The Other Monster Called OSCE

Dear Lord, I’ve been facing monsters since 2012! The first was the Philippine Nurse Licensure Examination, next was the NCLEX, then the IELTS and now, the OSCE. It seems that all I’ve done in my life was to take examinations. I should be getting paid for this!

Kidding aside, this post is for those who are studying/preparing for the OSCE. I will try to include as much information as I am allowed, and I hope to help you reach your UKRN dreams.

I. What is OSCE?

OSCE stands for Objective Structured Clinical Examination. For foreign-educated nurses, like us Filipinos, this is Part 2 of the exam that you have to take in order to qualify as a nurse in the UK. The first one is CBT, and you can read more about it here.

The OSCE is a practical exam consisting of 6 parts: Assessment, Planning, Implementation, Evaluation and 2 Nursing Skills. Since it is a practical test, it is basically a role-play. You will be given a scenario, which will include a patient, his/her medical case (ie disease/condition), and you are expected to perform the appropriate assessment on this patient, create a care plan, administer medication, create a transfer of care letter and afterwards perform two sets of nursing skills which can vary.

The exam has 6 stations. The first station of the exam is Assessment. So the task for Assessment is to get the vital signs, and other pertinent information. In addition, you should also be able to get two nursing problems because based from your assessment of the patient, you will have to construct two care plans for the Planning stage.

In the Assessment part, you will be given 15 minutes to conduct a complete assessment, and this also includes proper documentation of your findings. Unfortunately, there is no clear guidebook for the OSCE, aside from the Royal Marsden and whatever anecdotes you can get from previous OSCE takers. Also, because I signed a non-disclosure agreement, I cannot divulge everything that happened during my own OSCE stint.

Now, since it’s a practical test, you’ll have to role play and pretend to be a nurse.

Sounds silly right? But that’s how it is. It’s similar to what we have in the Philippines called Revalida. All of that for 15 minutes. If you run out of time, you’ll risk failing the test. If you commit a critical fail, it means that even if you did the other parts of the exam right, you will still fail. Sadly for candidates, there isn’t a list of what constitutes a critical fail, but based on my observation (having taken the exam twice), what could be critical fails would be:

1.wrong NEWS (National Early Warning Score– a system here in the UK wherein you get the vitals, calculate the score and depending on the score, you’ll know how frequent to monitor a patient). This is where I failed the OSCE the first time.

2. Wrong assessment techniques- for example, putting on the BP cuff too tight or too loose, not counting for the HR and RR for two whole minutes, basically not following the prescribed assessment technique in the Royal Marsden Nursing Manual.

3. Failing to mention and calculate the NEWS before your time runs out

4. Failing to document

5. Failing to notice the bedside traps –these are items they place near the patient which are instrumental in their care

6. Failing to acknowledge the patient’s concerns

So after Assessment, your next station is Planning, where you’ll be given 15 minutes to create a care plan based on the problems you have identified in your Assessment station. You cannot “invent” a problem (ex: patient presented with pain and difficulty of breathing but you made a care plan for elimination, which isn’t a problem of the patient)– this will lead to a fail. The care plan should be personalized and tailor-made for the patient you had during your Assessment. So any “standard” care plans would lead to a fail. The assessors have probably read tons of care plans so they already know if your care plan is already a template or not.

In addition, penmanship plays an important role. If they cannot read your penmanship, I’m sorry but they won’t read it and then you fail. If you submit an incomplete care plan, you’ll fail.

Once you’re done with Planning, the next step is to do Implementation. In this station, you will have a mannequin which will be your patient, and your task is to administer medications safely. You will be given time to familiarize yourself with the drug trolley, the equipment in the room, and other materials. Your assessor will instruct you on what to do and other specifications of the test. The task here mainly is to give the right drug and observe the 6Rs, as well as the NMC’s guidelines for safe medication administration. Again, this is in role play form, so similar to the Assessment station, you will have to act as a nurse, and verbalize all actions you’re doing. Also, since the patient is a mannequin, the assessor will answer in place of the “patient”.

As with Assessment, I do not know what exactly constitutes a critical fail, but as per my observation, it would basically be not following the 6 Rights of Drug Administration.

After Implementation, you will now create a transfer of care letter in the Evaluation  station. The Transfer of Care letter is basically a document wherein you write all that has been done to your patient and what else needs to be done. It’s basically written endorsement. Imagine that your patient during the Assessment stage is now going to be transferred somewhere (new ward, home, nursing home etc) and you are giving hand over to the next nurse who will care for that patient. Therefore you have to make sure that the endorsement is complete, and the nurse who will now take over the patient’s care has enough information to carry over. Hence, the critical task in this station is proper documentation. The Transfer of Care letter needs to be complete, accurate and safe for the patient. If you fail to document a critical aspect of the patient’s care (Ex: medications taken/omitted, frequency of monitoring) then you may fail.

Now that you have completed the Assessment, Planning, Implementation and Evaluation stations, the next part of your exam would be the 2 nursing skills. You won’t have an idea which skill you’ll perform until you enter the station, so it’s best to practice the nursing skills indicated by your trainers (most hospitals will give candidates sufficient time to train and have trainers or educators who give support for the OSCE).

You will have 15 minutes for the skills station each, and your assessor will also give you time to familiarize yourself with the equipment, as well as other guidelines for the examination.

II. Necessary Preparation

For the exam, different Trusts and hospitals provide different trainings and materials. In my case, me and my fellow candidates were given online resources and we also had a hospital library with copies of the Royal Marsden. We also had study days, and other Filipino nurses who had taken the exam pitched in to assist us in our review. In addition, I studied different diseases and medications and familiarized myself with different services available in the UK to support patients, because their healthcare system is very different from what I know. To put simply, I studied hard.

In spite of my preparation, I still failed the first time I took the exam. I believe this was due to both divine and mortal interventions, ie: it could be God’s way of saying that I am not ready to be a qualified nurse yet, and that I simply didn’t know what to expect in the exam. Regardless, I was crushed and I was embarrassed, especially since I am known in my family to be an achiever and, not to brag, but I have never failed a major exam in my life, ever. This was a first and the experience humbled me. I re-calibrated.

For my re-sit, I focused my study on my mistakes and practiced with my friends. I also balanced my study time and gave myself occasional breaks. Previously, I was very stressed up to my eyeballs, and rarely got sleep. Now, I granted myself “lazy days” and I found that I am able to better understand concepts when I am in the right mood and condition. This led to success, and I was able to pass the OSCE the second time.

Aside from studying, there are also necessary paperworks that you have to prepare for the OSCE. These are:

  1. Passport
  2. Original birth certificate
  3. Original diploma
  4. Original certificates of nursing qualification
  5. NMC Decision Letter
  6. Original IELTS scores

III. The Struggle

The struggle is real, literally. Aside from that the OSCE was basically something I’ve never heard of before, it’s a league of its own. I studied and practiced nursing in the Philippines and so I am not very knowledgeable about NHS and its practices. In addition to that, I am also living independently and working full-time in the hospital, with only just a week of study leave. Therefore, I had to juggle my time working, studying and taking care of my laundry, food and bills. Overall, the stress is overwhelming. I was fortunate to have understanding friends and a supportive significant other. It was difficult but I am very glad that it’s all over now.

IV. Relevant Links/Materials

Here are helpful links and materials to help you study the OSCE. Since I have taken my exam, there has been changes in the policies and to the exam itself, so keep yourself updated.

https://www.nmc.org.uk/registration/joining-the-register/trained-outside-the-eueea/

https://www.northampton.ac.uk/about-us/services-and-facilities/nmc-test-of-competence/

https://www.northampton.ac.uk/wp-content/uploads/2015/10/How-to-prepare-for-the-OSCE_September-2016.pdf

https://www.northampton.ac.uk/wp-content/uploads/2015/10/NMC-Test-of-Competence-Candidate-information-booklet.pdf

 

Good luck and all the best!

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