• objective, because examiners use a checklist for evaluating the trainees;
• structured, because every trainee sees the same problem and performs the same tasks in the same time frame;
• clinical, because the tasks are representative of those faced in real clinical situations; and
• an examination.

• Provide feedback on performance
• Evaluate basic clinical skills
• Measure minimal competencies
• Provide practice for the NBOME COMLEX-PE

• There are 4 standardized patient cases.  (Note:  NBOME COMLEX-PE consists of 12 encounters)
• You will have 23 minutes at each station. 
• 14 minutes to read the scenario sheet on station door, then evaluate and treat the patient as appropriate.
  • At 12 minutes, there will be an announcement indicating two minutes remaining.
  • At 14 minutes, there will be an announcement to leave the room. You may leave the room early, but you will not be able to reenter.
• 9 minutes, to write a SOAP note outside the room.
  • At 7 minutes, there will be an announcement indicating two minutes remaining.
  • At 9 minutes, you will be instructed to move to the next station and repeat the process.

• DO ONLY WHAT IS REQUESTED.
• No talking during the OSCE. This is an examination.
• Use your history to guide the scope of your examination, since a complete exam is not required in all cases.
• Elicit psychosocial, occupational, past medical/surgical history, medications and allergies as appropriate.
• Explain to the patient what you do before doing it, particularly while setting up OMM.
• If you are not sure what is wrong, do not say, “I will get back to you after I have discussed this with the attending.”  This does not evaluate your knowledge or skill.
• See also:  Example SP Check Sheet. 

• Instructions
• The setting: outpatient, primary care or Emergency Department
• Patient demographics
• Vital signs
• What is expected to be done
• SOAP note worksheet
• SOAP note sheet

• interviewing/interpersonal skills (history taking)—information gathered by the standardized patient.
• patient care (physical exam)—information gathered by standardized patient.
• professionalism (organization, courtesy, compassion, appropriate draping, listening  skills, eye contact, language used, demeanor, dress, hand washing, patient education and whether or not the standardized patient would select you as their personal physician.)—information gathered by the standardized patient. (See: example professionalism grading guide).
• medical knowledge (SOAP notes)—graded by physicians
• OMM (no HVLA techniques)—graded by physicians.

• Since 25% of the cases involve D.O. examiner scoring of OMM, points will be lost for failure to utilize any form of OMT when it is appropriate to do so, rather than for the techniques chosen or how they are applied.
• Read the doorway instructions and take them at face value to be correct.
• Introduce yourself and allay patient apprehension.
• Communicate using clear layman’s terminology.
• Treat each patient with respect.
• Use your history to guide the scope of your examination, since a complete exam is not required in all cases.
• Elicit psychosocial, occupational, past medical/surgical history, medications and allergies as appropriate.
• Explain to the patient what you are going to do before doing it, particularly while setting up OMM.
• Be sure you have considered osteopathic principles in all cases.

This feedback is being provided by your fellow students and will be helpful for the COMLEX PE as well:

1. Be confident walking into the room. You will get through this. We all had to do it and now you do, too!

2. Upon entering the room, shake hands and introduce yourself to the patient.

3. Before the physical exam is when you wash your hands. You can say "I'm going to now wash my hands before I begin the physical exam."

4. Before entering the room, write down the headings on the actually Soap note form (CC, PMH, PSH, Meds, Allergies, Fam Hx, Social, Immunization, VS, Gen, Heart, Lungs, plus other headings pertinent to the case). Then while in the room,  fill in the subjective fields while the patient is talking. This saves valuable time when it comes time to write the soap note in the hallway and also allows you to remember everything you should do.

5. Let the patient know everything that you are doing. Ex: I am going to listen to your heart and lungs now.

6. If appropriate, remember to check the patient’s reflexes and do a quick neuro exam, in addition to sensation and strength testing. It’s ok to be brief as long as they know you did it and are able to document your findings in your SOAP note.

7. Have a brief 1-2 sentence description of what OMT is so you can share this with the patient if they request treatment or ask about it.

8. Be prepared to do OMT on at least 1 patient. Review Strain/Counterstrain and muscle energy techniques.

9. When documenting somatic dysfunction in your plan, be sure to include the region (cervical spine, thoracic spine, etc) and the technique used. Ex: Somatic Dysfunction cervical spine. Muscle energy performed and patient tolerated well.

10. Think of the OSCE as preparation for the PE exam and RELAX!!!

11. Memorize the Red Flag questions for the top 25 presenting complaints and the physical exam components that correspond with them. This saves valuable time and allows you to be more succinct with the patient. By knowing what you need to do, you will be able to finish with extra time to write a more thorough assessment and plan.

12.Use the First Aid Step 2 Clinical Skills book to help organize what is needed to know for each case.

13. Listen on skin!!!  Make sure you listen to all areas for the heart and lungs.