Canadian Virtual OSCE Content Checklist / "Must-Know" Content

I. Introduction

Unlike traditional in-person OSCEs, virtual examinations present unique challenges that require candidates to adapt their communication, clinical skills, and reasoning for a remote setting. However, the set-up of OSCE stations remains the same. You may find that it is even more difficult to conduct a thorough exam through a screen than in-person. This medical exam OSCE checklist is designed to help you navigate the virtual format confidently and efficiently. For additional preparation, the NDEB Preparation Course provides further information and practice.

II. Key Features of the Virtual OSCE

The virtual OSCE is designed to mimic clinical interactions using digital platforms. Key features may include:

• Use of online platforms: Simulated clinical scenarios are conducted over video conferencing tools such as Zoom.
• Emphasis on communications: With physical exams limited, there is an emphasis on clear and concise communication to obtain and interpret key information and provide management.
• Adaptability: Candidates must demonstrate flexibility and professionalism despite the constraints of a virtual setting.

To prepare yourself for the virtual OSCE, a working camera, microphone, and stable internet is required. Ensure that you have a test run on your computer using the online platform in which the virtual OSCE is being conducted prior to the exam. Ensure that your workspace is free of clutter and that there are no distracting elements that may be visible to the examiners. 

Be prepared for any technical glitches that may arise during the exam. Oftentimes, the online platform provides a point of contact for such events. Ensure that you have this on hand prior to the exam.

III. General content checklist

• Virtual-specific communication: Develop the ability to build rapport, explain clinical reasoning, and gather information about medical history and chief complaint effectively through a screen.
• Professionalism: Maintain eye contact, appropriate tone, and posture. Dress professionally and minimize background distractions.
• Technical preparation: Ensure a stable internet connection, working microphone and camera, and a quiet, well-lit space.
• Clinical reasoning: Verbalize thought processes clearly since non-verbal cues and physical assessments are limited.
• Time management: Stay aware of station time limits and structure responses accordingly.

IV. System-based OSCE checklist

Each body system has unique OSCE expectations. As you move through the OSCE stations, you will find that patients will have varying presentations of signs and symptoms and it will be up to you to conduct a thorough examination and narrow down their specific condition. Here's a comprehensive OSCE exam checklist to help you review each system:

Cardiovascular system

History taking:

• Assessment of past medical history, current medications, vitals
• OPQRST pain assessment: onset, provocation/palliation, quality, region/radiation, severity, timing
• Assess virtual clues: breathlessness, posture, visible swelling or skin changes on camera (e.g., ankle edema, sweating, pallor)

Key patient descriptions and common conditions:

• Palpitations - arrhythmias, anxiety, hyperthyroidism
• Chest pain - myocardial infarction, angina, hypertension, GERD
• Breathlessness - pulmonary embolism, congestive heart failure
• Swelling of extremities - peripheral edema, deep vein thrombosis

Respiratory system

History taking:

• Onset and pattern of cough (productive or dry), wheezing, and shortness of breath.
• Ask about triggers (exercise, allergens), occupational exposure, and smoking history.

Online assessment tips:

• Listen for audible wheeze or cough during the consultation
• Observe use of accessory muscles
• Interpretation of findings: walk through auscultation assessment and spirometry results

Common conditions:

• Asthma
• Chronic Obstructive Pulmonary Disease (COPD)
• Pneumonia
• Pulmonary embolism

Gastrointestinal systems

History taking:

• Clarify abdominal pain characteristics: location, timing, food-related
• Ask about symptoms: change in bowel habits, blood in stool, weight loss
• Past medical history, medications, and family history of GI cancers or inflammatory bowel disease

Online assessment tips:

• Patient’s posture and discomfort during sitting may offer subtle clues
• Guide patients for self-assessment. You may find it helpful to demonstrate areas to palpate to guide your assessment.
• Interpretation of findings: labs (liver function tests, breath tests for H. pylori), read and explain abdominal ultrasound or CT scans

Common conditions

• Gastroesophageal reflux disease (GERD)
• Peptic ulcer disease
• Irritable bowel syndrome (IBS)
• Inflammatory bowel disease (IBD)

Neurological system

History taking

• Ask about any motor/sensory symptoms, aura, or headache onset
• Review their time course of symptoms - sudden or gradual?
• Prior episodes, family history, and medication use

Online assessment tips:

• Observe for facial droop, slurred speech, tremors
• Assess mental status by orienting the patient of date and location
• Assess cranial nerves by conducting an online neurological exam. A previously published Virtual Neurological Exam may help guide you. 
• Assess gait by having the patient walk towards and away from their computer.
• Interpretation of findings: walk through brain imaging results (CT/MRI), localize lesion based on the symptom pattern from your assessment

Common conditions

• Stroke or Transient Ischemic Attack (TIA)
• Migraine vs tension headache
• Seizure vs syncope
• Parkinson’s disease
• Multiple sclerosis

Musculoskeletal system

History taking:

• Pain onset, severity, provocation, pattern (inflammatory vs mechanical).
• Ask about trauma, fever, weight loss, night pain.
• Ask about functional limitations, such as walking or dressing.

Online assessment tips:

• Observe the patient’s posture
• Ask the patient to move to assess the range of motion
• Observe any joint swelling or deformities visible on video
• Interpretation of findings: X-ray or MRI of joints, labs (ESR/CRP, rheumatoid factor, uric acid levels)

Common conditions

• Mechanical back pain
• Osteoarthritis
• Rheumatoid arthritis
• Rotator cuff injuries
• Gout 

Obstetrics and Gynecology

History taking:

• Clarify pregnancy status
• Review details of their menstrual history: age at menarche, regularity, pain, flow
• Ask about contraception, sexual health, and screening history (Pap smears, STI tests)
• It is important to approach these questions with sensitivity. Use supportive and nonjudgmental language.

Online assessment tips:

• Observe emotional state - anxiety, distress, or tearfulness may be evident
• Be alert to signs of abuse, especially in reproductive health consults.
• Interpretation of findings: discuss prenatal screening results, explain pelvic ultrasound images and hormone labs.
• Be prepared to discuss the basics of prenatal counseling.

Common conditions

• Early pregnancy bleeding (miscarriage, ectopic pregnancy)
• Prenatal care and screening
• Pre-eclampsia 
• Gestational diabetes and hypertension
• Postpartum depression
• Menstrual-related conditions (amenorrhea, menorrhagia)
• Pelvic pain and STIs

V. Pediatrics

History taking:

• Focused developmental history: milestones, nutrition, behaviour, sleep
• Birth history (for infants): term/preterm, delivery complications, NICU stay
• Review immunization status
• Ask about fever pattern, feeding, behavioural changes

Online assessment tips:

• Observe child’s level of alertness and interaction during the call
• Note breathing pattern (tachypnea, nasal flaring) and skin appearance
• Be aware that in a remote consultation, it may be more difficult to engage the guardian and child
• Interpretation of findings: interpret growth charts and developmental screening results
• Be prepared to provide anticipatory guidance: feeding, safety, and when to seek urgent care

Common conditions:

• Fever in infants and children
• Asthma exacerbation
• Otitis media
• Gastroenteritis and dehydration
• Developmental delays
• Rashes (eczema)

VI. Communication skills

Succeeding in the Virtual OSCE requires more than just clinical knowledge - it demands adaptability, clear communication, and professionalism in a virtual environment. 

• Learn how to develop a rapport through the screen to make your interactions more genuine.
• Use the ‘SPIKES’ (Setting, Perception, Invitation, Knowledge, Emotions, Summary) protocol when delivering bad news or discussing sensitive topics
• Check patient understanding at every stage: “Does that make sense to you?”
• Ask for feedback or clarification: “Would you like me to explain that in more detail?”
• Use layman’s terms when verbalizing your differential diagnosis, next steps, and management
• Keep transitions smooth between history, interpretation, and management

VII. Examination Techniques in Virtual OSCE

You will find that performing a clinical exam virtually is completely different from in-person and will demand more precise language and communication.

• Provide clear and concise instructions for patients to perform self-assessments and physical exams. 
• Use non-verbal clues to help you in your assessment. This may include the patient’s physical status, emotional appearance, and language.
• Be prepared to use online imaging and lab result tools to interpret and demonstrate your findings.

VIII. “Must-know” Medical Conditions for Virtual OSCEs

An organized breakdown of common conditions and approaches for diagnosis and management:

Practice and Preparation Tips

Preparation for the Virtual OSCE can be overwhelming. Provided are some skills to develop and practice tips.

IX. Conclusion

By following this OSCE checklist and honing both your technical setup and clinical skills, you can approach your exam with confidence. Use this guide as a foundation, and supplement it with system-specific practice to ensure you’re ready for every station.

X. FAQ

Q: How are physical exams conducted in a virtual setting?

A: A physical exam in a virtual setting demands more communication by the practitioner. Unlike in-person exams, you will not be able to obtain pertinent information through routine assessments. Depending on the OSCE stations, you will have to obtain information from visual clues, thorough history taking, and by talking the patient through a self-performed physical assessment. As such, clear and concise communication becomes even more essential in this type of examination OSCE.

Q: What should I do if technical issues occur?

A: Remain calm and be patient, examiners understand that technical issues may arise during the Virtual OSCE. Oftentimes, the online platform used for the Virtual OSCE will have someone on hand to manage technical issues and the contact information is usually provided to examinees prior to the exam. Prior to the exam, ensure that you have a working camera and microphone, and a stable internet connection.

Q: Do I need to prepare differently for Virtual OSCE compared to traditional OSCE?

A: Like a traditional OSCE, the Virtual OSCE is designed to test the candidate’s medical knowledge, clinical skills, and ability to diagnose and provide a management plan. To practice medical diagnosis and treatment, the NDEB Preparation Course provides representative questions and high-quality solutions.

Additionally, it assesses the candidate’s ability to communicate effectively and demonstrate empathy. To prepare for the Virtual OSCE, additional skills should be practiced such as instructional communication to guide the patient’s self-performed assessment, detailed history taking, and attention to visual cues. These will help guide the candidate in their virtual exam for thorough diagnosis and management.