Sport and Exercise Medicine OSCEs

An Essential Revision Guide

Natalie F. Shur

• Publisher: CRC Press
• Year: 2021
• ISBN:
  9781000477306
• Edition: 1
• Topic: Medicine
• Subtopic: Sports Medicine

As the only text on the market for Sport and Exercise Medicine objective structured clinical examinations (OSCEs), this is an invaluable guide for those studying sport and exercise medicine and sitting examinations. Whilst specifically targeted at the OSCE, this book will have much wider appeal throughout the clinical setting.

Sport and Exercise Medicine is a new and developing specialty and there has been a rapid increase in the number of universities offering MSc degrees in Sport and Exercise Medicine and more candidates year on the year sitting the Faculty of Sport and Exercise Medicine (FSEM) diploma exam. It is a niche specialty, with very little content taught at an undergraduate level, therefore knowing the material that is examined is often challenging compared with other specialties. This book provides the content to fill that need. The book is divided into sections based on the main topics that arise in sport and exercise medicine OSCEs, with both core knowledge and practical tips to ensure a fluid and confident performance by the examinee in every station.

A wide range of readers will benefit from this book, including those about to sit a postgraduate examination in sport and exercise medicine or those enrolled in a postgraduate certificate or master's course in the specialty. It will also be useful to doctors and allied healthcare professionals, such as physiotherapists, sports therapists, podiatrists and nurses, as well as undergraduate students. Further, the young clinician who is just starting out and wants to build their confidence in musculoskeletal assessment and presenting to seniors will gain much from reading this book.

1 How to prepare for an OSCE examination in SEM

DOI: 10.1201/9781003163701-1

• Introduction
  • How to approach OSCE revision
  • The day of the exam
  • Stations with management plans
  • Examiners' questions

Introduction

If you have passed the first written part of the exam, you have demonstrated that you have the breadth of knowledge required to practice sport and exercise medicine (SEM) in theory. The aim of the objective structured clinical examination (OSCE) is the clinical application of this knowledge and the assessment of several parts of the curriculum that cannot be demonstrated in a written exam. This includes not only your knowledge of SEM but also your communication skills, clinical decision making, investigation interpretation and pitch-side safety as well as professionalism and behaviour. You won't fail for not knowing minutiae. The exam is ultimately assessing your ability to practice SEM safely and competently, being able to think widely in constructing a differential diagnosis and management plan, and in being able to communicate with patients accurately and professionally. Find out the format of the particular exam you will be sitting including the length of the stations and base your practice around that.

This book has been put together to aid you in your revision. It will cover the main topics that arise in SEM OSCEs and provides key knowledge and practical information to perform well on the day. For ease, this book has been divided into three parts covering the main types of stations that may arise: Part A covering history and examination and clinical cases (Chapters 2–10), Part B covering communication stations (Chapters 11–15) and Part C covering emergencies (Chapters 16 and 17). Finally, there is a radiology chapter summarising the radiological features of key diagnoses in the specialty. Several topics have been written as though they are an OSCE station with a ‘clinical vignette’ at the beginning similar to the ones you may receive before each station in your actual exam.

How to Approach OSCE Revision

The first step is to carefully research the format of the specific exam you are sitting, including the length of stations, topics covered and skills being assessed so that you can focus your revision. Practice in groups as much as possible, ideally with candidates with the same level of knowledge or better than your own. Groups of three or four people are best, with one person being the candidate, one person being the ‘patient’ and the other the examiner. Critique each other constructively at the end of each practice station. Communication-type stations can be practiced online in groups if necessary, but examination and emergency stations are best practiced face to face. Practice timed stations so you start to automatically get a feel for how long the stations will be. If the station is a 10-minute examination station, aim to complete the exam in approximately 7–8 minutes. Don't waste the first 3 minutes nervously chattering away as this will not pick up points. You will need at least 2–3 months whilst working clinically to prepare for an OSCE. Get registrars and consultants to critique your examination technique and grill you. The key is to practice scenarios ad nauseum.

In the United Kingdom, The Membership in SEM exam is designed to assess the knowledge, skills, competence and professional attitudes required of a doctor who wishes to practice as a SEM physician in the United Kingdom. Candidates must have passed the Faculty of Sport and Exercise Medicine (FSEM) Membership Part 1 written exam before being eligible to apply for Part 2. The exam can be sat by doctors with a medical qualification acceptable to the UK General Medical Council for Full or Provisional Registration or to the Medical Council in Ireland for Full or Temporary Registration and either:

• Be a current trainee in SEM.
• Have a minimum of 2 years clinical practice or postgraduate training after obtaining full registration and must have competence in cardiopulmonary resuscitation and pre-hospital care.

Successfully completing Parts 1 and 2 of the exam provides formal accreditation in the field of SEM. The Membership exam is essential for candidates wishing to:

• Obtain a Certificate of Completion of Training (CTC) in SEM.
• Apply for membership of the Faculty of Sport and Exercise Medicine, UK (MFSEM). It is also part of the requirements for a Fellowship application.

The FSEM Part 2 exam is run annually and consists of 12 × 10-minute stations, approximately a third of which are core skills (emergency scenarios), a third are clinical skills (musculoskeletal) and a third of which are oral examination stations (communication and ethics). Practice all three during your preparation. One station may be a preparatory station prior to a communication station (e.g. team travel planning scenario).

The Australasian College of Sport and Exercise Medicine Part II exam is a clinical exam typically sat in the final year of higher specialist training for sport and exercise medicine registrars. Candidates must pass the Part I exam to sit the Part II exam. The clinical exam is approximately 4 hours in duration and includes the following three Assessment Stations with rest periods in between (in any order):

1. Long case examination – 30-minute history and examination time with patient, 10-minute preparation (patient not in room) followed by a 20-minute assessment time with examiners (patient not in room) to present the case to the examiners, discuss investigations and management and answer relevant questions on the case.
2. Short case examinations – 45-minute session where a number of different cases/patients are examined.
3. Viva examination – 30-minute session covering various areas to assess clinical and medical knowledge, investigations, equipment and management.

The Canadian Academy of Sport and Exercise Medicine (CASEM) clinical exam comprises 18–20 OSCE stations. At each station, the candidate is asked to carry out a specific task or series of tasks, e.g. take a history and examine a patient with a specific problem, council an athlete or carry out an examination appropriate to the clinical situation. Pre-set standards are used as the basis for an objective evaluation of performance. Candidates must have a minimum of 2 years of independent medical practice, or a Fellow of the Royal College of Physicians and Surgeons or College of Family Physicians of Canada and have completed a 1-year Sport Medicine fellowship recognised by a University Faculty of Medicine Program. The program must include documented participation of 50 hours of team/sport/event coverage.

The American Medical Society for Sports Medicine (AMSSM) has a Certificate of Added Qualifications (CAQ) written exam, and Fellowship programs use OSCEs as part of their assessment during a fellows’ training. In order to apply, candidates need to maintain their Family Medicine Certification, complete of a minimum 12 months of full-time training in an accredited Sports Medicine Fellowship Program and pass the Sports Medicine Certification Examination.

Numerous universities internationally run MSc or postgraduate diploma courses in SEM and feature an OSCE exam as part of their assessment. In countries where SEM is not a registered medical specialty, often an MSc in SEM is recognised by the home council. Entry requirements vary by institution, but typical entry requirements include a 2:1 in a relevant degree like Physiotherapy, Sports Therapy and other allied health sciences, or a Pass on a Bachelor of Medicine and Bachelor of Surgery degree (BMBS, MBBS, or equivalent). Historically some institutions running SEM MSc's also include anatomy stations in the OSCE involving anatomical prosections. This book will not specifically cover anatomy, as this knowledge is predominantly assessed during written exams. The emphasis is on you to find out the exact format of the OSCE used at your institution.

If your training programme in SEM is evaluated using continual assessment, e.g. comprising of Case-Based Discussions, then hopefully this book should give you the foundations to confidently assess and present cases in a logical, fluid and considered fashion.

The Day of the Exam

Arrange travel and accommodation in good time. Ask for study leave with 6 weeks’ notice and arrange any swaps for on-calls if required. If you are taking the exam at a distant location, it may be worth arriving the day before to avoid any stressful on-the-day travel delays and make sure you know how to get to the venue. Get a good night's sleep the evening before, ideally child-free, and bring some water and a snack with you on the day. You may be required to act out resuscitation in an acute scenario so make sure you wear comfortable but smart clothing.

Make sure you read the question. If not an acute station, it is normally either a communication station in which the history is key, or a station with a brief history with examination and discussion of management plan. If the latter, do not spend half the time taking a detailed history. You will not earn points. Be open minded and flexible in your ...