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Sample Objective Structured Clinical Examination (OSCE)

Example 1



The candidate demonstrates the ability to take a history and reach a differential
diagnosis in an effective way in a case of joint pain.

NB TO EXAMINER: At the 30 second bell, ask the candidate for a differential diagnosis.


  1. Presenting Complaint: Elicits
    a history of acute mono-arthritis. Checks are recurrent. Checks are of sudden onset. Checks are responsive to Indometacin.
  2. Other History Takes a good social history. Checks sexual history (absence of STD). Checks alcohol consumption. Checks
    eating habits. Excludes symptoms of other joint diseases.
  3. Differential Diagnosis Made a reasoned assessment of the patient's problem Suggests a diagnosis of gout.
  4. Listening, Questioning & Diagnosing Ensured they have understood the patient's symptoms/problem and concerns Summarised and clarified understanding
  5. Approach to the Patient Introduced and orientated patient and themselves Established an attentive, respectful and non-judgmental relationship Acknowledged patient's emotions and concerns

Joint pains - instructions to candidates
This station tests the candidates ability to take a history and reach a diagnosis.
Mr McKenzie has been referred to you in the Rheumatology Clinic because he has had pain in the right big toe joint.
Take a relevant history and suggest a likely diagnosis to the examiner.

This station will last five minutes

Joint pains - instructions to simulated patient

You are Mr McKenzie, a married man in your mid-30s. For the last 6 months some of your joints have been painful. Your general practitioner (GP) has sent you to see a rheumatologist. The first time you had trouble was when you returned from hospital after having your inguinal (in the groin) hernia repaired. That was around 48 hours after the operation. Your right big toe became excruciatingly painful and swollen. It was so bad you could not put any weight on it for 2 days. Your general practitioner (GP) gave you some indometacin (anti-inflammatory) tablets and these helped. You remember that skin around the foot was bright red for 3 or 4 days. Gradually the symptoms subsided and after about a week you were able to hobble back to your job as a sub-editor.
The foot got a lot better for some weeks. However, about 3 months ago the same thing happened suddenly to your left knee - intense pain and swelling, though no skin colour change this time. The pain subsided again with the help of indometacin after a couple of weeks; however, it has remained slightly swollen and a bit stiff since. The foot has also started playing up as well, though is not swollen like it was before. The stiffness in the two joints appears to be worse first thing in the morning, but eases off by the time you get to work. Over this six month period you've been well in yourself and have not suffered any infections.
You are married with 2 young children. You have had no extra-marital sexual intercourse. You work erratic hours, often night shifts and socialise heavily with your colleagues. On an average night you might drink 3-4 pints or a couple of whiskies. Average nights tend to happen every weekday night! At weekends, if you and your wife entertain you have 1-2 bottles of wine. You are otherwise well, outgoing and don't take any medications.

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