This document provides an orientation for candidates taking the National Assessment Collaboration (NAC) Objective Structured Clinical Examination (OSCE). The OSCE assesses clinical competence for entrance to postgraduate medical training in Canada. It includes 12 clinical stations that involve interactions with standardized patients to assess history taking, physical exams, and clinical problem-solving skills. Candidates are provided guidance on the structure, logistics, and expectations of the exam.

1. CANDIDATE
ORIENTATION
© NAC / MCC Pre-Exam Orientation 2013

2. [ NAC OSCE Examination ]
 The National Assessment Collaboration (NAC) Objective
Structured Clinical Examination (OSCE) assesses the
competence of candidates — specifically the knowledge, skills
and aptitudes essential for entrance into postgraduate training
in Canada.
 The NAC OSCE examination may include problems in:
 Medicine
 Pediatrics
 Obstetrics and Gynecology
 Preventive Medicine and Community Health
 Psychiatry
 Surgery
 In addition, the candidates will be assessed on their basic
knowledge of therapeutic management of common clinical
problems.

3. [ Duration ]
 The examination duration is approximately 4
hours.
 Plan to be at the examination site for a minimum
of 6.5 to 7 hours.
 No external contact will be permitted during the
examination and sequestering period.
 Candidates will not be dismissed until the
specified time on the information sheet.

4. [ Items to Bring ]
 Reflex hammer
 Stethoscope
 White lab coat
Items that are NOT permitted:
 Cell phone, pager, iPod,
or any PDA (Palm, Blackberry, etc.)
 Pens, pencils, pen lights
 Paper, books, notebooks
 Bags, briefcases

5. [ Candidate Notebook ]
 Do not open your notebook until the examination
begins.
 Inside, you will find a sheet of bar code ID labels
and some blank paper for your use during the
examination.
 Never rip out any pages; your notebook must be
returned intact at the end of the
examination.

6. [ Organization of the Examination ]
TWO PARTS:
 Written:
Therapeutic Management Examination
 A series of questions unrelated to any of the
patients in the OSCE portion of the examination.
Then a short break, followed by the:
 OSCE
 12 clinical stations with standardized patient
encounters.

7. [ Introduction to the
Therapeutic Knowledge Component ]
 A written examination component
based on the knowledge of
therapeutic content.
 Multiple--choice questions — approximately
24 in total.
 The session will last 45 minutes.

8. [ Written
Therapeutic Knowledge Session ]
 Wait for the signal from staff before beginning.
 Questions DO NOT relate to any patient that
you will see in the OSCE portion of the
examination.
 These questions test your ability to recognize
common therapeutic approaches including the
prescription of medications for common clinical
problems.
 Read the questions carefully.

9. [ Written
Therapeutic Knowledge Session ]
 Record your answer to each question by filling
in the corresponding bubble with a pencil ().
 To change an answer, completely erase the
bubble you do not want counted.
 Only clearly filled bubbles will be scored.
– The following marks will NOT be recognized:
,,.
 If you fill in more than one bubble for a
question, you will be scored ZERO for that
question.

10. [ Introduction to the OSCE ]
 What is an OSCE?
Objective Structured Clinical Examination
 A form of performance-based testing used to measure
candidates’ clinical competence.
 During an OSCE, candidates are observed and
evaluated as they go through a series of stations in
which they interview, examine and treat standardized
patients (SPs) who present various types of medical
problems.
 NAC OSCE:
 12 stations of 11 minutes

11. [ Candidate Instructions ]
 At each clinical station there is a written
statement (candidate instructions) that:
 Introduces a clinical problem
 Directs the candidate to appropriately interact with
a patient (standardized patient)
 Specifies the task, such as obtaining a focused
history, conducting a focused physical examination,
or assessing and addressing the patient’s issues
 Indicates whether there are examiner oral
questions at the 8-minute signal

12. [ Important Reminders ]
 Read the instructions carefully
 If the task is ―take a focused history‖ – that is what you
will get credit for. You will not get credit for advising or
educating if the assigned task is focused history taking.
 Use closed-ended AND open-ended questions
 Use open-ended questions such as: ―Can you describe
the pain for me?‖ or ―What other changes have you
noticed?‖
 Limiting yourself to yes/no questions also limits what
the patient can answer.

13. [ Important Reminders ]
 Listen to the patient
 If the patient’s answer is not clear and the issue is
important, explore the point further.
 You are expected to elicit the patient’s story; if the
patient feels you are indifferent, judgmental or
hostile, he or she will be reluctant to confide
underlying fears or embarrassing information.

14. [ Important Reminders ]
 Get full scores on physical examination
stations
 You cannot receive scores for rectal, genital or
vaginal exams unless you indicate to the examiner
that you would like to do such an exam.
 State what you are doing and report your findings —
both positive and normal.
Give specific information
 Avoid giving generic information.
 Advise the patient with information or advice specific
to their problem.

15. [ Important Reminders ]
 Do not talk too much or too little
 By talking too much, you may lose valuable time
and miss information.
 Use professional courtesies of introducing yourself
or explaining briefly why you must ask a difficult
question.
 Speak in a language that the patient will
understand — do not use medical jargon.
 Avoid lecturing the patient — engage them instead.

16. [ Important Reminders ]
 Your badge has a station number that indicates
your start station.
 Candidate instructions are posted outside each
station.
 READ everything carefully.
 Pay attention to the statement, which explains
your task.
 A copy of the instructions will be available inside
the room for your reference.

17. [ Physical Examinations]
 Examiners may intervene by:
 Asking you to reread the instructions
 The intent is to remind you to refocus on the task and to
save you time.
 Stopping genital, rectal or vaginal examinations
 If such examinations are appropriate, all you need to do
is clearly inform the examiner.
 Help the examiner score by:
 Telling the examiner what you are doing
(e.g., inspection)
 Describing any findings
 Include findings that are normal.

18. [ Physical Examinations]
 You will be expected to use the hand sanitizer that
will be available in every physical examination
station. You may be prompted by the examiner.
 Be sure to drape the simulated patients
appropriately.
 Carry out any maneuvers necessary
for assessing the presenting problem.
 Examiners only give credit for tasks
completed satisfactorily!

19. [ Signals ]
 The 8-minute warning signal will indicate:
 EITHER that your time with the patient is over and the
physician examiner will begin to ask you questions
 OR if there are no questions (as indicated on the candidate
instructions), that you still have 3 minutes remaining with the
patient.
 A signal also indicates the beginning and the end of
each station.
 After each final signal, you will have 2 minutes to
move to the next station and read your instructions.

20. [ Oral Questions at 8 minutes ]
 Physician examiner oral questions may follow the warning
signal in the OSCE stations. They:
 Are related to the patient you just saw
 Ask about matters like diagnosis, management
decisions, and/or your response to an ethical issue
 Candidate instructions on station doors will indicate
whether there are oral questions at the 8-minute signal.
 If there are no oral questions, you will have the
full 11 minutes with the patient.

21. [ Physician Examiners, SPs and
Labels ]
 Hand 1 bar code label to the examiner as you walk
into the room (instructions on the door).
 Examiners observe and assess your performance
with preset rating sheets.
 Standardized patients are
trained to simulate patients’
signs and symptoms in a
reliable and consistent
manner.
 Treat them as you
would real patients.

22. [ Signing Out ]
 Before leaving, you must follow the sign-out procedure.
 When it is your turn, hand in your:
 Candidate notebook (all pages intact)
 ID badge
 Unused bar code labels
 Sign out on the sheet.
Congratulations! At this point,
the examination is over!

23. Final Review of Important Points
Read your instructions carefully.
Complete the specified task.
Demonstrate your clinical skills.
You receive credit for tasks completed satisfactorily.
Treat the standardized patients as real patients.
Do not provide more answers than
specified in the question.
DO NOT LEAVE without signing out.

24. Focus on the Examination
Your group leader and the support staff are
there to answer your questions and guide you
from station to station.
Try to relax and stay focused on the
examination.
The purpose of the examination is a fair and
accurate assessment of your clinical skills.

25. RESULTS
 Results will be made available to you in your
online account at the MCC 6 to 8 weeks after
the exam date.
 Through your online account, you will be
able to:
 view your results documents.
 share them with other organizations.

26. [ Questions? ]
© NAC / MCC Pre-Exam Orientation 2013