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The objective structured clinical examination

Senior House Officer to Professor Oyebode, Queen Elizabeth Psychiatric Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2QZ

I read with interest the recent letter regarding the Part I MRCPsych OSCE (Yak et al, Psychiatric Bulletin, July 2004, 28, 265–266). However, I disagree with some conclusions.

From personal experience, most candidates feel that the OSCE does provide a fairer assessment of their skills, and I do not believe that the process of dissecting skills into an OSCE format is inherently harmful to the training of future psychiatrists. There are many important clinical skills that can be comfortably demonstrated within seven minutes; first-rank symptoms must be elicited before their context can be understood.

However, I would agree that too often, time itself becomes the major hurdle. This is quite contrary to clinical practice. If a difficult patient takes longer than expected in clinic, we would not rush them out, or end prematurely, but would take the necessary time and if required the clinic would overrun. The emphasis of the exam should not be different.

I am also concerned with the progression of the type of vignettes seen in the three OSCE exams so far. From the initial, very reasonable subjects, the cases are rapidly evolving into unreasonable scenarios. How many of us saw cases of temporal lobe epilepsy during our first year in psychiatry?

The OSCE exam, therefore, is less than perfect, but at least fair. I remain more concerned about the Part II examination, where candidates struggle against the hopelessness of the uncontrollable variables of patient and examiners. Perhaps it is the candidates, rather than the chief examiner, who adopt the mantle of Sisyphus (Tyrer & Oyebode, British Journal of Psychiatry, March 2004, 184, 197–199).

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