Useful Phrases for OSCEs

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Introduction

OSCEs can be challenging. Performance anxiety, time pressure and complex clinical scenarios can cause you to trip over your words and lose track.

Whilst it is important to respond naturally to avoid sounding overly rehearsed or robotic, having a few key phrases up your sleeve can help to streamline the conversation and build rapport with your patient in moments of panic!

This guide aims to equip you with a range of useful phrases to convey professionalism, empathy, and clarity. However, while these phrases are useful guides, always adapt your language to the specific patient and OSCE scenario. 


Opening the consultation

The introduction serves as the foundation for establishing rapport and trust between you and the patient.

In OSCE scenarios, a well-executed introduction is not just a formality but a key aspect assessed in the mark scheme. Remember, from a patient safety perspective, it is important to ensure the right patient is present during the consultation or that you are performing a clinical procedure on the correct patient!

A good introduction should clearly identify your name and role, confirm the patient’s details (name and date of birth/age, at minimum), and explain why the consultation is necessary.

Before proceeding, you should seek consent from the patient.  

Introducing yourself

“Hello, my name is [your name], and I am [your role]. It’s nice to meet you. Can I please confirm your full name and date of birth (or age)?”

Personalise the interaction

Ask the patient how they would like to be addressed during the consultation. 

“[Confirm patient details]. Is [first name] okay, or would you prefer me to call you something else?”

Confidentiality

It may be appropriate to explain the confidential nature of the consultation, especially if discussing a sensitive topic (e.g. sexual health). However, remember confidentiality is not an absolute right! You can read more about this on the General Medical Council website.

“Everything we discuss during this consultation is kept confidential unless you say something that makes me concerned about your safety or that of others. If I need to break your confidentiality, I would make every effort to tell you first.”

Acknowledge the presentation

“How are you feeling today? *pause* I’m sorry to hear that. I’d like to ask you some questions about that [symptom] so we can work together to find out what has been going on recently. Is that okay with you?”

“I understand that you’ve been experiencing [symptom]. Are you happy if we talk a bit more about that [symptom]?”

“As this is the first time we’re meeting, I’d like us to make sure we’re on the same page. Can you tell me a bit more about what’s been going on recently?”

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Displaying empathy

During a consultation, patients may discuss anything, ranging from significant pain to grief. Whilst it’s never wrong to say, “I’m sorry to hear that” or “That must be very difficult for you”, it can come across as impersonal or insincere.

Showing genuine empathy in an OSCE setting is often challenging but can be achieved by ensuring the dialogue is patient-specific.

Show that you have listened by using reflective statements, paraphrasing what the patient has said, and validating the patient’s emotions. Avoid saying you know how the patient feels, as everyone’s experiences and reactions are unique.

Reflective statements

“It sounds as if [sympom(s)] has/have been really challenging for you.”

“That must have been a really difficult time for you when you lost your [person’s name or relationship]. I can see how much pain it causes you now as well”

“You’ve shared some really difficult experiences, and I can see how much they are affecting you”

“I’m so sorry for your loss. It’s clear that [person’s name or relationship] meant a lot to you, and it’s natural to feel the pain you’re experiencing now”

“What you’re dealing with sounds incredibly overwhelming. It’s okay to feel the way you do, and I’m here to support you with the rest of the team”

Acknowledging physical symptoms and cues

“I can see you’re in a lot of pain right now. Let’s see what we can do to make you more comfortable. Are you okay to continue talking, or would you prefer to lie down?”

“It’s clear that you’re in pain at the moment. I’m so sorry. I’m going to do my best to help alleviate some of that pain as soon as possible”.

In an OSCE and in real life, if the patient says they’re in pain or there are obvious signs of discomfort (e.g., wincing, groaning), acknowledge their pain and offer to help them find a more comfortable position or pain relief.

In an OSCE, you won’t be able to provide medication or physically move the patient; however, a proactive approach shows you care and can make a significant difference.


Asking tricky questions

Sometimes, in a medical history, you need to ask sensitive questions (e.g. sexual health, recreational drug use).

It can be helpful to acknowledge the personal nature of these questions to ease the discomfort of the patient and remove any stigma they may feel. Emphasising that these questions are part of their care and a requirement, not you passing personal judgment, can help the conversation flow and maintain rapport.

Normalise and contextualise

“We ask these questions to everyone who presents with symptoms like yours.”

“I’m just going to run through some questions we ask everyone. Do you smoke? Do you drink? Do you use any recreational drugs?”

“Next, I’d like to ask about some aspects of your life that can impact your health, like your alcohol consumption and smoking. These are routine questions we ask all patients.”

“I need to ask you some personal questions about your sexual health to assess your risk of sexually transmitted infections. Please let me know if you would prefer not to answer a particular question or stop the consultation at any point. Sometimes, there are some preferred words or terms people would like to refer to their genitals or words they would rather us not use. Do you have any preference?


Ideas, concerns, and expectations

Understanding the patient’s ideas, concerns, and expectations is crucial, and it is often an essential component of the OSCE mark scheme.

These elements are best explored after discussing the history of the presenting complaint. While it’s not wrong to ask the patient questions like “Have you had any ideas what this is?” “Why are you concerned?” or “What do you expect?”, you don’t need to use the terms “ideas,” “concerns,” and “expectations” explicitly to meet the criteria.

Instead, focus on eliciting the patient’s specific thoughts and feelings to tailor the conversation more effectively.

Ideas

“Have you had any thoughts about what might be causing this/[the symptom]?”

“What do you think might be going on with your health?”

Concerns

“Is this something you’ve looked into or have any particular concerns about?”

“You mentioned a few things here, is there one thing particularly concerning you?”

“Often, patients can Google their symptoms and worry about specific things. Is there anything you’re worried about?”

Expectations

“Is there something in particular that you were hoping we might do for your [symptom] today?”

“Have you had any specific thoughts on how we might be able to help?”


Summarising

Summarising is a great tool for both you and the patient. It shows that you’ve listened and are being careful and methodical, wanting to ensure you haven’t missed any of their information.

It provides an opportunity for the patient to correct any information as well as add anything they’ve accidentally forgotten. If you realise you can’t remember something specific, be proactive and ask – it’s better to double-check than forget.

Confirming details

“Before we move on, I just want to check that I’ve understood everything we’ve talked about so far. [Summarise the main parts of the history back to the patient]. Have I missed anything, or is there anything else you’d like to add?”

“Can I just confirm a few details with you?”

“To make sure I understand correctly, you mentioned….”

“I want to double-check something quickly to ensure I’m on the right track and I haven’t missed anything”


Signposting

Signposting is a communication technique used to guide the conversation smoothly from one topic to another without abruptness.

It helps prepare the patient for additional information gathering and ensures the conversation flows naturally and logically.

Signposting can be used in conjunction with introducing a sensitive topic as it gives patients a warning shot and an understanding of the direction of the conversation.

Examples

“Now that we’ve talked about [symptom], I’d like to move on to finding out a bit more about your health and your day-to-day life”

“Let’s just shift focus for a moment and talk about your past medical history and medications. If you think of anything else, we can talk about it afterwards”

“We’ve covered what brought you in here today as well as your medical history, so now I’d like to learn about your lifestyle and ask some more personal questions”


Chunk and check

Breaking down information into manageable parts and checking for understanding is important in effective communication.

This technique involves giving small “chunks” of information at a time, pausing, and then checking the patient’s understanding.

It’s important to use phrases that encourage questions, as simply asking “Do you understand?” may not invite the same open response as “Is there anything you’d like me to explain again?”.

It is also helpful to acknowledge that you are providing a lot of complex information in one go and reassure the patient if they don’t remember or understand everything immediately. When asking the patient to summarise for you, suggest you want them to summarise so you can check your explanation, not that you’re testing them on their ability to retain the information you’ve given.

This approach improves comprehension and makes the patient feel more comfortable and supported. It also provides an opportunity to arrange follow-up or support materials (e.g. leaflets).

Examples

“I understand that this can be a lot to take in. Let’s break it down step by step together.”

“So we’ve just talked about what causes this condition. Does that all make sense? Is there anything you’d like me to explain again? Okay. Now we can move on to what medicines we can use to treat this condition.”

“We’ve covered a lot here. Is there anything you would like me to go over again?”

“Just so I know that I’ve explained everything right, would you mind summarising some of the key points you understand from what I’ve said so far?”

“This is all quite complex, so I want to make sure that I’m explaining it well. Would you mind repeating some of the key information about what I’ve said so far so I can make sure I haven’t missed anything?”

“This is probably a bit of information overload. Don’t worry if it all seems a lot right now. We can have another conversation about this again, and when we’ve finished talking, I’ll give you some information leaflets and resources to check out at home.”


Filler words

Refrain from filler words such as “cool” or “okay, great.” When used inappropriately, they’re likely to detract from the clarity and professionalism of your communication.

Nodding along to the patient and choosing neutral expressions such as “yes,” “right,” or I see can be helpful.

OSCE examiner’s tip

Using filler words can be a natural response when we’re placed under pressure (like in an OSCE!). However, if you use inappropriate filler words, they can significantly detract from the consultation and will reduce your marks. 

Here’s an example of an inappropriate filler word in a chest pain history station:

Patient: “It’s like a tearing pain, right in the middle of my chest…I…I just feel like I’m going to die. You know my dad died suddenly of a heart attack when he was out jogging, he was only 63. I really hope I’m not having a heart attack.”

Student: “Ok, that’s great….I need to ask some other questions, do you have any shortness of breath?”

In this situation, the student is pleased they’ve elicited part of ICE (the patient’s concerns about having an MI) – but obviously, saying “ok, that’s great” out loud in the consultation is inappropriate and dismisses the patient’s concerns.

If you know you tend to use filler words then work on removing them from your consultations. It’s okay to have short pauses or silence!


The natural flow

In moments of panic, when you can’t remember anything, use cues from the patient to guide the conversation.

If a patient mentions a symptom, ask them to elaborate. If they bring up smoking, ask more about it there and then rather than waiting until you get to social history. While it’s important to follow a structure, don’t allow the structure to prevent the natural flow of the conversation.


Closing the conversation

Effectively closing the conversation is as important as starting it well. When closing the conversation, reiterate the next steps, ensure understanding, and express gratitude for the interaction.

Closing statements

“Before we wrap up, let’s quickly review our plan. [Review plan]. We’ll schedule a follow-up appointment to discuss any further steps. If you have any questions before then, don’t hesitate to get in touch.”

“It was lovely meeting you today. Please don’t hesitate to contact me or another member of the team if you have any further questions or issues.”

“Thank you for sharing all this information with me today. I can see it has been challenging for you, but it’s really important to understand your health needs.”

“Before you go, is there anything else you’d like to ask or discuss?”

“Do you have any questions you feel I haven’t answered today, or are there any details you’d like me to clarify?”

“We’ve discussed a lot today. Would you like me to write any of it down for you?”

“We’ve discussed a lot today. If you feel it would be beneficial to involve your family members, we can schedule another appointment, during which I can provide a thorough explanation to everyone involved.”


 

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