FRCEM -Intermediate (SAQ)

So I took the Intermediate exam back in September 2017 (the SAQ bit only, I did not book the SJP or the OSCE) and I am happy to say I passed it. That’s two down and…err…about 6 more to go? or is it 5? Sheesh! give me a break!
Anyway – this post is a long time coming, I thought I had written this already but turns out I had done so only in my head.

Having passed the FRCEM Primary in June that same year (thank you thank you *takes a bow*) I was in no way in the right mind to take another exam so soon. The next available attempt for the SAQ was end of September, which meant that I had little over 2.5 months to prepare for yet another exam – along with a new rotation change (I was about to enter the wonderful world of anaesthetics and ITU in August) new responsibilities and the very many issues related to portfolio hassles. Not to mention my wife would not be too happy at literally having had to raise our 2 year old on her own these past few months as I juggled preparing for the primary, and then right after finding out I had to prepare for a second exam. Flowers. And chocolates. lots of them. problem solved. I spoke to my colleagues and my friends and specially my mentor back home in Pakistan. He really really I mean REALLY pushed me to seriously attempt this. This being a clinical oriented syllabus of this exam, he was of the opinion that I just had to build on my standing knowledge and based on my experience having worked in ED these past few years I would not find preparing or taking the exam too hard. I had my doubt but he impressed upon me the need to give it my best shot – if I pass then that’s good, if I don’t then it will be a learning experience. He felt that if i gave it my all there was no reason 2+ months of prep time (sincerely) couldn’t help me pass.

I discussed it with my wife who to my surprise pushed me to go for it! I applied for the exam about 2 days before the deadline to apply. And here is where I found out how every little thing you do, even the smallest tiniest thing, can help out in the long term. It is a long and boring story, but the long and short of it is that someone from an exam prep website saw my blog posts and were interested in sharing said posts on their own website – as a gesture of good faith and in lieu of my contribution to their site, they offered to ‘allow’ me to use their vast question bank free of charge to help me prepare for the intermediate examination! It felt like a sign from above (yes I am that superstitious!) and I decided to do the questions from WWW.FRCEMEXAMPREP.CO.UK

The SAQ is an interesting exam in that I have never taken an exam like this before. As it’s name suggests, you have to write short answers to each of the questions. There are 60 questions in all, each carrying 3 marks. Each question can be one solid question requiring a lengthy answer, for 3 marks, or it can be divided into 2 or even 3 parts, with varying marks for each part but the total for that whole question would be 3. You have 3 hours (180 minutes!) in total but essentially 3 minutes to read each question’s stem (or the stem in each part or each question), think of and formulate your answer or the order of your answer and THEN WRITE IT ALL DOWN. It sort of leaves not much room for any errors or erasing and re-writing or thinking a lot. This I found the toughest thing to do: TIME MANAGEMENT. Since you are not used to writing answers out to questions, you do not realise how time consuming it is to think about your answer and then to write it down so that the examiner can read it and find all the required information that was asked in the question.

The practise questions were good, but like any practise question bank for this sort of exam, it only gives you a key of answers that are deemed correct. There may be other answers/varieties of the same answer worded differently that may be correct, or indeed a completely different answer might be correct. For example, in a scenario of a young male patient with appendicitis apparent as the clinical picture, if the question asks for 4 steps of management in ED, the answers could be: 1) analgesia 2)surgical consult/referral 3)fluids 4)antiemetics 5)antibiotics 6)urine dip and other investigations to rule out other causes for similar clinical picture 7)NBM till further orders – now if the key shows only options 1/2/3/4 as the only steps in management, someone writing the other steps could be deemed correct as well, or any combination of the above options. They essential bit to understand is that the more you practise these questions, the better you become at thinking about the answers and formulating the correct answer and writing them down in a concise and legible manner, with the addition of time constraints.

There were recommendations to read some textbooks as well – but I found I had no time to read anything, I only focussed on practising as many questions as I could. The questions I got wrong, I did read up on a few of those concepts, but mainly I found the explanation in the website to be quite sufficient, it gave you a broad overview of the topic at hand, and it gave all relevant information related to the query at hand. With each question I got more and more confident, and the explanations were very very helpful in preparing for these. I first utilised the option of doing the questions subject wise – there were a wide variety of them, including paediatrics and gynae and medicine and pharmacology etc – I found I didn’t do too well when I knew what the subject matter was. After I had gone through all the questions in the subject wise manner, I then opted for the shuffled questions – The site rang up a mixture of all subjects and gave me 20 or 50 or whatever number of questions I needed to do or had the time for.

On my days off I did approximately 10-14 hours of these question banks, approximately 50-100 questions with their explanations – my days off were very few and far between. On my days at work, while I was still in A&E I found myself unable to do more than 20 or a maximum of 30 questions a day – but I made it a point to do atleast some if not too many, every day. I think the trick to this exam is to be consistent in your prep. In the last 5-6 weeks before the exam I started in my new rotation in anaesthetics – and I found a great rota, one with weekends off and no nights or on call commitments. Granted, I was paid a lot less than I expected but I got a good time to do those questions! Once I had finished the questions subject wise, and then again as a mixture, I just randomly kept doing questions – I still got a few wrong, I only read explanations for those, the ones I got right I didn’t waste time reading up on them unless I felt it was a weak subject for me.

I took 5 days of study leave (not including the day of the exam) and the day before the exam I did not study anything. I do not believe in cramming till the last second. I spent the day with my family, went out with them to the town centre, had an educational supervisor meeting, made a few phone calls to family back home in Pakistan, watched the Minions movie with my son for the thousandth time, cooked a meal and just generally relaxed and enjoyed and rested – before the trauma of the next day.

Even though it was an early start for me, I was almost 7 minutes late to the exam (effing traffic jams on the way to London where my station was!) and I rushed in and totally convinced myself that there is no way I am passing this exam now – but I did, and so can you! Just…make sure you do not convince yourself that time is too short and there is no way I can prepare for this in such a short time…just make sure you atleast attempt it, you may end up surprising yourself. I did, and so can you. Just…make sure you do as many questions as you can, as frequently as you can, in as timely a manner as possible. Again. And again. And again.

Good luck!

My PLAB experience (a VERY long time coming!)

Very recently, I was asked by one of my friends if I could share my experience about the PLAB exams, as guidance for prospective candidates. Having taken the exams quite a while back (2014!) I found it hard to address the issue, so they sent me a questionnaire to make things easier to explain to someone not very familiar with the way forward when contemplating taking the PLAB exams. I am sharing the whole Q&A session here (with a few minor adjustments/deletions with the author’s permission). Thank you @Sadaf Taymor (http://sidtay.blogspot.co.uk) for the opportunity to express myself and to share an important experience with everyone!

The curious case of PLAB (09/10/2017)

What is the PLAB exam and how does it help in initiating a medical career in UK?
There are many routes of entry into the UK for doctors who wish to train here. The easiest and most common one is to take the PLAB  (or Professional and Linguistics Assessment Board) exam and become GMC certified. Let me tell you a bit about this – basically any country that you work in has their own authority that confirms that you are good to practice in that country. For Pakistan, that authority is the Pakistan Medical and Dental Council, for the UK it is the General Medical council. Passing BOTH PLAB 1&2 gets you the license for the GMC to practice. After you get those out of the way and are certified then you are basically allowed to practice in the UK. That’s what people usually do.
The PLAB exams are the basic, entrance-level exams. You could potentially also get GMC certified by taking any of the more advanced membership exams for any of the Royal Colleges (but more about that at a later juncture – let’s keep this simple!)
The bottom line is you can not practice medicine in the UK without being GMC certified, and the easiest and most common route of entry to get that is to take the PLAB exams.
What kind of a format does this exam follow and what time limit does the candidate have for the exam
The PLAB has 2 parts – both are compulsory to pass individually. The first part is theoretical, and is based on the multiple choice questions format (or should I say, the single best answer format). You are given three hours to answer 200 questions. I have often heard people lament that the time is not enough, but I think it is doable. It may be difficult if you are not used to such a format, but in this field, better get used to this format, because later exams are also going to be in the same manner, same time frame (possibly even worse!)
The second part is interactive and consists of multiple stations. It is OSCE-based format, where each candidate rotates in 14 stations, each station assessing a different skill. Examples of such interactive sessions include taking a proper history, examining certain system, counselling a patient about something, and so on.
You can attempt the PLAB 1 as many times as you wish. Once you pass it, you have three years to pass the second part, failing which you will have to take the PLAB 1 again. You have 4 maximum attempts to take the PLAB 2.
Does the test have a certain validity?
Once you pass both parts of the exam and are GMC certified, you do not have to retake it again. You just have to keep up to date your assessments and your competence and you get re-validated automatically every 5 years.
 Any specific tips on cracking the test?
For the first part, I would advise go back to your roots, back to the basics. The whole syllabus is available on the GMC/PLAB websites. Try to practice as many questions as you can, get your tempo going, get used to this format before you take the exam. 2-3 months of prep should be enough.
For the second part, it can only be taken in the UK so make sure you have everything sorted before you travel for the exam. There are course available which guide and prepare and help practice the various stations that may come in the exam. These preparatory courses are much recommended before you take the PLAB 2 (if you have never worked in the UK or similar circumstances before).

FRCEM Intermediate (SAQ) – “Revisiting the recent past (recalling the nightmare!)”

  1. picture of a bruised foot. fallen off horse, foot stuck in stirrup and dragged upside down. now unable to weight bear. bruising evident on medial dorsal area and lateral plantar area of involved foot. what is the mechanism of injury? what is the injury?
  2. patient with small stab wound to epigastrium. X-ray (picture shown) shows air under diaphragm on right side. what is the finding on X-ray and what does it signify? what is the management plan for this condition? how will you investigate/comfirm diagnosis next?
  3. image of bilateral knees of a middle aged patient. presented with sudden swelling and painful left knee, which is shown as slightly swollen. cause? treatment/management?
  4. paeds patient, infant, barking cough every time they cough. sniffling viral like symptoms …diagnosis? management?
  5. anaesthetic machine shown with knobs for respiratory rate and tidal volume adjustment, rest rate set at 8/min. scenario given of patient with head injury, aside from other measures, what will you do to ventilator settings to help, and how will it help.
  6. picture of pneumothorax (right sided) shown. what are the 2 abnormalities in the radiograph? (i could only see the pneumothorax) management questions about where to insert the seldinger, and what common complication can happen and how will you avoid it (what measures will you take to ensure it doesn’t happen)
  7. elbow posterior dislocation image shown. how will you manage in ED (explain/summarise maneuver) and what nerve tends to be damaged and what will you look for on neurological examination. what x 2 steps will you do after reduction
  8. image of posterior dislocation of shoulder shown. radiological sign?
  9. young child, accidental ingestion of paracetamol syrup. asymptomatic. previous history of similar episode last year. what steps will you take? when will blood need to be drawn?
  10. wife presents to ED with injuries sustained from beating by husband. has minor children but are not currently living at home with her or husband and have not witnessed abuse. she self discharges and does not want to press charges. what steps do you need to take
  11. image of open mouth, what is the malampatti scoring?
  12. young male, fallen from 30 foot height, complaining of back pain. otherwise normal examination. what is the first reasonable investigation?
  13. head injury patient, subdural hematoma. gcs 13/15 initially, on revaluation, drops gcs to 10/15, what will be your next step in management? how will you proceed? if they initially are ventilating well, and then drop sats, how will you proceed further?
  14. transferring patient who is intubated and ventilated suddenly notice significant drop in sats, blood pressure OK, what is likely cause, how will you manage/proceed?
  15. sudden onset painful testicular swelling in young male – likely cause? management? what time frame? if not this, then what is the next likely cause
  16. young girl – dizziness and fainting spells. biochemistry shows hypoglycemia, borderline raised potassium, borderline low sodium. diagnosis? what investigation will you do?
  17. renal failure patient, sudden worsening. ecg shown, hyper acute t waves seen. diagnosis? management? mechanism of action of 1 drug that you will prescribe
  18. pregnancy 3rd trimester. abdominal trauma. abdominal pain, hypotension, diagnosis? management?
  19. middle aged female, found with suicide note and empty pill packets. low gcs. blood gas shows alkalosis, low co2, high bicarb. likely drug?
  20. paeds with sob, not eating, generally unwell but appears well, playing with toys, interacting, low sats but other jobs all normal no fever. cxr shown (normal looking?) ? diagnosis?
  21. elderly patient, hip fracture, fascia iliac block administered for pain relief. sudden dizziness, followed by cardiac arrest. cause? how will you manage? (dose and name of drug)
  22. how will you immobilize/pull femur on child with fracture femur? analgesia options?
  23. image of facial trauma during RTC – airway concerns? how will you manage complications/difficulty? what will you advise your colleagues to do or not do
  24. post vomiting, chest pain, car shown, findings? (subcutaneous emphysema)what 2 causes can be attributed to this condition? how will you investigate further to find out which cause this is
  25. ecg shown ? LBBB?
  26. ecg shown – VT – conscious patient with palpitations. shocks given x 3 not reverted, how will you manage further.
  27. epipen administered. what total dose in MG of adrenaline administered in single dose?
  28. seizure activity in epileptic patient, already on phenytoin. status epilepticus. diazemols/lorazepam 1 dose given. allergic to valproate. what is the next 2nd line drug to give?
  29. patient on warfarin, routine blood tests high INR of 8-9 no bleeding, recent antibiotics. what possible antibiotics would have been used? first step in management?
  30. female child from african country, returning from trip, feeling unwell, crying, not interacting. c/o ado pain etc. no fever, all obs normal. nurse noticed bloody discharge on underpants. likely diagnosis? who will you inform? how will you manage?
  31. hip pain, limping child, non traumatic? X-rays shown. what view is it? what is the diagnosis? what are x 2 common causes of hip pain without trauma in paediatric age group?
  32. renal colic clinical picture. analgesic of choice? investigation to confirm? complications?
  33. paracetamol overdose patient. what x2 investigations will you perform?
  34. elderly patient present with a fall. what bedside investigation can you do to rule out dehydration
  35. patient with ascites, fever, abdo pain. diagnosis? where will you put needle in for ascitic tap?
  36. patient with red eye shown (image) presents with sudden onset headache, vomiting. diagnosis? management? what topical drug will you administer in ED?
  37. elderly patient, agitated, needs cannula. what will you give to the patient? what will you tell the helping nurse to do?
  38. patient with chest pain. ecg shows inferior MI.
  39. IVDU. c/o back pain. tender lumbar region. diagnosis? investigation?
  40. question about intraosseous access
  41. young male with rectal bleeding and diarrhoea travelling from african/middle eastern country. cause? give non infectious/non inflammatory cause
  42. scenario is patient has ingested amyl nitrate. picture of patient’s wound site with swab on – showing bleeding, blood is ?darker color than usual? identify what the abnormality is, and how will you treat it
  43. high BMI (50) patient, unconscious/collapsed – what factors affect her airway and what makes it a difficult airway for her – what manoeuvres will you do to improve/mange these factors
  44. do not remember the question but size of cannula given and rate or time 1 litre of saline gets completely given through it

Interesting Observations on a mock OSCE Teaching Day

Hi all – so a few days back I had the unique opportunity to organize (OK who am I kidding? I helped to organise) a 1-day course for the FRCA OSCE exam in our deanery. We as the juniors of the department of anaesthetics/ITU/Theaters were called upon to help with various tasks: timekeeper for the different stations, be a patient for history taking, or be one of the relatives for counselling, be a mannequin for examinations, etc. I had a multitude of nominal tasks on the day, but what I found to be invaluable to me that day were a few observations that I made observing the various candidates as they filed through the different stations, and I list those observations here in no particular order to be taken as advice for all my colleagues who have OSCEs to take, bear these in mind:

– Be cognisant of time. As you walk up to the OSCE station, whether it gives you 30 seconds to read through an initial scenario or there is a piece of paper with questions written on it that you are expect to answer, get into the mental zone where you can mould yourself to give what is required of that particular station in the time provided. If there is one question that needs to be answered, you can be a bit relaxed, if there are 3 questions on the paper, make sure you are aware of the time you have to divide amongst them all to do justice to all. If the station requires an interaction with someone like a viva or a direct encounter, make sure you have a framework in mind, a mental checklist to check things off during the actual station so that you are not rambling on about your second point when there are 7 other things you need to be talking about.

–  When asked a question, don’t feel pressured to answer as soon as you sit down – take a breath, pause, ponder over the question for a few seconds, frame your answer for the next few, and then open your mouth to speak. Do not repeat the question back to the examiner in wonderment, as if puzzling it over, you may think you are buying time while you collect your thoughts, but it looks unprofessional. If you need time to answer, take it, but do not insult the examiners’ intelligence by repeating the question back word for word. It is a waste of time.

– When asked a question, avoid using pronouns like ‘you’ as a general term. “If you are on the floor for a long time, your creatinine kinase levels may rise.” While correct, it looks like you are addressing the examiner, whereas a more professional way to answer would be “Patients lying on the floor for extended periods of time may have elevated levels of creatinine kinase.”

– Following on from the previous point – when describing the anatomical location of anything, or a function, it is OK to use your hands to express yourself, but do not gesture towards your own body as a descriptor for your answer. In answer to the question Where can an IO needle be inserted? you may think it is the right answer to point to your sternum, your humerus or your tibial tuberosity, but it won’t score you any points. Also please practise certain expressions or gestures, gesturing towards your crotch for instance when talking about urinary catheterisation is inappropriate. And for goodness sake, it is even worse to point these things out on the examiners body.

– Use proper terminology, use buzzwords if you know them (we all know them) and specific things carry specific marks so make sure you attend some sort of course at least once in your life for OSCE practise so that you know what the examiner is looking for in a particular station when they ask you a particular question. Also, examiners know when you are beating about the bush and not getting to the point – so don’t waste their time (and yours), admit you do not know, and move on.

– Having done poorly in a previous station has no bearing on how you can or should perform in the next one – so do not let anything bother you. Yes, you may well have failed the previous station, but if you continue to mull over it or let it get to you, you may ruin your chances of passing the next one as well. Once you step out of one station, close that chapter, and open the next one with a clean slate.

–  Do not try to impress with big words and fancy terms – be simple, logical and just answer to the best of your knowledge. They are there to test your knowledge and see how good you are with using that knowledge. They are not there to ask for your hand in marriage.

–  If there is a written station, please write clearly. In our current professional examination climate, where usually there is a tick box or a fill-in-the-correct-circle type answer sheets, we forget how to answer the short answer type questions. Make sure it is legible. Your right answer is useless if no one can decipher it.

–  Read up on the simple things (in case of our anaesthetics colleagues, anatomy and physiology, undoubtedly – aside from the usual physics etc) – understand the concept behind why something is done or not done, and it will make it easier for you in these exams.

–  Study. I don’t know why it is so under-rated, that OSCE exams are interaction based and so I just don’t need to read up on how to take a history or do a pre-op assessment or perform a physical examination or test the cranial nerves – we do it everyday, and we get into a comfortable zone – but the exam might need for us to brush up on those skills and make sure we are not missing out on anything. MOST candidates missed an important part of the history taking station, as well as the counselling station – points were docked, valuable points, and for some that can mean the difference between passing and failing.

Guest Blog Post by Dr. Hassan Alraee – “My MRCEM OSCE Experience”

This is our second guest blog post from esteemed colleague Dr. Hassan Alraee – Emergency Medicine Registrar (Ireland). I take no credit for the following text.

Dear Colleagues,
I am sharing my MRCEM OSCE experience with you guys as I realized while preparing for the exam there was not much guidance available online. The aim of this post is to familiarize everyone with what the exam entails and a few tips which may be helpful in your preparation for the OSCE.
This may not be a structured or typical guidance post, it may come out as a random collection of thoughts but I will try my best to note down everything that was helpful to me during the preparation for the OSCE.
First of all to be eligible to appear in the exam you need to have passed the FRCEM Primary exam, passing the FRCEM Intermediate SAQ exam is NOT one of the eligibility criteria. However, in my experience passing the FRCEM Intermediate SAQ exam gives you a baseline in theoretical knowledge that is required for the OSCE. So it would be ideal to attempt the exams in the sequence that has been set, i.e. Primary, Intermediate and OSCE.
Before beginning your preparation for the exam have a look at the MRCEM Information Pack available on the RCEM website. A list of study material that may be helpful includes;
1. MCEM Part C: 125 OSCE Stations by Kiran Somani
2. Mastering Emergency Medicine: A Practical Guide by Mathew Hall
3. Bromley Webinars
4. At least 1 (if not more) of the following courses; The London Clinical Course, The Bromley Course or the Manchester Course.
The exam itself feels like a daunting task during the preparation phase as it is completely different to the previous parts and reading books alone is not the best way to get through it. My advice would be to stick to one of the above mentioned books and go through it once. The next step would be to create a practice group which should comprise of at least 3 members. This would mean all 3 of you would be able to rotate through different roles during the practice sessions, i.e. The candidate, The actor and The examiner. In my humble opinion this practice group is the key to being successful in the exam. The final step would be to book one of the above mentioned courses. In order to maximize the courses you need to be fully prepared for the exam by the time you attend the course and treat it as a Mock Examination.
Each of the courses has their own pros and cons but all of them are helpful in preparing you for the OSCE.
Each OSCE comprises of 18 stations, 2 of which are rest stations. The exam does not test your theoretical knowledge to a great extent, the stations in the OSCE are designed to test various skills. Like all OSCE exams there is a fair degree of play acting and exaggeration of your daily practices is required. By this I mean that the examiner will only mark you on the actions you perform during the exam, so make sure you show every step and tick most boxes in the examiner’s checklist.
The basic outline of the stations encountered within the OSCE are;
1) There are 2 to 3 history taking stations, remember to complete the station by giving the patient a management plan based on the history.
2) A Systemic examination station (CVS, Respiratory, Abdominal, Cranial Nerve or Peripheral Vascular examination)
3) A Joint examination station (Hip, Shoulder, Knee, Back, C-spine or a limb examination)
4) A Breaking Bad News scenario
5) There are 2 or 3 teaching stations which may include teaching a procedure or examination to a student or a junior doctor.
6) There is always a Conflict Resolution in the OSCE as well, which may be a missed fracture or pneumothorax or a difficult referral. This station also includes talking to a patient with Alcohol Dependence or Binge Drinking.
7) 2 scenarios within the OSCE are always Resuscitation Scenarios and test your skills in ACLS, APLS or ATLS. These stations seem like they are the most difficult ones while preparing for the exam, but in my opinion you can easily pass these if you make a good approach towards resus stations during your practice sessions. The Key to the resus scenarios is sticking to the ABCDE approach.
8) ENT and Eye station; in the exam they can check your knowledge on these in various ways it can be a simple otoscopic or ophthalmoscopic examination, teaching may be incorporated into it or history taking could be tested but there will always be a station that will involve ENT or Eye.
9) A quick assessment station; this one is a tricky one, it usually has the task of taking a short history, performing a focused examination and formulating a management plan based on your findings and summarizing it to the patient.
10) An Information Providing station; this station usually involves a relative of the patient to whom you have to explain a new diagnosis or management of a medical condition. Juvenile Diabetes Mellitus and Addision’s Disease are 2 examples that I can recall.
11) A Psychiatric Station is always present in the OSCE, you may be asked to performed a Mental state examination on a patient or assess suicide risk, they may add a conflict resolution component to this station as well.

In my opinion if you divide your preparation according to these 11 types of stations you will be able to cover most of the things required to be successful. Some additional topics that are tested in different ways and I haven’t categorized under the stations include; DVT, major incidents, seizures and driving advice. It would be wise to look up the NICE guidelines on these.
I would also suggest that you reach the city where the exam is being held one day earlier and have a look at your examination center that day. Just so you know how long it takes to get there and don’t have the extra stress of finding the center on the morning of the exam. Please spend your last 2 days traveling and relaxing, there is no point in trying to cram in stuff over the last 2-3 days as this is not a theoretical exam where they expect you to know everything.
On the exam day itself it is understandable to be anxious and stressed and believe me the examiners know that the candidates are under pressure and are not there to fail you. You should know that staying cool and calm is the most important feature that will enable you to be successful. It usually takes 1 or 2 stations to get into the groove of the exam as the 1st station comes up it is normal to feel a little nervous or blank out temporarily. Do not act bold and wing it if you are unsure about something, be safe at this stage and say you are unable to recall at this point in time and that you will consult the department policy or your consultant before implementing it.
Do not worry if any of your stations don’t go as well as you expected them to, leave the previous station behind you and move on to the next one. Do not let your performance on the previous station affect your performance on the next one. I know this is easier said than done but it has to be said as it is human nature to dwell on the past. You should also know that there is not a minimum number of stations that need to be passed to pass the exam, that was how it used to be in the past. The marking scheme has changed to a cumulative score now and a different passing mark is set for every OSCE day so even if you fail a station you carry forward marks from it towards your overall score. Therefore it is imperative that you score marks for the basic things on each station. Some of these include greeting the actor, washing hands before and after examination, wearing personal protective equipment (or at least mentioning it to the examiner), being warm and courteous and thanking the actor at the end. These simple things may be the difference between a pass and fail score in your OSCE.
I hope it was helpful for all those that are reading this post, good luck with your exam, with a bit of structure and practice I’m sure you will pass the OSCE.