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How to pass the international MRCGP OSCE – cheat sheet

29 Dec

The OSCEs are standardized stations where specific history, examination and thinking skills are going to be assessed. The RCGP have provided for the international MRCGP five main areas or domains that are being tested for in the OSCEs. These are probably as equally applicable to the nMRCGP CSA section as well. To make life easier and, God Willing, help you pass try and learn what I call ‘trigger phrases’, these will trigger the examiner to record a tick in the particular domain that they are assessing you during the exam. If you do it well and have practiced, practiced and practiced then you should get a high score. One thing I recommend strongly is putting yourself under test conditions and get someone who has experience with the MRCGP to mark you, and video yourself and marl yourself and see how you can improve your technique and the flow of the consultation.

In the following table I have listed a natural flow for a consultation and the key ‘trigger phrases’ that you need to adopt. Of course your ‘trigger phrase’ may be different to the one table but make sure it is triggering the right OSCE domain. All the best with your exams!

Patient consultation setting:

Verbal

Body language

OSCE Domains

Introduce yourself

Hi, I am doctor Abc.

Smile, nod, lean forward slightly to show interest but look professional

A: courtesy consideration

Take a history

How can I help you today?

Again nod you head and look as you are interested in what the patient has to say, look at the patient not anywhere else! Listen carefully

A: Full focused history

Encourage the patient.

Hunt for the hidden diagnosis if the history is nebulous or psychiatric. If the patient provides a problem assess their iedas by asking them what they think is the cause, they might think eczema is contagious hence they are not going out in which case you can address their worries or correct through education their ideas. If after 1 minute you can see they are rambling and they pause this is probably a heart sink patient and you need to ask what their expectations are so you can work out what they want you to do?

You mentioned (pain/ walking difficulty/ dizziness / thirst/ chest discomfort / breathing problems etc), can you tell me a bit more about it?

Is there anything else on your mind? Are you worried about anything else? [Concerns] What do you think is causing it? [Ideas].  What would you like me to do for you today? What would you like to see happen today?  [Expectations]

Listen for the cues, the role playing patients will give them and expect you to pick them up! Remember the patients will be talking in layman’s language.

The actors will try and look uncomfortable or hesitate – this is a cue to a hidden agenda, they may avoid eye contact or say something like ‘There was something else but it’s not important’.

B: sensitivity to patient, facilitates free expression of ICE (ideas, concerns and expectations)

C: Good communication skills

E: Considers implications for the patient and others.

You have a diagnosis in mind, think is anything serious, ask the important questions, red flags, things that will sift important from less important. Think red flags: Upper GI: weight loss, dysphagia. Lower GI: Change in bowel habits >6w Resp: Weight loss, sweating at night, cough >2 weeks. Cauda equine lesion: weaknes, bladder bowel control loss, pain raditing to tip of toe etc. Check the NICE fast track referral guidelines!

Ask the socio-economic impact of the problem.

Back pain: Do you have numbness in between your legs. Any problems with passing urine such as difficulty controlling it?

Clarify difficult questions.

Is this affecting your life or work? Do you find it difficult to deal with the children?

Use your fingers to demonstrate what you mean by in between. Try and use body language to help your questions.

A: takes a history sufficient to exclude a serious condition.

Examine appropriately, don’t do a full exam, concentrate on the bits you need, and don’t miss postural hypotension if they are dizzy!

I would like to examine your back / hands is that okay?

I will need you to (mention what you need them to do)

Pause after asking permission!

Demonstrate the exam procedure if simple with your own body, i.e. position your hands etc.

A: Examines patient appropriately and efficiently.

Diagnosis

Make your diagnosis, and add 2 differentials if appropriate. If the diagnosis is obvious just state it and do not add differentials unless the patient asks could it be anything else. Don’t forget to rule out any concerns that patient had said at the beginning. Don’t forget to assess for understanding at the end by asking for any questions.

Let me explain what I think, From what you have said and the exam I think you have A or B or C. I think A is likely but we will need to do some tests to work out if it is A or B or C. Let me explain what A is …

You mentioned you were worried about skin cancer, I can reassure you that this is not related to skin cancer but is eczema.

Do you have any questions?

C: Offers clear explanation of symptoms and diagnosis to the patient.

Management

Start with the least expensive (show correct resource management), and offer a couple of options quickly explain the pros and cons of each and then hand over to the patient. Be prepared to negotiate i.e. I want CBT and medication – say we have limited resources and we should try one and then the other

For the depression we can use talking therapies or medications or herbal therapies. Talking therapies work as well but take time, tablets work quickly while herbal remedies can work but can also be unpredictable. What would you like to do?

C: Negotiates management of patient. Involves them in decision.

D: Treats and investigates appropriately, offers range of options, safe prescribing.

Summarise and Safety Net.

Health promote – tag this on here.

Let me summarise so I am sure I have explained things well: You have depression. We’ll treat it with an anti-depressant which is one tablet per day. I would like to review in one week to see how you are getting along. If you have any problems don’t hesitate to come back and see on the on call doctors or if it out of hours one of the out of hours services. Just one more thing I would like to add: have you had your cervical smear / do you smoke? (if they say yes) Could we please talk more about this, could you book an appointment in the next few weeks whenever is convenient?

You could write down basic points on a sheet of paper and give them to the patient. Your prescriptions will be assessed so write fully and legibly.

E: Arranges follow up requirements

E: Arranges health promotion.

How to pass the international MRCGP OSCE – cheat sheet by Dr Taqi Hashmi MB BChir MA Cantab, MRCGP (UK) Distinction

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81 Comments

Posted by on December 29, 2008 in MRCGP

 

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81 responses to “How to pass the international MRCGP OSCE – cheat sheet

  1. dr k

    January 9, 2009 at 7:44 pm

    brilliant.thanks so much

     
    • almas hamdi hadi

      September 8, 2012 at 11:32 am

      Dear dr
      can you tell more informations about MRCGP part one in Egypt , i am from Iraq and i want to get part one of MRCGP
      with my best regards
      Dr.almas hamdi

       
      • drtaqi

        September 17, 2013 at 11:40 am

        I am sorry I do not have any specifics about Egypt. Please have a look here: . Please reply if you have any information, thanks.

         
      • Aban

        September 17, 2013 at 8:53 pm

        Egypt MRCGP Int as far as I know requires candidates to enrol in a kind of residency training program and only those candidates can sit for MRCGP.
        In contrast Dubai, South Asia, Qatar accept the past clinical experience instead of insistence for joining a training program

         
  2. Gireesh

    January 22, 2009 at 4:38 pm

    Hi, Dr.taqi, Thank you very much for information, all the MRCGP Int appearing candidates are grateful to you and your work,

    Every body is talking about verbal and non verbal communication, but i wanted to know how much depth they will go when we give 2-3 Differential diagnosis, and Basic investigation?
    Thank you once again

     
    • drtaqi

      March 1, 2009 at 10:21 am

      I am not too sure what y mean by giving 2-3 differential diagnoses. The point of the MRCGP int or otherwise is not to come up with differential diagnosis but really to assess a person as a composite family physician. The domains that are assessed are not just diagnostic ones. It is conceivable that your differential may not quite concur with the ones that examiners have in mind but as long as they are not outlandish or far fetched they are not reason alone to fail.

       
    • Aziz Mengal

      December 22, 2009 at 10:28 am

      they don’t ask you anything, as they only assess your communication/consultation skills in the OSCE. Actually your knowledge has already been assessed in your MCQ exam. What you to do to just improve and dtrenghthen your as said verbal and nonverbal communication and bring fluency in your consultation.

       
      • Dr Jamal

        December 23, 2009 at 6:50 am

        Dear Dr Aziz ASA- You are our former colleague from AKUH.I work at the corporate sector. iI hope you are doing wonders at your new job. Can you provide us a list of high yield cases or diseases that we should prepare.The reason being that we are not actively practising family physicians.
        Also wish to know your email address as well.

        Dr Jamal
        Family Med, AKUH,
        OMV(Pakistan).
        AKUH

         
  3. DR.SYED.MANSOOR.UL.HAQUE

    February 3, 2009 at 6:10 pm

    Sir please send me few cases as I am appearing in OSCE of MRCGP in April.Really I will great thankful to you for this extra favour.

    With regards!

    Dr.Mansoor

     
    • drtaqi

      March 1, 2009 at 10:17 am

      Keep an eye on the blog, I will try and post some cases up. Thanks

       
  4. DR A RAUF

    February 3, 2009 at 6:34 pm

    THANKS FOR THE V HELPFUL HINTS FOR OSCE. MAY ALLAH GIVE YOU THE REWARD

     
    • drtaqi

      March 1, 2009 at 10:17 am

      Thank you and aameen.

       
  5. Dr Mohammad Osman Gani

    February 3, 2009 at 9:41 pm

    Thanks a lot for your help. I will be happy if you tell the followings–

    1) In MRCGP Int OSCE is there any Simulated patient ( SP ) in any station ? or there will be Patient and observer both in same station ?

    2) In there any padiatric case in MRCGP Int OSCE ?

     
    • drtaqi

      March 1, 2009 at 10:16 am

      1. All the patients are simulated (i.e. actors).

      2. Paediatric cases are by proxy i.e. a mother will rpesent and say the child has constipation etc. And you have to discuss the case with the mother. Remember to add the caveat that you help is limited by the fact the child is not present but you will do your best.

       
  6. MOHAMMAD AKMAL

    February 9, 2009 at 7:54 pm

    PREPARING OSCE

     
  7. dr Rahila

    February 16, 2009 at 5:15 pm

    a very useful guide thanks a lot

     
  8. Dr Jamal

    October 17, 2009 at 1:01 pm

    Dear Dr Taqi can you help us develop a list of 50-60 common cases being seen in the routine practice. Secondly also develop a list of common symptoms and signs. We can then learn the different but 6 – 8 common differential diagnoses for each of the symptoms and signs. This shorlisting will help us in a focussed preparation for the MRCGP Int Exam in Apr 2010.

    Eagerly awaiting your reply.

    Take care,
    Dr Jamal,
    Pakistan

     
    • Dr Jamal

      October 19, 2009 at 12:23 pm

      Dear Dr Taqi – eagerly awaiting moderation by you…

       
      • drtaqi

        November 5, 2009 at 8:45 pm

        Will try and put something together ان شاء الله God Willing.

         
      • Dr Jamal

        November 14, 2009 at 2:46 am

        Dear Dr Taqi – Many thanks for your reply. The exam is very near & need your expert advice at the earliest.

        Take Care – Jamal

         
    • Dr Jamal

      December 23, 2009 at 6:27 am

      Dear Dr Taqi – as promised by you request the 50 -60 diagnostic challenges from you.

      I also request Dr aziz Mengal to help out as well.

      God bless you.
      Dr Jamal

       
  9. Dr Jamal

    October 19, 2009 at 12:22 pm

    Dear Dr Taqi – eagerly awaiting moderation by you…

     
  10. Dr-ali

    November 24, 2009 at 7:02 am

    hallo.. can I have your mobile telephone number

     
    • drtaqi

      December 22, 2009 at 6:25 am

      Sorry. The blog is the best way to get into contact with me.

       
  11. Dr Muhammad Ali

    December 2, 2009 at 4:50 pm

    Dear Dr Taqi, pl guide me for preparing osce mrcgp(int).I will thankfull

     
  12. Dr. Mohammad

    December 19, 2009 at 9:32 pm

    Dear Dr. Taqi

    I have just come to know about MRCGP intl. I did not yet find a website that properly tells about the application, exam dates, etc. Kindly, inform me of the dates of the next examination to be held in Jeddah and the process of application.

    May Allah reward you for your help.

    JazakAllah khair.
    Dr. Mohammad

     
    • drtaqi

      December 22, 2009 at 6:42 am

      السلام عليكم

      The dates are given here:

      This is the RCGP page on the application process. In short you have to apply to via the centre you wish to take the exam at. The South Asia exams also include applicants from Saudi Arabia – as Saudi Arabia is not yet an accredited centre by the RCGP. But you should be able to the part 1 exam of the South Asia exam in Saudi Arabia.

      This is the application guide for South Asia, but you should make sure you have the most up-to-date application. It has the addresses to which applications are sent. They are sent to the local centres. The centre for processing applications from Saudi Arabia is Bangladesh. The responsible person is as given below an email is included.

      If you are in Saudi I would contact Professor Falahuzzaman and ask him the edtails of the Part 1 exam centre in Jeddah. It may be organised by the British Council though I am not sure of that.

      Prof Dr Falahuzzaman Khan
      Head, MRCGP[INT] South Asia Secretariat
      Urban Zephyr, Apt No. 4/B, House No.# 42, Road No.# 13/A
      Dhanmondi R/A, Dhaka 1209
      Bangladesh
      Telephone: 00880 02 9143607
      Mobile: 0088 01552 333690
      E Mail: proffzamankhan@yahoo.com

       
  13. dr ahmed al montasir

    December 22, 2009 at 7:28 am

    many thanks. i am a bangladeshi doctor. learnt a lot from ur blog. would you pl give me some suggestion how can i prepare myself for paper 1 mrcgp?

     
    • drtaqi

      December 22, 2009 at 7:33 am

      I am glad the information is helpful.

      As for preparing for Part 1 of the intMRCGP / MRCGP I would advise reading widely: NICE guidelines, BNF (especially the summary drug sections at the front of every drug class) and I personally like Polmear and Khot’s Practical General Practice. In addition practice with past paper exams and the various websites offer this and they will be useful.

       
  14. Jamal

    December 26, 2009 at 3:27 am

    Subject – Prep for OSCE.
    Dear Dr Taqi – You are like an angel sent from heaven. Can you history taking & clinical examination routines algorythms ( of common signs & symptoms as well as various systems) with us to pracice & perfect.

    Happy New Year to you & your Family.

    Cheers – Dr Jamal – Pakistan

     
    • drtaqi

      December 26, 2009 at 8:20 am

      إن شاء الله that is the plan for the case list to link it with an algorithm and check list. Though it will take time to put together. I once saw a book that I quite liked that one of our department colleagues used which had a fair number of cases and berakdown in it – I will try and find the name and put it up.

       
  15. Nizamuddin

    December 26, 2009 at 7:54 am

    Dr Taqi
    Do you recommend any specific book or siite for OSCE preperation?
    Thanks
    Nizam

     
    • drtaqi

      December 26, 2009 at 8:23 am

      Books – personally I did not use any book but relied on the diections of others (course organisers and exmianers).

      being videoed and then having your video criticised with someone who is familiar with areas that the examiners are looking for is the best thing to do.

      I will إن شاء الله try and find a book that some one my department colleagues used which I thought was quite useful – if complemented with the video sessions.

       
      • Jamal

        December 26, 2009 at 12:15 pm

        BRAVO DR TAQI – YOU ARE MARVELOUS. REQUEST YOU TO PUT THE SCANNED VERSION OF THE OSCE BOOK ON THE BLOG. IT WILL BE A GREAT SERVICE TO HUMANITY. YOU KNOW WE ARE NOT SO BRIGHT CLINCIANS & CAN USE ALL THE HELP THAT WE CAN MUSTER.

        THANKS ONCE AGAIN.

        GOD BLESS YOU.

        CHEERS – JAMAL,
        PAKISTAN

         
  16. ROOHI

    January 10, 2010 at 6:38 am

    can u guide me for prepration MRCGP part1

     
    • drtaqi

      March 27, 2010 at 11:00 am

      For MRCGP related articles and tips look here.

      .

       
  17. Nizamuddin

    January 10, 2010 at 9:46 am

    Dr TAqi your doing great job by helping we all is it possible to get the refference from you which you have mention in reply to my last blog thanks
    Nizam

     
  18. dr naeem rasheed

    February 16, 2010 at 1:25 pm

    dear dr taqi AOA u doing a wonderful job. everybody praising ur blog but where is it/ how and where can i find it?

     
    • drtaqi

      March 27, 2010 at 10:14 am

      Dear Dr Naeem

      You are at the blog. A blog is just a list of dated web entries. If you are looking for MRCGP related articles they are available here.

       
  19. Jamal

    March 21, 2010 at 8:28 am

    Dear Dr Taqi – Any update on books & videos etc.
    Take care
    Dr Jamal

     
    • drtaqi

      March 27, 2010 at 10:11 am

      Dear Dr Jamal
      I think this book is very good, though the cases are not exhaustive the layout is very good and once you have gone through it the key thing to learn is the case approach rather than the cases.

      Cases and Concepts for the new MRCGP: Clinical Skills Assessment and Case-based Discussion: CSA and CbD: CSA and CbD for the NMRCGP (Paperback)

      Amazon link.

      I will insha Allah post up some extract pages so you can get an idea.

      Dr Taqi

       
  20. ahmar jamal

    March 28, 2010 at 4:57 am

    Dear Dr Taqi – Many thanks for the info. Can we get it in Pakistan? Or are there free versions available on the web which we can download?
    God bless you for your efforts.
    Take Care
    Dr Jamal

     
  21. ahmar jamal

    March 28, 2010 at 5:00 am

    Dear Dr Taqi – After seeing this book online, I remember that I have this book already. Well if it is good then I will definitely study it.
    Take Care,
    Jamal

     
  22. dr aftab

    April 6, 2010 at 2:51 pm

    Sir!
    you are doing marvelous job there!

    I’m intrested in MRCGP can you please guide me for part 1
    1) is this from clinical subjects or basic?
    2) what books should be reffered?

    thanks a lot Sir!

     
  23. Jamal

    April 12, 2010 at 7:27 pm

    Dear Dr Taqi – many thanks for your support. I am appearing for MRCGP – OSCE in Sep 2010. Appreciate if you could share some common physical examination & common condition algorithyms i.e. syncope etc with us or guide to relevant resources.

    God bless you.

    Dr Jamal
    Pakistan

     
  24. Dr Jamal

    June 4, 2010 at 1:46 pm

    Dr Taqi Assalam Alekum,
    In your cheat sheet you have mentioned the following statements about ICE ( ideas, concerns & expectations). Should we ask our patients, all the items which have been numbered i.e no. 1,2,3,4. Are statements 1&2 synonimous i.e do we address any one or both of them from the patient.
    1)Is there anything else on your mind?
    2)Are you worried about anything else? [Concerns]
    3) What do you think is causing it? [Ideas].
    4)What would you like me to do for you today? What would you like to see happen today? [Expectations]

    Secondly, you have mentioned NICE Fast Track Reference Guidelines, can you paste the link?
    (Check the NICE fast track referral guidelines!)

    Thirdly is there a website where a sample prescriptions & therapeutics i.e drugs & dosages are present. I am asking this b/c my exposure of family medicine is limited as I am Occupational Health Physician. If you could pass me some notes on therapeutcs of common illnesses I will be obliged.
    Can you also explain the concept of safety netting & health promotion, please give examples for other cases as well. Please explain these points given below, so that we can ably apply them.

    Have a nice day.

    Dr Jamal

    Summarise and Safety Net.

    Health promote – tag this on here

     
  25. Dr Zainab

    June 14, 2010 at 10:54 am

    hi ive been following ur blog long time now;its helpful in givin afair idea of the exam;i just cleared part1 in may 2010;and what do you think shall i give osce in sept itself or prepare well and wait till next march;also can you give list of common practical skills asked;i know they ask u to demonstrate use of inhalers or insulin devices;what else;also can u give a samp;le of a scenario as asked in exam;the reason why i am askin is do they mention specifically do an exam or just scenario is kept u have to decide whether to examine or not.thanx so much awaiting ur reply

     
    • drtaqi

      September 13, 2010 at 1:55 pm

      Hi,

      Sorry to be very brief but in short: I understand they can ask you to do a blood pressure, asthma associated exam (inhaler advice , peak flow) simple exams : chest, back perhaps a shoulder. Insulin demonstration is unlikely. The most important thing to remember is that this is not a medical clinicals final exam where the exact choreography of the demosntartion is very important. Here if you missed something minor it will not be counted against you as long as it does not impair the overall score of the consultation in a signficant manner.

      I would like to invite anyone who has been through the exam to give their input as well.

       
  26. muhammad kamran mustafa smc

    July 6, 2010 at 12:03 pm

    dear dr taqi
    aoa i have been thru your blog and the information you put, v nice work, i have passed part 1 may 2010, now will apper in sept 2010 for osce, i m working near mecca 50 km from haram in phc the way toward al leeth since 4 years. you know the phc status of kingdom, and the languabe barier, so i found it little difficult to preapear for osce, can you guide me how i will prepear for osce,
    plz also answer the last request of dr jamal, it will also be v helpful.
    thanks, we know that your time is precious, but we need your kind guidance
    maa salama

     
  27. Dr syed hasnain ali

    July 8, 2010 at 11:13 am

    dr taqi
    assalamoalikum
    very good effor from u
    i have just did mrcgp int,part 1
    and got registered in 2nd in sep exam in siri lanka
    what do u think is it possible for me to prepare for exam to get through & can u guide,
    is there r any videos to see.
    Secondly, you have mentioned NICE Fast Track Reference Guidelines, can you paste the link?
    (Check the NICE fast track referral guidelines!)

    Thirdly is there a website where a sample prescriptions & therapeutics i.e drugs & dosages are present. If you could pass me some notes on therapeutcs of common illnesses I will be obliged.
    Can you also explain the concept of safety netting & health promotion, please give examples for other cases as well. Please explain these points given below, so that we can ably apply them.

    thank u
    ALLAH HAFIZ

    waitig for ur reply

     
  28. Dr Jamal

    July 9, 2010 at 8:44 pm

    Dr Taqi Assalam Alekum,
    In your cheat sheet you have mentioned the following statements about ICE ( ideas, concerns & expectations). Should we ask our patients, all the items which have been numbered i.e no. 1,2,3,4. Are statements 1&2 synonimous i.e do we address any one or both of them from the patient.
    1)Is there anything else on your mind?
    2)Are you worried about anything else? [Concerns]
    3) What do you think is causing it? [Ideas].
    4)What would you like me to do for you today? What would you like to see happen today? [Expectations]

    Secondly, you have mentioned NICE Fast Track Reference Guidelines, can you paste the link?
    (Check the NICE fast track referral guidelines!)

    Thirdly is there a website where a sample prescriptions & therapeutics i.e drugs & dosages are present. I am asking this b/c my exposure of family medicine is limited as I am Occupational Health Physician. If you could pass me some notes on therapeutcs of common illnesses I will be obliged.
    Can you also explain the concept of safety netting & health promotion, please give examples for other cases as well. Please explain these points given below, so that we can ably apply them.

    Eagerly awaiting your response.

    Have a nice day.

    Take Care,
    Dr Jamal

    Summarise and Safety Net.

    Health promote – tag this on here

     
    • drtaqi

      September 13, 2010 at 12:37 pm

      Walaikumsalaam
      Thank you for the question. Sorry for the delayed reply. I agree that items 1 & 2 could be synonymous, but sometimes 1 is referring to a second item or the hidden agenda, wheeras 2 would be referring to a concern they may have that prevents them from complying etc. Example: a patient comes with an area of eczema. The doctor asks: Anything else on your mind? he replies yes I have this black spot on my back that my wife is worred about. A concern would be that he is afraid to come to the doctor because his friend had a similar spot and it turned out to be cancer a year ago.

      Cancer referral guidelines: from NICE can be seen here.

      Drugs and Dosages: I usually recommend Practical General Practice by Polmear and Khot or the SIGN Guidelines

      There is a very good book that came my way on common illnesses in General Practice called 100 Cases in General Practice.

      Safety Netting: In short: RV7dinboeiwow = I would like to ReView you in 7 Days If you are Not Better Or Earlier If You are Worse or Worried. You change the number of days depending on the disease (conjunctivitis 3 days, cough 2 weeks etc.) and flesh out what you mean by Worse: For a cough: ‘If you cough up any traffic lights I need to see you again: I mean any cough with the colour Red : blood, Yellow or Green or your are more short of breath. And so on.

      Health promotion: I will Insha Allah put up a link of the head screening guidelines, I am currently following the USPSTF guidelines which are not too dissimilar from the UK ones. But simple things: Have you have a cervical screen? Do you smoke? Mammogram? DEXA if on steroids or very old or premature menopause etc.

      Hope that answers your questions. All the best for your future.

       
      • Ahmar Jamal

        September 13, 2010 at 1:32 pm

        Dear Dr Taqi Assalam Alekum & Eid Mubarak,

        Thanks for your reply – I thought you had forgotten us. Anyhow, it is great to see you. In the feedback given by examiners for OSCE – Mar 2010 – they had mentioned that candidates should be aware of latest guidelines of common ailments. My query for which common ailments ( 10-15 ) should we study NICE or SIGN guidelines – which one is better. For e.g. NICE guidelines on Hypertension are very old dating back to 2004 etc.

        Secondly from where can we get 100 cases in General Practice in Pakistan or can you upload or email electronic version b/c we can afford it at the prices quoted at the website.

        God bless you for the affection & kindness.

        Dr Jamal

         
  29. Aban Usmani

    August 7, 2010 at 4:58 pm

    I hope Dr. Taqi Does not mind my commenting here. I did my MRCGP Int 2 years ago and am constantly involved with coaching Of OSCE candidates in Riyadh and arranging MOCKs for the same.
    I benefitted from Dr. Taqi’ cheat sheet while preparing for the OSCE though the main benefit was from the Role Play of Clinical Scenario with other friends preparing for OSCE of MRCGP Int under supervision of candidates who had passed in the past.
    Regarding ICE in your consultation you have to establish which is the main concern…most of the time one is the main…try to establish ICE for that specific.

    Is there anything else on your mind?…will identify any hidden agenda

    Again in my opinion “Are you worried about anything else? [Concerns] is for hidden agenda rather than covering the concern. A person with tummy ache would be thinking that it is because of Cancer…this would be the idea…but he might be scared of the surgery or worried who would take care of his kids in case of Cancer…would be the concern.

     
    • drtaqi

      September 13, 2010 at 12:11 pm

      Thank you for your comments which are very welcome.

       
    • Ahmar Jamal

      September 13, 2010 at 1:35 pm

      Dear Dr Usmani,

      Thanks for your response. Appreciate if you could also give your valued response in relation to my comments above. It would also be a highly appreciable if you forward me your email address so that we can keep in touch as well.

      Take Care,
      Dr Jamal

       
      • Aban Usmani

        December 7, 2010 at 10:13 pm

        Dear Friends

        I am sorry since I have been quite busy so couldn’t reply.

        My e.mail is abanusmani@yahoo.com. I am developing MRCGP Riyadh page on facebook for my coaching schedule etc.

        What Dr. Taqi has said about the video recording of self is one of the most valuable tools where one can correct one self without exposing oneself to humiliation in front of others and especially for people living in isolation. If possible in my opinion the best option supervised practice in small groups.

        As far as the guidelines are concerned yes you have to be aware of the latest guidelines but NICE or SIGN or AMA or Australian or Canadian they are all acceptable.

        BMJ Learning modules available online and GP learning website or Even Mayo Clinic can give candidates a decent idea.

        If you have an obese Diabetic and you don’t start him on Metformin you are wrong…similarly giving Asprin to younger diabetics is off the table… similarly if there is a young hypertensive and the physician starts one on Beta Blocker it will not be good.

        If one knows the facts but does not agree with starting Metformin from the beginning and negotiates its use with the patient and lets the patient go for couple of months of life style change one will score points… since negotiated management plan is the best thing in view of OSCE examiners. This is the thing that defines and can change the doctor-centered-near-fail consultation to a definite pass patient-centered consultation.

        For candidates in Pakistan I would suggest to attend Dr. Rukhsana’s courses in Karachi and Dr. Nasir Shah’s courses in Lahore. If I am not wrong both are Professor Riaz Quraishi’s trained AKU family medicine fellows.

        Asking ICE is of course one of the most important part of the OSCE consultation since without covering the Idea Concerns & Expectations of the SP one cannot truly have a consultation patient centered.

        According to the feedback I got from various examiners, candidates asked ICE very robotically…this is not unexpected, since most of the candidates appearing in MRCGP Int are practicing in their native languages, and even native Urdu, Hindi etc practicing Family Medicine in Arabic in the Gulf countries but unacceptable

        How to do it friends….you can check out as many places but no one phrase can be used in all situation…

        The only way to get to the right combination is to keep practicing in small groups i.e. of 6-10 candidates…ideally will be supervised practice but it is not always possible so do it on your own and when possible do it supervised…if you are on your own record your video and review and marking yourself as suggested by Dr. Taqi will result in very quick improvement

         
    • Dr Jamal

      September 27, 2010 at 6:06 am

      Dear Dr Usmani Assalam Alekum,
      Your comments are very well formulated. Can you llist a few questions/statements to elicit the concerns of the pateint. You rightly commented that – Is there any thing else on your mind? elicits hidden agenda….
      Please keep in mind first you have to ask the patient about ideas & then concerns. Can you mention a few statements to synchronise & elicit questions related to ideas & concerns in a smooth manner.

      Regards,
      Dr Jamal

       
  30. Dr Safeer Zaman

    August 8, 2010 at 8:19 am

    Execellant work done

     
  31. Dr syed hasnain ali

    September 14, 2010 at 12:26 am

    very nicely guided

     
    • Dr. Khalid Yousaf

      October 9, 2010 at 9:59 pm

      Congratulations on passing MRCGP INT

       
  32. Ahmar Jamal

    September 15, 2010 at 1:25 pm

    Dear Dr Taqi,
    can you pass the link of NICE Fast Track Guidelines on the web & also advise as to which ones to study from OSCE Perspective.
    Dr Jamal

     
  33. Dr. Khalid Yousaf

    October 8, 2010 at 9:42 pm

    Nice work by Dr. Taqi, I appeared in osce in sep. 2010, but failed, can u guid me , how i can asses myself while every thing gone perfect
    God bless u

     
    • drtaqi

      November 11, 2010 at 10:15 pm

      Assalaamualaikum,
      Buy a simple camera with video facilities and a tripod (or borrow one) and video your mock cases. Then get the marking sheet and mark yourself and get your revision team or someone who passed the exam to mark you. It will insha Allah be a very profitable and useful exercise.

       
      • Dr. Khalid Yousaf

        December 12, 2010 at 9:20 pm

        Thankyou very much Sir, I will do it

         
  34. Aban Usmani

    December 10, 2010 at 12:14 am

    Dear Friends

    I am sorry since I have been quite busy so couldn’t reply.

    My e.mail is abanusmani@yahoo.com. I am developing MRCGP Riyadh page on facebook for my coaching schedule etc.

    What Dr. Taqi has said about the video recording of self is one of the most valuable tools where one can correct one self without exposing oneself to humiliation in front of others and especially for people living in isolation. If possible in my opinion the best option supervised practice in small groups.

    As far as the guidelines are concerned yes you have to be aware of the latest guidelines but NICE or SIGN or AMA or Australian or Canadian they are all acceptable.

    BMJ Learning modules available online and GP learning website or Even Mayo Clinic can give candidates a decent idea.

    If you have an obese Diabetic and you don’t start him on Metformin you are wrong…similarly giving Asprin to younger diabetics is off the table… similarly if there is a young hypertensive and the physician starts one on Beta Blocker it will not be good.

    If one knows the facts but does not agree with starting Metformin from the beginning and negotiates its use with the patient and lets the patient go for couple of months of life style change one will score points… since negotiated management plan is the best thing in view of OSCE examiners. This is the thing that defines and can change the doctor-centered-near-fail consultation to a definite pass patient-centered consultation.

    For candidates in Pakistan I would suggest to attend Dr. Rukhsana’s courses in Karachi and Dr. Nasir Shah’s courses in Lahore. If I am not wrong both are Professor Riaz Quraishi’s trained AKU family medicine fellows.

    Asking ICE is of course one of the most important part of the OSCE consultation since without covering the Idea Concerns & Expectations of the SP one cannot truly have a consultation patient centered.

    According to the feedback I got from various examiners, candidates asked ICE very robotically…this is not unexpected, since most of the candidates appearing in MRCGP Int are practicing in their native languages, and even native Urdu, Hindi etc practicing Family Medicine in Arabic in the Gulf countries but unacceptable

    How to do it friends….you can check out as many places but no one phrase can be used in all situation…

    The only way to get to the right combination is to keep practicing in small groups i.e. of 6-10 candidates…ideally will be supervised practice but it is not always possible so do it on your own and when possible do it supervised…if you are on your own record your video and review and marking yourself as suggested by Dr. Taqi will result in very quick improvement

     
  35. DR.KUKAMBER

    December 20, 2010 at 11:51 am

    Let us discuss some cases..that came in last OSCE in Colombo..!

     
  36. DR.KUKAMBER

    December 20, 2010 at 12:06 pm

    DR.TAQI,Salam. 8m pg lady came with ECG Tachycardia 150/min…concerned.it will affect her baby.All screenings -ve incl.Thyroids.How to manage this case.Iwillbe glad if u plz tell this case briefly.If refer how to refer..?

     
    • drtaqi

      January 3, 2011 at 11:14 pm

      Walaikumsalaam,

      Right thinking off the top of my head. My brain says this is unusual for a lady to be so tachycardic in a state of pregnancy & she is concerned. But all the tests have come back negative, which I presume means an ECG, bloods (i.e. she is not anaemic), no electrolyte disturbance. I am assuming she is not short of breath and there is no clinical evidence making me suspicious of a pulmonary embolism. I am further assuming there is no acute emergency of pregnancy. Lastly I am assuming baby is moving, no contractions, abdomen soft non tender, no PV bleeding or other signifcant fluid loss, no evidence of infection infection and a fetal heart sound is heard and appropriately fast.
      So I am left with a case of tachycardia possibly due to anxiety of the mother or something potentially serious and a worried mother. The key here to me if this is an OSCE lies in the explanation and management. There will be no clearly right answer but they may be wrong or very poor answers. You can see this is a real ICE (Ideas, Concerns, Expectations) moment. Why is the mother worried? Does she remember another person who has lost a child? Or has she heard something on the news about tachycardia etc.? I can explain the causes of tachycardia, and tell the mother that I do not think she has any major life or baby threatening cause. I would like to deal with whatever she then speaks about in a direct manner. Then I would offer her various options: conservative with a review in 24 hours or in a later session if she lives nearby (logic: if anxiety – it will settle and we can re-examine her.) or if she is still worried I can ask for a second opinion at the local hospital where they can monitor the baby more closely and give mother a more detailed checkup (this would be reasonable if there are also social factors – mother is alone at home, lives far away from medical help, has no transport to bring her in to medical care etc.) She can choose which of the options best suits her. Poor answers would be: Offering her a routine antenatal opinion in 2 weeks, reassuring and say come back if she is worse, not trying to rule out any mother-fetal threatening causes if the history suggest it. That’s what I would think off the top of my head. Any suggestions from others are welcome.

       
      • Aban Usmani

        January 24, 2011 at 12:45 am

        I have been very busy with the intensive preperation courses of OSCE. We have discussed the aforementioned case…generally I agree with Dr. Taqi’s opinion except that confirmed pulse of 150+ needs assessment and probably admission with obstetrics

         
  37. Aban Usmani

    March 13, 2011 at 6:49 am

    Hello Guys
    Last year there was one patient with an MRI report of Multiple Sclerosis…a lot of friends did it as breaking bad news and other who did it as a simple counseling case thought they had made a mistake
    In my opinon a real bad news is which drastically changes a persons perspective of life…usually a cancer, HIV or death of a dear and near one…I don’t think the Multiple Sclerosis merits that description
    It is a debilitating illness with a relapsing remitting course but manageable and >15 year life expectancy quite good

    What do others think?

    There was also a case of cystitis in a female where she accepted her tummy to be examined…this is quite in contrary to what we expected initially! females SP’s allowing abdomen to be examined!!!

    plz comment

     
  38. Aban Usmani

    March 13, 2011 at 7:02 am

    All people preparing for MRCGP OSCE please check if you know explanation of all Ailments and investigative procedures in layman terms…what is Asthma, DM, Epilepsy, Cystoscopy, Endoscopy, MRI, DEXA Scan etc etc most candidates are failing to satisfy the SP in this aspect

     
  39. mansoor ali

    June 11, 2011 at 5:55 pm

    i wanted to post the mcqs from akt may2011 if i m allowed to do so

     
    • drtaqi

      November 9, 2011 at 10:46 am

      Thank you, that sounds like a good idea.

       
    • asma

      December 17, 2011 at 7:58 pm

      please do it

       
  40. DR. MOHAMEMD AZIZULLAH

    December 22, 2012 at 3:45 pm

    AS SALAM ALAIKUM
    I LIKES TO KNWO HOW TO DO APPEAR FOR MRCGP

     
    • drtaqi

      September 16, 2013 at 9:49 am

      Walaikumsalaam:

       
    • Aban

      September 17, 2013 at 8:33 pm

      If you wish to appear for MRCGP Int South Asia (Pakistan, Sirilanka, India, Bangladesh, Nepal etc) you need to have a 4 year experience of working as a general physician.
      They have their own website you can look on google for MRCGP Inr South Asia.
      The exam is in 2 parts. Part 1 is 200 MCQs while Part 2 is a 14 station OSCE

      If you are looking for MRCGP UK it is open only to people working in UK. Dubai, Qatar or Egypt also hold MRCGP Int but have their own structure.

      Dr. Taqi has probably become busy over the years and this blog is not very active.
      I advise people for MRCGP Int South Asia through my Facebook page Mrcgp Riyadh. You or any other colleagues are more than welcome

       
      • drtaqi

        September 17, 2013 at 9:01 pm

        Great information, thank you very much Dr Aban.

         

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