other investigations
    - Basic respiratory function tests
    - Bladder catheterisation
    - Taking a cervical smear
    - Safe disposal of sharps

  • Communication skills are tested through the observation of interaction between the candidate and another person, usually a simulated patient or the examiner. The candidate is expected to know the major legal and ethical principles set out in duties of a doctor.

  • Examples of the communication skills which may be tested are:

    - Explaining diagnosis, investigation and treatment
    - Involving the patient in the decision-making
    - Checking understanding
    - Communicating with relatives
    - Communicating with health care professionals
    - Breaking bad news
    - Seeking informed consent/clarification for an invasive
    procedure or a post-mortem
    - Dealing with anxious patients or relatives
    - Giving instructions on discharge
    - Giving advice on lifestyle, health promotion or risk factors

  • The following are examples of symptoms of presenting patients. Candidates should be competent in taking a history from any of these patients and reaching an appropriate diagnosis, if required.

  • - Diarrhoea
    - Wheeze
    - Vaginal bleeding
    - Palpitations
    - Abdominal pain
    - Headache
    - Anxiety
    - Weight loss
    - Joint pain
    - Difficulty in swallowing
    - Episodes of loss of consciousness

  • The ability of the candidate to maintain effective records may be tested through the writing-up of findings. The marking will focus on completeness (date, time, name of author), legibility and clarity.

  • Examples of emergency management situations include:

    - Dealing with post-operative collapse
    - Acute chest pain
    - Trauma assessment (initial and secondary)
    - Basic adult and paediatric cardio-pulmonary resuscitation

  • Stations will be chosen from a matrix of medical areas (e.g. cardio-vascular, neurological, surgical) and skill areas (e.g. history taking, practical, examination), with a view to sampling across the range of medical and skill areas.
  • It would be helpful if the candidates familiarise themselves with the range of equipment routinely available in teaching hospitals.The patient is played by an actor, who has been provided with a detailed script beforehand. The examiner will observe the candidate and not intervene, except in very limited circumstances.
  • The candidate will be given one minute before entering the station to read the instructions, for example, To examine a patient, take a history and give a diagnosis or carry out a practical procedure.
  • Each station has a number of sections or objectives (e.g. Communication, Past History, Diagnosis) which will be graded by the examiner between A and E for each objective.
  • Each objective is weighted, with the total weightings for each station adding up to 100%. An overall grade is calculated for each station. The candidate must obtain a 'C' grade or above in 10 or more stations to pass part 2 of the test. A candidate cannot pass if he or she obtains grade E for more than one station.
  • Once inside the examination room, the candidate should stand outside their first station booth and read the candidate instructions outside the booth. The candidate will have one minute to read the instructions. The candidate should not enter the booth until the bell rings for the start of the station.
  • When the bell rings, the candidate should enter the booth. Inside the booth there will be an examiner.
  • Where there is a manikin at the station, comments if any should be addressed to the examiner and not to the manikin.
  • A bell will ring after four and a half minutes to warn the candidate that there are only 30 seconds remaining. The tasks at some stations, in particular those tasks requiring practical skills, may take less than five minutes to complete. In case one finishes early they should remain in the booth until the five-minute bell rings.
  • When the five-minute bell rings, leave the station.
  • There will be one minute between stations. During that time, the candidate should move to the next station, read the candidate instructions and wait outside the booth until the bell rings to signal the start of that station. The stations are numbered clearly from 1-16. Move in the direction indicated. Staff will be available to assist.
  • On entering the booth, the examiner will greet and check the name and candidate number as shown on the candidates badge which will be provided at the candidate briefing.

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