Kgothatso Legong – sixth year medical student at Sefako Makgatho Health Sciences University - offers some advice to junior doctors preparing for their OSCE slide show exams.
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The Objective Structured Clinical Examination (OSCE) is one of the most nerve-wracking, yet rewarding, experiences in medical school. While much of the OSCE involves live stations with standardised patients, another common format is the OSCE Slide Show: a timed, image or scenario-based assessment that tests your ability to recognise signs, interpret results, and apply clinical reasoning quickly. Preparing well for this format requires a different kind of strategy. Here’s how to do it right.
1. Understand the format and purpose
In an OSCE Slide Show, you are typically shown a series of clinical images, charts, investigations, or short clinical scenarios, each timed for 30–90 seconds. You may be asked to identify a diagnosis, interpret a lab, suggest a management step, or list relevant differentials. It’s rapid-fire, and you don’t get time to second guess, a lot of time.
Tip: Ask your tutors or seniors what types of slides your school tend to use, dermatology, radiology, ECGs, and fundoscopies are especially common.
2. Revise visual diagnosis topics
You need to be fluent in pattern recognition. Focus your revision on image-heavy systems: In dermatology, learn to identify common rashes (eczema, psoriasis, measles, impetigo). For radiology, chest X-rays (pneumothorax, heart failure, pneumonia), abdominal films, fractures. Ophthalmology: Red eye, fundoscopy findings (e.g. papilledema, diabetic retinopathy). ECGs: Basic rhythm strips - AFib, STEMI, heart blocks. Procedures & Instruments: Know how a nasogastric tube, chest drain, or cannula looks and how it’s placed.
Use flashcards or image-based applications or even Google Images to quiz yourself.
3. Practice with timed slides
Simulate the real format. Gather clinical slides or screenshots from textbooks, lecture slides, or past assessments. Set a timer and challenge yourself to answer each one in under 60 seconds. Don’t pause. This builds speed and confidence under pressure.
You can also practice in groups:
- One person shows a slide.
- The others must respond within a set time.
- Discuss the reasoning and reinforce correct answers.
4. Use a systemic approach
Time is short so train yourself to think and answer systematically.
For images, ask yourself these questions:
- What is it?
- What system does it involve?
- What is the most likely diagnosis?
- What is the next step?
For ECGs or X-rays:
- Start with rate, rhythm, axis.
- Look at obvious abnormalities.
- Mention key signs (e.g. “batwing pattern” in pulmonary oedema).
For labs:
- Recognize key patterns: Diabetic Ketoacidosis (DKA) (↑ glucose, ↓ bicarb), cholestasis (↑ALP, ↑GGT), etc.
- REMEMBER: Always mention the most clinically significant abnormality first.
5. Don't skip the basics
Sometimes the most obvious things are missed:
Know normal values and revise them. Remember, for paediatrics and obstetrics the values might be different from the ones in internal medicine. Furthermore, recognize common patterns. Don’t overcomplicate, this isn’t a time to show off rare syndromes unless they clearly apply.
In conclusion, an OSCE Slide Show tests your ability to recognise, prioritise, and respond quickly, just like real clinical practice. With enough visual exposure, structured thinking, and timed drills, you’ll build the pattern recognition and confidence you need to walk in calm and walk out strong.
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