The objective structured clinical examination (OSCE)

The objective structured clinical examination was introduced in spring 2003 as a more comprehensive and a fairer method of assessment of the clinical abilities of the candidates for the Part I MRCPsych. It was thought that this method would examine candidates’ clinical abilities over more clinical subjects than the traditional long case could achieve. Instead of having only two examiners, the candidate is examined over 12 different areas by 12 different examiners. We would have grave difficulty in satisfying examiners as to our competence in this type of exam!

The time available to trainees to perform what we would regard as difficult and complex investigations is not sufficient. It would appear that we should be teaching our trainees that it is right to perform quick, perfunctory, examinations of patients, so that ‘snap’ diagnoses can be made. Our experience in psychiatry would indicate that this is not a skill that should be seen as beneficial or helpful, either to the psychiatrist or their patient.

It would appear that the OSCE format has been ‘borrowed’ from the MRCP exam of the Royal College of Physicians. While in general medicine you can make an exam centre around specific clinical tasks, in psychiatry this is much more difficult and can lead to serious problems in understanding. Psychiatry surely is about the whole person; physical, psychological and social. This bio-psycho-social model of psychiatry makes it necessary for assessing psychiatrists to see psychiatric symptoms within their physical, psychological and social context. It is impossible to even attempt such an evaluation within the 6 minutes a candidate has with a patient.

We may live in the age of fast food, fast communications and fast turnover of patients on our wards, but is ‘fast psychiatry’ something the College should actively promote? We think not. We are still in an age where accurate diagnosis of all aspects of our patients’ problems requires careful thought and often time consuming examination. For the College to use this type of format in its professional exam appears to us to be badly thought through, and in urgent need of review.