OSCE practice

NZREX OSCE Practice Stations – Full Set of 20

Station 1: Clinical Reasoning – Mental Health Assessment

Candidate Instructions:

• You are an intern in General Practice.
• A 38-year-old man presents with fatigue, poor concentration, and lack of interest in activities.
• Take a focused history, perform a basic mental state examination, and provide differential diagnoses and a management plan with 2 minutes to go.

Actor Instructions:

Your name is Lucas Henderson. You are a 38-year-old IT consultant with recent emotional exhaustion and poor sleep. You recently separated from your partner and are drinking more at night. You're not suicidal but have fleeting thoughts of “wanting it all to stop.”

• Only open up if the candidate is empathetic.
• Do not volunteer details unless asked directly.

Station 2: Integrated – Shoulder Injury

Candidate Instructions:

• You are a house officer in Orthopaedics.
• A 40-year-old builder presents with pain in his right shoulder after lifting heavy material.
• Take a focused history, examine the shoulder, and explain your findings.

Actor Instructions:

Your name is Matiu Rangi. Two weeks ago, you injured your shoulder while lifting. It hurts with overhead movement. Rest and ibuprofen haven’t helped much.

• Demonstrate pain with abduction or external rotation.
• Express concern about returning to work.

Station 3: History Taking – Gastrointestinal Symptoms

Candidate Instructions:

• You are an intern in a GP clinic.
• A 58-year-old woman presents with bloating, irregular bowel habits, and occasional rectal bleeding.
• Take a focused gastrointestinal history. Do not discuss investigations or management.

Actor Instructions:

Your name is Fiona Willis. For 3 months, you’ve had bloating and bright red blood in the stool. You’re vegetarian and don’t smoke.

• Mention blood only if asked about red flag symptoms.
• Appear mildly embarrassed.

Station 4: Communication – Delivering Bad News

Candidate Instructions:

• You are a house officer in the Medical Assessment Unit.
• A 72-year-old patient’s imaging has revealed metastatic pancreatic cancer. You’ve been asked to update the patient.
• Break the news using clear, empathetic communication. Offer support and ensure patient understanding.

Actor Instructions:

Your name is Mark Leighton. You’re a 72-year-old retired mechanic. You were hoping the scan would explain your recent weight loss and fatigue, but didn’t expect cancer.

• React emotionally if not handled gently.
• Ask if this is curable, and what happens next.
• Feel calmer if the candidate is honest, empathetic, and supportive.

Station 5: Integrated – Ankle Injury

Candidate Instructions:

• You are a house officer in ED.
• A 23-year-old man presents with right ankle pain after falling while tramping.
• Take a focused history, examine the ankle, interpret a provided x-ray, and outline your management plan.

Actor Instructions:

Your name is Rohan Gupta. You fell on a muddy trail 5 days ago and twisted your ankle. You can walk now, but running hurts. You iced it and wrapped it initially but didn’t seek medical attention until today.

• Demonstrate mild tenderness over the lateral malleolus when touched.
• Ask: “Will I need a cast?” and “When can I run again?”

Station 6: Behavioural – Conflict Resolution

Candidate Instructions:

• You are an intern on a medical ward.
• A patient is refusing their medication and becoming increasingly agitated.
• Engage respectfully, de-escalate the conflict, and try to reach a mutual understanding.

Actor Instructions:

Your name is Elaine Hart. You are refusing antipsychotic medication because it causes tremors and emotional numbness. You have schizophrenia and don’t like how it makes you feel.

• Become defensive if pressured.
• Open up if candidate acknowledges your concerns and collaborates respectfully.

Station 7: Integrated – Chest Pain

Candidate Instructions:

• You are an intern in ED.
• A 65-year-old man presents with sudden chest pain radiating to the left arm.
• Take a focused history, examine cardio/respiratory systems, interpret ECG, and present your management plan.

Actor Instructions:

Your name is Alan West. You had sudden central chest pain while gardening an hour ago. It radiates to your left arm and jaw. You are now mildly short of breath but still in discomfort.

• Ask “Is it a heart attack?” and appear anxious.
• Mention diabetes and hypertension only if asked about history.

Station 8: Musculoskeletal – Teenager with Knee Pain

Candidate Instructions:

• You are a house officer in a rural clinic.
• A 16-year-old netball player presents with 3 weeks of right knee pain.
• Take a focused history, examine the knee, and explain your findings.

Actor Instructions:

Your name is Chloe Li. You’ve had pain over the front of your right knee after training hard. It’s worse going downstairs or after sitting long. There’s no swelling or locking.

• Demonstrate discomfort with patellar grind test.
• Ask if you can safely play nationals next week.

Station 9: Cultural Safety – Māori Patient

Candidate Instructions:

• You are an intern in General Practice.
• You are seeing a 60-year-old Māori man with longstanding diabetes who is new to your clinic.
• Use culturally safe practices to establish rapport and understand his views on care.

Actor Instructions:

Your name is Wiremu Tane. You’ve had diabetes for years and feel past doctors didn’t listen. You value connection and being treated with respect.

• If the candidate uses your name correctly and is respectful, you open up.
• If they don’t acknowledge your background, you stay distant and guarded.

Station 10: Integrated – Paediatric Fever

Candidate Instructions:

• You are an intern in Paediatrics.
• A parent brings their 3-year-old child in for 2 days of fever and lethargy.
• Take a focused history from the caregiver, examine the child, and explain your working diagnosis.

Actor Instructions:

You are the parent of Noah, a 3-year-old. He’s been unwell for 2 days with fever. He’s not eating and feels hot at night. No seizures. You’re worried and want to know if it’s serious.

• Ask: “Does he need antibiotics?” and “Should we go to hospital?”
• Get more comfortable if the doctor reassures you clearly and calmly.

Station 11: Clinical Reasoning – Abdominal Pain in a Young Woman

Candidate Instructions:

• You are an intern in the Emergency Department.
• A 25-year-old woman presents with lower abdominal pain.
• Take a focused history, request relevant investigations, and present differential diagnoses and a management plan with 2 minutes to go.

Actor Instructions:

Your name is Rebecca Latu. You’ve had a dull ache in your lower abdomen for 24 hours, worse on the right. You’re nauseated but not vomiting. Your period is overdue by 2 weeks. No contraception used. No urinary symptoms.

• Offer pregnancy history only if asked.
• Appear slightly anxious but cooperative.

Station 12: Integrated – Hip Pain in an Elderly Patient

Candidate Instructions:

• You are a house officer on the surgical ward.
• An 82-year-old woman has been admitted following a fall at home.
• Take a focused history, examine the hip, and share your findings with the examiner.

Actor Instructions:

Your name is Maureen Clarke. You slipped in the kitchen this morning. Your left hip hurts badly and you can’t stand. No head injury. You live alone and usually manage independently.

• Show discomfort when candidate moves your left leg.
• Ask: “Will I need surgery?”
• You’re cooperative but mildly distressed.

Station 13: History Taking – Weight Loss and Night Sweats

Candidate Instructions:

• You are working in General Medicine.
• A 44-year-old man presents with fatigue, weight loss, and night sweats.
• Take a focused history only.

Actor Instructions:

Your name is Karim Hossain. Over the last month, you’ve unintentionally lost 6 kg and had drenching night sweats. You have a persistent dry cough. You were exposed to TB in childhood in Bangladesh.

• Mention lymph node swelling only if asked.
• Reveal TB exposure if travel or contacts are explored.

Station 14: Behavioural – Angry Family Member

Candidate Instructions:

• You are an intern on a medical ward.
• The daughter of a patient is upset and complaining about poor communication from staff.
• Your task is to de-escalate the situation, acknowledge her concerns, and offer next steps.

Actor Instructions:

Your name is Jess Atkinson. Your 79-year-old mother was admitted 3 days ago. You feel no one is giving you updates and you’ve been ignored. You’re angry and frustrated.

• Begin loud and direct. If the candidate listens and explains clearly, calm down.
• Become more upset if they are dismissive or vague.

Station 15: Integrated – Paediatric Limp

Candidate Instructions:

• You are working in Paediatrics.
• A 6-year-old child presents with a limp for 2 days.
• Take a focused history from the caregiver, examine the leg, and offer a likely diagnosis and plan.

Actor Instructions:

You are the parent of Riley, age 6. He started limping 2 days ago, refuses to bear weight on his right leg. He had a mild fever and cold a few days ago.

• Mention recent illness only if asked.
• Ask: “Does he need an X-ray?” or “Will it get worse?”

Station 16: Communication – Breaking Diagnosis of Type 2 Diabetes

Candidate Instructions:

• You are an intern in General Practice.
• A patient’s recent blood tests confirm a new diagnosis of type 2 diabetes.
• Break the news, explain the condition clearly, and involve the patient in discussing next steps.

Actor Instructions:

Your name is James Lau. You’re 50 and were expecting your tiredness to be from work stress. You didn’t think it was medical. You’re shocked when told it’s diabetes.

• Ask “Will I need insulin?” and “Is this my fault?”
• Respond better to simple language and reassurance.

Station 17: History Taking – Dizziness in an Elderly Patient

Candidate Instructions:

• You are a house officer in Geriatrics.
• An 81-year-old man reports frequent dizziness.
• Take a focused history and offer a leading diagnosis with 1 minute to go.

Actor Instructions:

Your name is Arthur Tamati. You feel dizzy when standing quickly. It lasts a few seconds. No chest pain. You’ve fallen once at home and take medication for blood pressure.

• Only reveal the fall if asked directly.
• You don’t like being labelled as frail—appreciate respectful tone.

Station 18: Integrated – Hand Swelling After Injury

Candidate Instructions:

• You are working in ED.
• A 28-year-old woman jammed her hand in a car door yesterday.
• Take a focused history, examine the hand, interpret X-ray findings, and outline your plan.

Actor Instructions:

Your name is Amy. You injured your right hand in the boot yesterday. It’s swollen but you can move your fingers. You’re a florist and use your hands daily.

• React with pain when 4th metacarpal is palpated.
• Ask: “Can I still work?”

Station 19: Cultural Competence – Language Barrier

Candidate Instructions:

• You are working in Outpatient Services.
• A 60-year-old Samoan woman with poorly controlled hypertension is attending her first appointment.
• Engage respectfully, offer interpreter services, and explore cultural preferences and barriers.

Actor Instructions:

Your name is Maria Tui. You speak limited English and usually rely on your daughter to interpret, but she isn’t here today. You’re polite but unsure.

• Smile and nod without understanding if confused.
• Open up more if offered translation help or spoken to simply and kindly.

Station 20: Integrated – Suspected Stroke

Candidate Instructions:

• You are on call in ED.
• A 72-year-old man presents with sudden-onset left arm weakness and slurred speech from 45 minutes ago.
• Take a focused history from the patient or support person, perform a neurological exam, and outline initial management.

Actor Instructions:

Your name is Bruce Logan. You suddenly developed left arm weakness and slurred speech at lunch. You’re scared but able to speak. You have a history of heart disease and take aspirin.

• Slight facial droop and left arm weakness should be simulated.
• Ask: “Am I having a stroke?”