By Johnny Green –
Walking into your MRCEM OSCE without preparing for these high-frequency stations is like running a trauma call without an ABCDE approach – possible, but needlessly risky. Based on analysis of 200+ candidate reports and examiner feedback, these are the stations that appear most often…
1. Breaking Bad News (The “Guaranteed” Station)
Typical Scenario:
“A 32-year-old woman has had a miscarriage confirmed on ultrasound. Explain this to her.”
How to Ace It:
Use the SPIKES framework:
1. Setting (Private room, tissues ready)
2. Perception (“What have you been told so far?”)
3. Invitation (“Would you like me to explain the scan results?”)
4. Knowledge (“I’m sorry to tell you the scan shows…”)
5. Empathy (Silence > false reassurance)
6. Strategy (“We’ll have a midwife stay with you”)
Examiner Tip: For this sort of station Don’t say “You can try again” – it invalidates grief.
2. The Hypotensive Trauma Patient
What You’ll See:
– A “bloodied” actor with tachycardia (BP 80/40), distended abdomen
Must-Do Actions:
1. C-spine control while approaching – ATLS Work
2. Obstructed breathing? (Listen for breath sounds)
3. Bleeding sources? (FAST exam for free fluid)
4. Two large-bore IVs + bloods (Say “I’d activate Major haemorrhage protocol”)
5. Pelvic binder + TXA (Verbalise even if not physically present)
Pro Tip: The “C” in ABCDE is almost always haemorrhage in these stations.
3. The Febrile Child (Paeds Nightmare)
Classic Case:
– 2-year-old, temp 39.5°C, sleepy but rousable
Critical Steps:
Sepsis screen: Cap refill, BP, rash, urine output
Immediate actions:
– “IV access + bloods (including lactate)”
– “Broad-spectrum antibiotics NOW” (Say exact drug and dose: e.g., ceftriaxone)
Safety net: “If rash develops, call me immediately”
Fail Point: Missing “antibiotics within 1 hour” in sepsis.
4. ECG Interpretation Under Pressure
They Love Testing:
- STEMI (vs. benign early repolarisation)
- PE (S1Q3T3 + tachycardia)
- HyperK+ (Tall tented T-waves)
3-Second System:
1. Rate? (Fast/slow/irregular)
2. Rhythm? (Sinus/other)
3. ST changes? (Elevation/depression)
4. Anything else? (Peaked T’s, QT interval)
Script: “This shows inferior STEMI with reciprocal changes. I’d give aspirin 300mg, call cardiology for PCI, and move to resus.”
5. The Angry Relative
Scenario:
“Why are you ignoring my mother’s pain? She needs a CT scan now!”
De-escalation Formula:
1. Listen fully (Don’t interrupt!)
2. Validate (“I hear how worried you are”)
3. Explain rationale (“CT has radiation risks; we’re doing X first”)
4. Offer alternative (“We can re-assess in 1 hour”)
Key Phrase: “I want the best care for her too. Let’s work together on this.”
6. The “Simple” Procedure (That Tricks Many)
Most Tested:
– Suturing (Say: “I’d use 3-0 monofilament for this facial laceration”)
– IV Access (“I’d use ultrasound if no visible veins”)
– Joint Aspiration (“I consent for infection risk + would send crystals”)
Auto-Fail Moves: Not cleaning skin, not labelling samples.
7. Data Interpretation (ABGs + CXRs)
ABG Quick Checks:
– pH <7.35? → Acidosis (Check HCO3 vs. CO2)
– PaO2 <8? → Give O2 immediately
– Lactate >2? → Sepsis alert
CXR Must-Knows:
– Pneumothorax (Look for deep sulcus sign in trauma)
– NG tube check (Must cross diaphragm + not in bronchi)
8. The “Silent” Station
Twist: Examiner won’t speak until you initiate.
Solution:
1. Introduce yourself
2. Explain consent
3. Ask: “Any pain before I examine?”
4. Expose properly (Then cover respectfully)
9. The Overdose Scenario
Common Cases:
– Paracetamol (4hr level + NAC if >150mg/kg)
– Opiates (Give naloxone if RR <12)
Key Question: “Any other drugs taken, like alcohol?”
10. The Handover Station
SBAR Template:
– Situation: “This is Dr. X handing over Mrs. Y, 65 with sepsis”
– Background: “PMH: DM. Came in with fever”
– Assessment: “Currently BP 85/50, lactate 4”
– Recommendation: “Needs ICU review for noradrenaline”
Final Tip: Your Secret Weapon
Practice these stations out loud 3x before the exam. Candidates who verbalise their practice pass more often.
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