Ask the Examiner: the OSCE’s

For those of you who are preparaing for the forthcoming College of Optometrists OSCE’s (Objective Structured Clinical Examination), then we have created an Ask the Examiner thread.  Please feel free to join the discussion!


  1. Hello,

    My query is regarding third nerve palsies.
    I have found conflicting opinions on how soon to refer (whether it be immediate or urgent) dependent on pupil involvement. However, whether the pupil is involved or not, both carry the potential of life threatening complications such as stroke, so in both cases is it not correct to do an immediate referral?

    Thanks in advance

  2. Simply it is to do with the location of pupil fibres. They are peripherally positioned, at least anteriorly, thus are spared if the palsy is due to an infarct of the vasa nervorum, running through the core of the nerve.
    If pupil is involved it suggests external compression, most likely from a posterior communicating artery aneurysm, which had a high risk of infarct and needs urgent referral for clipping – Simon.

  3. It’s because compressive (e.g aneurysm) 3rd nerve palsies are usually pupil involving and will need surgery. Pupil sparing (something vascular is happening) is usually medical. With a blown pupil the compression is usually at the junction of the posterior communicating artery and the internal carotid artery – Joy

    PS If vascular will usually only affect the peripheral fibres of nerve.

  4. hi
    having sat my osce exams in january i was stunned by the lack of questions/response from the examiners, my question here is, when communicating to the examiner alone do we still use laymans terms? or correct terminology?
    many thanks

  5. The ‘O’ in OSCE’s stand for Objective… and that’s’ what they are supposed to be. Bit tricky if you have examiners conducting vivas etc. So what has been devised is a system whereby the examiner has minimal interaction with the candidate, to maintain consistency between examiners and between stations. The why’s and wherefore’s are too many to go into here and this is not the most appropriate forum either. But there you go – as examiners we must try to remain objective, neutral and mark each candidate according to the same hymn sheet. Thus, the examiner will not ask you questions, like in a standard Viva examination.

    When you address patients , use patient language but when addressing the examiner when you are explaining, for example, your referral criteria, use clinical terminology.

    All the very best of luck! Manchester? See you there 🙂

  6. Hi- I have failed my OSCE twice now- it has diminished my confidence in my own ability. I am a good student. I got a first in my degree. Each time I achieved the pass mark required but only managed to pass 9. I have no idea as to what I can do better as what I failed on the first time I passed the second. I believe I am competent and assumed that if I am safe to practice then I will pass- that does not seem to be the case. I don’t believe a lack of revision is the problem- I know my stuff- what is it that the examiners want to see that gives them the impression of competence

  7. Hi Taz – first of all I am sorry to hear that you have failed the OSCE twice. It is difficult to understand where you may have gone wrong given that there is little feedback that can be obtained. That is the nature of these exams and is a given, so not much can be done there. However, regardless of the method of how trainees are examined, the overriding pass/fail criteria has always been, and continues to be, safety to practice. Examiners are looking for that in all OSCE stations – have you made an appropriate referral, was the referral to the right person and in the right time frame, did you obtain a good view, was the equipment set up correctly so that the best view was obtained, did you miss the symptom, did you act appropriately on the presenting symptoms, did you obtain all the necessary information to make an accurate informed decision.
    These exams are as objective as they can possibly be – and should not be swayed by an examiner having an ‘off day.’ we are given very concise instructions and judge according to a strict brief. Whilst I am in no doubt that you know your stuff, what I would try to focus upon is the application of that knowledge in the real-time environment. Easy for me to say following 20+ years of clinical experience, and sadly it is not something that is written in a book. If I were in your shoes now, focus more upon your weak areas of clinical techniques (we all have them) and most importantly, referral criteria. (Who, when, why, where, what, how..) and practice communicating this with both colleagues and patients. What you say to patients and how you convey this information holds just as much weight.
    May I wish you the best of luck – Jane

    • Hi what would be the referral urgency for optic neuritis and nerve palsys without pupil involvement?

      kind regards

  8. Hi
    I just wanted your advice on how best to prepare for the osce exams.
    What exactly are the examiners looking for?

    • Hi Manj,

      The examiners are looking to make sure you are competent and that you are “fit” to practice.

      You will need to revise all the competencies covered in your work based assessments (stage 1 and 2).

      When you actually attend the OSCES read the instructions carefully so you make sure you complete what is needed.

      Unlike your work based assessments, examiners will not prompt you so you need to ensure you complete all that is needed.

      The OSCES will cover communication skills, data analysis (including clinical decision making) and actual clinical techniques.

      Revisit the competency framework and pay special attention to the performance indicators as a guideline.

      Good Luck

  9. Vijay Shah says:

    Vijay , Hi , in a question it stated to take bifocal measurements . What measurements are they looking for , apart from the following : Mono pd for dist/near, seg heights (HCL or lower rimm) explaining to px what pd is , adjusting the frame, is there anything else?

    • hi Vijay, depending on the prescription you may need to take bvd, pantascopic angles. Need to discuss frame options, including materials and how to use the bifocal.

  10. hi, are there any courses for osce preparations? I’ve tried applying for the J&J course but they’re fully booked.

  11. Hi Maulia
    This is the first year we are not hosting OSCE courses at City University where we had been hosting summer exam prep courses for 8 years. We could not compete with the free courses run by JnJ.

  12. Farida Patel says:

    Hi I was wondering if we are allowed to use the fundus photos given to us in the assessment while explaining the condition to the ‘patient’. For example, if the station is to explain AMD, and a fundus photo of AMD is present, can I use this to help explain to the patient what AMD is? Thankyou.

  13. Bronagh McClelland says:

    Hi, I have just recently found out that I failed my osce exams and don’t really understand why I failed because I studied very hard for them. Any tips how to study for the next ones?

  14. Hi Jane are there any courses that can prepare me for stage 2 visit

    • Sorry but we are not currently running any courses for Stage 2

    • My OSCEs are I’m January. Any tips for preparation?


      • The OSCE’s, I will say, are created in such a way that to be fair, there is little studying that you can do for them. In one way that is the beauty of them, but the flip side is the sheer frustration in being unable to plan a course of preparation.
        The OSCE’s assess your ability to make decisions, your ability to analyse data, your ability to discuss results with your patients. None of this can be found in a book. To be comfortable of a good pass, you need experience.
        So, prepping for the OSCE’s means getting in as many patients as you can and with a wide variety of clinical features. I appreciate that is probably not what you want to hear just a couple of weeks away, but given the wide extent of competencies covered, literally anything could come up.
        There is one station you can prep for, however, and that is the Volk lens station. A least you have a heads up on that one so no excuses for failing foul of the examiner’s mark sheet there.
        If I was prepping for the exams now I would work up to the last minute and book lots of patients. I would take the day off before to relax. And I would get a copy of the Core Competencies and have a read through every one – it will focus your mind. Have a read through and try to relate the competencies as you read them with the patients who are fresh in your mind.
        Oh, and get that Volk lens out. On everyone. Dilated and undilated.
        May I wish you the very best of luck. See you on the other side 🙂

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