If you find the material on this website useful, you will find that the two books ACES for PACES and KEYS to SUCCESS in Medicine complement the material on these sites and will enhance your studying and revision




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Clinical Skills Blogspot




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         Objective Structured Clinical Examination (OSCE, OSCES, OSCEs) is now widely used in medical schools as part of the examination process.

ª       They are used in the medical finals (MBBS, MBChB) and in the earlier years as well.

¨        They are also used in postgraduate examination and in licensing examinations such as PLAB and USMLE.

§        The Royal College of Physicians of the United Kingdom (MRCP UK) has a modified type of OSCE known as the PACES examination or Practical Assessment of Clinical Examination Skills; this is an advanced type of OSCE with fewer more complex stations.

         However, the skills required for this examination (MRCP PACES) are similar to those required for an OSCE (OSCEs) although   more specialised and requiring greater depth and expertise.

ª       OSCES (OSCE, OSCEs) usually test practical skills rather than knowledge

The skills tested are:

Clinical (Bedside) Skills

         History Taking Skills

ª       Physical Examination Skills

¨        Communication Skills

§        Ethics (Attitudes)

Procedural Skills

For example

         Intravenous injection

ª       Catheterisation

¨        Recording an ECG

Management Skills

§        Planning investigations

         Interpreting investigations

ª       Treatment

Depending on the medical school or examining body the emphasis of the examination may vary, but most largely wish to examine the clinical components as the rest of the skills required to be a doctor may be tested using multiple choice questions.

Preparing for OSCEs (preparation for OSCES, OSCE)

When preparing for examination such as OSCEs, which are largely practical examinations, it is essential to set about it in a systematic manner

Concentrate on the following:

¨        The examination

§        Methods

         Relevant knowledge base

ª       Presentation

The Examination (OSCE, OSCEs)

¨        Read up ACES for PACES chapter 1. This will give you an idea about examinations in general and the PACES examination in particular. Although the MRCP PACES is more advanced than OSCES the principles of a structured clinical examination are the same and this will give you a good insight into how these examinations are conducted and importantly how candidates at this type of structured clinical examination are assessed.


§        When learning a method of performing any practical task, it is essential to break the task down into its components, learn each component and then learn how to string the components together.

         It is also essential to have an idea as to why you do what you are doing. If you understand what you are doing then perfecting you method becomes much simpler.

ª       If you have a good teacher then ask them to teach you the methods in a systematic fashion

¨        If not read a book on methods

§        Practice endlessly. This is the secret of success

Clinical Methods

         First learn why you do what you do

ª       Read ACES for PACES chapters 2 to 7

       Learn the method of history taking and practice it repeatedly (ACES for PACES chapter 4)

ª       Next, learn how to examine the different systems. (ACES for PACES chapter 8-17) The first part of each chapter will take you through clinical method in detail

¨        Learn the method of communication  (ACES for PACES chapter 18)

§        Practice the methods, revise the chapters, repeat ad infinitum.

         Ethics are discussed in ACES for PACES chapter 18

Management Skills

         Learn how to plan investigations and treatment by reading ACES for PACES chapter 18

Relevant Knowledge Base

         At a clinical examination it is essential to have an idea about what findings one may come across are and how one should interpret these findings

ª       The best way to learn this is by seeing as many patients as possible

¨        Supplement this with extensive reading

§        As experience is limited at medical student level one should read widely

        The chapters on the various systems in ACES for PACES have a section on lesions that may occur. Study this so that you are aware of the lesions that may occur and focus your studying on these lesions.

ª       Read the chapters on the various systems in ACES for PACES and learn the clinical features that may occur in diseases of the different systems and their causes


¨        This is vital without good presentation it is not possible to score highly however good your skill may be

§        Present you findings in the order in which you performed the designated task and this makes it easier to recall findings and the relevant negatives

         If asked a diagnosis give the complete diagnosis and be prepared to back it up with reasons ACES for PACES chapter 3

For more details on ACES for PACES see www.acesforpaces.com

Making a Diagnosis

         There are several methods clinicians use to make a diagnosis

ª       The most commonly used and the method that most clinicians ultimately use is called the hypothetico-deductive method

¨        This is where an initial idea comes to mind and one pursues this finding clues in favour of and against this idea and ultimately deducing the answer

§        The examples given in the aces for paces website and the cases described in the clinical skills blogspot will make this clearer

         For a further explanation of this method read the preface in ACES for PACES

ª       Another method that is described is pattern recognition

¨        In this method one gathers all the information available and then tries to match these features to a pattern that one may recognise

§        This is an unreliable method and is not recommended

         In addition in the PACES examination one is not given time to think about the diagnosis after finishing examination

ª       Questions will be asked almost immediately and one’s thoughts should be clear by then

¨        The hypothetico- deductive method allows one to come to a diagnosis more quickly and with greater reliability and is hence the method of choice

§        In summary

Use the hypothetico-deductive method not pattern recognition


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