Preparing for the OSCE and VIVA.

by Dr. Ed Hughes & Dr. Claudia Porteous

Passing the Written.

We've all been there. It's written results day, and after four weeks of the exam taking a back seat it’s here again. You spend all day watching for the results, checking The College twitter feed, refreshing your inbox, waiting. Then it happens, the email drops into your inbox. There's your candidate number and the word ‘PASS’ emblazoned next to it.

Congratulations, you've done it, you're halfway there. Ride the crest of this wave to the end of your exams.

In passing The Written you will have gained the knowledge you need to pass the remainder of the exam. It's now a case of honing your presentation so that you can shine when you arrive at The College.

But how do you do that? How do you communicate your vast knowledge in a clear and concise manner? How do you learn to do this in 6 to 8 weeks?

The short answer is practice.

The long answer is that there is an entire set of inter-related skills that are pivotal when communicating clearly under pressure.

The OSCE and VIVA require different but complementary approaches. Neglect either at your peril.

What you need

The greatest asset you have in preparing for the OSCE/VIVA is people. You need to feel comfortable talking at length, and you don't have to be selective in who you talk to. There are some higher yield opportunities than others, in order of personal preference these are:

  1. A trusted, critical friend. Especially one who has done or is doing the exam. They need to be a good enough friend to be honest with you when your performance requires improvement, but kind enough to tell you in a way that is productive rather than punitive.
  2. Consultants. They can be a brilliant resource. Practicing with a boss introduces a formal element similar to the exam. However, be mindful that for many consultants the experience of the exam may be a distant memory (or they haven’t had personal exam of sitting FFICM) Their ability to generate a pressure similar to the exam may be limited. Speaking from experience, it can also be hard for a senior to provide an honest and well-meaning critique in a way that does not inadvertently harm your confidence.
  3. Junior Colleagues. As the saying goes, if you can't teach it, you don't understand it. Take every opportunity you have to teach as the chance to practice your viva techniques. Be aware that they may not question or interrupt you like an examiner would, but it is a good way to explore the limits of what you know with a captive audience.

But what do you talk to these people about?


Twelve stations.

Subjectively this will be both the fastest and slowest 3 hours of your life.

Rapid, quick-fire knowledge wins the day here. The skill is being able to quickly recite facts with no wasted words. You must be able to think fast and flexibly.

Before you begin preparing for the OSCE your knowledge is nebulous, swirling, and unformed. You might know everything but it's difficult to access quickly. The work preparing for the OSCE is to crystallise that knowledge and make it razor sharp. Two things will help you do that.

The first is to use the books listed in the recommended resources with your trusted friend and talk through as many past stations as possible. The key is to be strict with the answers and stricter with timings. Your responses need to be like monosynaptic reflexes with their speed. On the day, your exchanges with the examiner will be rapid, with your examiner being focused on checking points off the mark scheme. You cannot waste time being silent. This isn't to say that you can spend the entire station spewing a word-salad in the hopes of scoring points, the examiners are aware of that tactic. Your responses need to have a loose structure and minimal narrative. This brings me to the second element.

You need to work in structuring your knowledge around frameworks that will allow you to access it rapidly. Some topics lend themselves to well-known frameworks such as the causes of acute kidney injury. Others will require you to use your own. Try to break questions down into certain categories and come up with frameworks for each, such as causes/differential diagnoses, diagnostic modalities, treatment options, supportive/ disease modifying therapy. You don't have to verbalise your framework, doing so would be a waste of time, just use it to activate your prior knowledge.

Finally, you need to go into this exam with the low hanging fruit in the bag. You are guaranteed stations on ECG's, radiology, and simulation. These should be marks in the bank for you with appropriate revision. Check out the examiners reports and a couple of ECG and Radiology libraries before you head down to The College. Learn a structure for reviewing ECGs and Xrays – this will help you to ensure you don’t miss the easy marks.

Go into that room with grit and determination. It's a tough exam, and you need stamina. There will be questions that make the ground feel like it's falling away from under you. You have to roll with the punches and not let it affect your performance in subsequent stations. There are no killer stations. It’s a cliché but this is only an exam. Yes, you’ve worked really hard, but no one will die If you mess it up.

Be prepared to be constantly asked anything else? This means the examiner is trying to get every mark for you, don’t be alarmed. Most commonly you missed an easy mark, pause take a deep breath, think from the start.

It's not over until that bell rings for the last time and sets you free.

The VIVA (Structured Oral Exam)

The SOE is a different beast to the OSCE. This exam is still a test of knowledge, but to pass you need to communicate that knowledge in an effective manner. This requires composure and technique.

To start, look through the published questions on The Faculty website. You'll see that each question has approximately 5 stems arranged around a central theme. Look at the amount of content, there is easily in excess of 30 discussion points in each question. Finally, look at the mark scheme, you'll be graded from zero to three.

What you need to take from this is that the mark scheme cannot capture all detail the of the question and the examiners are afforded a degree of license in how they assess candidates. You don't have to know everything to pass, you just need to project the confidence and competence of a doctor who is approaching consultancy. It is very unusual to sit a viva and not get asked a question you don’t know, get used to this feeling, having composure whilst dealing with this is key to passing the exam. This style of communication is a skill that can be learned

Practice is the key. However, where the OSCE required distilled facts and speed, the SOE needs care and finesse. Take the sharpness the OSCE has given you and present those facts with a smile.

When you’re practicing:

  1. Always pause before you begin to speak. Collect your thoughts. Think of your system, know where your sentence is going to end. Eliminate thinking noises and filler words, it will make your delivery seem confident and assured.
  2. Try to categorise – examiners have to test both breadth and depth of knowledge. If you categorise, your examiner can help to guide you to the areas where they are more marks.
  3. When you begin speaking make eye contact with your examiner, smile, and talk in a steady ever pace. You might not feel confident but fake it until you make it.
  4. Practice using stock phrases to succinctly state obvious points in your answer. Please see some examples listed below.
  5. Answer the question that you are asked. If you don't know the answer say what you know, not that you don't know. Finally, only when you have completely exhausted your knowledge it is ok to say “I don't know”.
  6. Maintain your composure. You've been in far more stressful situations than this. Don't let the occasion get to you. If you get flustered you won't be able to access your knowledge effectively. Even if you think you are doing terribly, persevere. I've lost count of the number of people who have told me they have done poorly and when results come though they have aced it. I've done that myself.

Practice. Practice until you are sick of it. When you get to the point when you don't care and you cannot do anymore, you're ready.

If you're struggling with getting practice, take a look at's MASTER Course. We keep the numbers low to protect quality but we will teach you how to be successful in an SOE.

As you prepare, check out our articles about what to expect on the day and (hopefully) what to do after the FFICM.

Good luck, and we'll see you on the other side.