Abstract
This is a British Royal College of Psychiatrist's publication that examines the relatively new MRCPsych part 1 objective structured clinical examination (OSCE). The first 30 pages are a very useful introduction to the issues surrounding the setting of OSCEs, their validity, the practicalities of organizing them and the rationale for using them as an assessment of clinical skills. This is very useful for anyone setting or organizing OSCEs for medical students or psychiatric trainees and contains an excellent synthesis of the evidence in this area. I have also found some of the scenarios in the subsequent section useful as a basis for modification when setting OSCEs.
The second and much larger section of the book is designed primarily for candidates sitting the MRCPsych OSCE exam. It could potentially therefore be useful to candidates sitting the OSCE in the Australian and New Zealand College exam. There are, in fact, some useful aspects to it. Each section has a series of scenarios with model interactions between a candidate and an actor. Particularly useful is the section entitled ‘Key points to be covered’. This could be a very useful basis from which registrars could construct mental checklists for a number of possible scenarios.
The actual model interactions I found slightly less useful. They consist of short pieces of dialogue that are designed to illustrate ideal approaches a candidate should take to each scenario. The problem with this is that OSCE scenarios and real life interviews are infinitely variable and trying to learn ideal approaches from a book does not seem to me to be particularly useful. I would generally favour skipping this part and substituting lots of real practice. However, the explanation of ‘sensate focus’ and the parallel of this to Arsenal's soccer training drills in Chapter 12 is worth reading just for its entertainment value.
More useful potentially is the CD-ROM included with the book, which includes a number of small sections of interviewing. In some cases these are designed to illustrate good and in others bad interview technique. It is always going to be easy to criticize the ideal interviews, it is clearly very brave of the authors to produce such a CD and opinions always differ regarding good interview technique. However, although most of the clips are useful there were some notable exceptions such as the patronizing and irritatingly indirect approach to the man with a gamma GT of 657 in which the interviewer seemed strangely reluctant to use the word ‘alcohol’.
Overall I would recommend this book to those who set OSCEs and to registrars who are candidates for the Australian and New Zealand exam. However, for the latter in my opinion it should be approached selectively, and in the context of ongoing practice and instruction from colleagues.
Richard Porter
Christchurch, New Zealand
© 2007 Richard Porter