Some free resources for NAC

OSCE exam preparation

(Some of the NAC OSCE Network Facebook Group posts)
Vahid Nilforushan M.D.
Contact information

© Vahid Nilforushan M.D. 1

Frequently asked questions about NAC OSCE
• If you are just starting preparation for the NAC OSCE exam, you may
have questions such as:
• 1. Is this the right time to register for the NAC OSCE?
• 2. When should I start preparation?
• 3. Where to start and what to do?
• 4. How to proceed?
• 5. Should I take a course?
• 6. When should I take a course?
• 7. Which course should I take?

© Vahid Nilforushan M.D. 2

FAQs about NAC OSCE (cont’d)
• If you are among those who ask these questions from themselves, you will
certainly benefit from using a beginner’s video guide for the NAC OSCE exam
preparation.
• It is a valuable resource which is currently offered as free. Although it is not
comprehensive, it contains a lot of practical and useful points that can help you
avoid major, costly and irreversible mistakes in your journey.
• Even those colleagues who had already taken paid courses or had passed the NAC
OSCE or the MCCQE2 exam have found new and valuable points in this course as
the points discussed in the course are hardly available elsewhere.
• It contains 8 videos, a guideline, a checklist and a survey. The videos are about 1
hour long in total.
• The successful applicants are those who are serious, are concerned about their
results and complete the guide early in their preparation and apply its
instructions. Unfortunately, those who take it lightly or do not complete it, do not
usually get good results.

© Vahid Nilforushan M.D. 3

Focused approach
Conducting a FOCUSED history or physical examination is one of the most
important factors that contributes to a high score in NAC OSCE. The
importance of being FOCUSED is explained on the last paragraph of the
following link from the Medical Council of Canada website. It needs to be
read very CAREFULLY.
http://mcc.ca/examinations/nac-overview/osce-station-description/

N.B: A FOCUSED approach could be regarded as an approach which helps

you in making a diagnosis and ruling out some of the probable DDx and
complications for the CURRENT OSCE station

© Vahid Nilforushan M.D. 4

Focused approach: Two resources for DDx
There are two useful resources that can help you with DDx in any clinical
(NAC OSCE, MCCQE2, USMLE step 2 CS) or even non-clinical examination as
well as the real-world clinical encounters:

• 1/ Objectives for the qualifying examination accessible

at: http://apps.mcc.ca/Objectives_Online/objectives.pl?lang=english&loc=c
ontents

• 2/ First aid for the USMLE step 2 CS (book). Review mainly the mini-cases
section of the book. You may want to review the patient note page in the
practice cases section as well. It does not cover all the sections in the
Objectives (first resource), so you may miss some points that may be tested
in the Canadian exams if you rely solely on this reference. However, in
general it is an acceptable resource for a quick review of DDx in a short
period of time.
© Vahid Nilforushan M.D. 5
Focused approach: How to recall DDx
Recalling DDx, is one the most important keys to success in any clinical skills
exam or real clinical encounter. Writing DDx along with diagnostic studies on
flash cards or excel spreadsheets (from resources mentioned in previous
posts) could be very helpful for quick review and practice. Preparing excel
spreadsheets are specially useful, since you can review them on your cell
phone wherever you are. However, it takes time and may interfere with your
plans if your exam is scheduled for the near future.

Despite using the above strategy, the stress of the exam may still pose a
problem in recalling some of the DDx on the big day! In that case, there are
still two other strategies that can help you in most clinical encounters:

© Vahid Nilforushan M.D. 6

Focused approach: How to recall DDx (cont’d)
• 1- Use an anatomical approach. Think of the closest systems to c.c
followed by the furthest ones. Try to think of diseases in each of those
systems that could cause the c.c. For example for chest pain think of
diseases in Cardiovascular, Pulmonary, GI, Musculoskeletal and Nervous
system that could cause chest pain.
• 2- Use VITAMINS C or any other useful mnemonics. V= vascular,
I=infectious, T=traumatic, A=allergic, autoimmune, M=metabolic,
I=iatrogenic, idiopathic, N=neoplastic, S=substance abuse, psychogenic,
C=Congenital. For example for chest pain we can think of vascular,
infectious, traumatic, substance abuse or psychogenic causes. Keep in mind
that some of the questions that we routinely ask the patients (for example
h/o recreational drug use) is included in VITAMINS C.
Although the above strategies are very helpful, they may not be useful in all
the clinical encounters or may not cover all the causes.
© Vahid Nilforushan M.D. 7
Physical exam: an online resource
One of the useful free online resources for preparation for the physical
examination component of clinical skills exam is Geekymedics:
http://geekymedics.com/category/osce/page/3/. There are a number of free
videos regarding different parts of the PE.
The videos are valuable for IMGs who are looking for English phrases that
could be useful in communication with SP and examiner in OSCEs. They are
also a good resource for reviewing the signs of the diseases, as the signs are
displayed throughout the videos.
However, they may not be a perfect resource. The videos are
comprehensive and demonstrate a very systematic approach for PE. For
example, a video regarding abdominal examination starts with the
examination of hands, arms and oral cavity for signs of diseases related to GI
tract (Cirrhosis, IBD, …). Since in most clinical skills exams, a FOCUSED
approach is expected, following the same pattern may not lead to a high
score. Although we should try to be as systematic as possible, a better
approach for PE in NAC OSCE might be:
© Vahid Nilforushan M.D. 8
Physical exam: an online resource (cont’d)
• 1/Considering the patient’s age, sex, the clinical setting (office, emergency
room,…), Hx (if available), to narrow down the DDx, and so the PE.
• 2/Quickly noting the general appearance of the patient.
• 3/Asking the examiner for the VS. (if not posted on the doorway
instructions)
• 4/Performing a systematic examination of the abdomen (inspection,
auscultation, percussion and palpation), including any special tests needed,
followed by the CVA.
• 5/Mentioning the need for DRE and/or inguinal, genital or pelvic exam to
the examiner if appropriate.
• 6/At the end, if there is any time left, performing the other and less
important parts of the exam for the current clinical encounter.

© Vahid Nilforushan M.D. 9

Physical exam: an online resource (cont’d)
Although it may not seem a totally systematic approach, you will cover all
the NECESSARY parts that you need to do and are assessed for. This
approach is especially important for the combined Hx and PE stations.
Indeed, a FOCUSED approach is an approach which helps you in making a
diagnosis and ruling out some of the probable DDx and complications for the
CURRENT OSCE station.
Regarding the videos, you may need to modify some of the phrases as well.
(for example, telling the patient that I am going to examine your cranial
nerves is a use of medical jargon). You may also find some other resources
better in performing some parts of the PE.
In brief, although geekymedics might not be the best resource for the PE
component of the NAC OSCE, with some modifications you could find it
useful. If you are looking for a perfect resource for PE for the exam, you may
consider taking this course (or only the PE component of that course by
contacting its instructor).
• N.B: If you find it difficult to change the position of the examination table
for a part of PE, IMMEDIATELY ask the examiner for help to save your
valuable time.
http://geekymedics.com/category/osce/page/3/ © Vahid Nilforushan M.D.
10
Physical exam: an online resource for MSK
British Journal of Sports Medicine contains a collection of useful videos
regarding physical examination of the musculoskeletal (MSK) system. In this
collection, the videos presented by Dr. Hutchinson are especially helpful in
demonstrating the routine and special tests of the shoulder, hip and knee.
The videos are accessible here:
https://www.youtube.com/user/BJSMVideos/playlists
• N.B: In the acute phase of traumatic injuries, performing some of the
routine or special tests of the MSK system may worsen the injuries or may
not be tolerable by the patient. Thus, if the clinical scenario represents an
acute traumatic injury, a thoughtful, selective and modified approach
should be used for the physical examination of the MSK system.
© Vahid Nilforushan M.D. 11
Communication skills: an online resource
Doccom is a high quality resource for development of communication and
interpersonal skills in clinical encounters. It contains 42 modules containing
texts and videos. Although most of the modules need paid subscription, four
of the modules are free of charge.
The modules range from core interviewing skills to advanced competencies.
Although the level of communication skills presented in Doccom modules is
generally higher than what expected from examinees in NAC OSCE, the
modules are useful and demonstrate a patient-centered approach in clinical
encounters.
The free modules consist of: Build a Relationship, Responding to Strong
Emotions, Giving Bad News and Effective Clinical Teaching are accessible
here:
https://webcampus.drexelmed.edu/doccom/user/individual_logon_1.asp#fr
eeModules
© Vahid Nilforushan M.D. 12
Assessment and Management: an online
resource
"BC Guidelines" is a very useful resource with over 50 evidence-based
clinical guidelines that provides recommendations to BC physicians on
delivering high quality care to patients.
It contains important information regarding evaluation and management of
different and common clinical conditions such as acute chest pain, febrile
seizure, osteoporosis and abnormal liver chemistry.
It would be helpful to review the table of contents and select a few
important guidelines and read them in more depth before any medical
examination.
You can browse the guidelines by topic area or download the entire
collection of BC guidelines at:
http://www2.gov.bc.ca/gov/content/health/practitioner-professional-
resources/bc-guidelines

© Vahid Nilforushan M.D. 13

Assessment and Management: an online
resource
There are 4 important Clinical Decision Rules regarding ordering an imaging
study in Canada known as: Canadian CT Head Rule, Canadian C-Spine Rule,
Ottawa Ankle Rules and Ottawa Knee Rule.
They help physicians to standardize care of the patients and to be much
more selective in the use of CT and radiography.
They are accessible at the following link:
http://www.emottawa.ca/eng/70-publications_presentations.html

© Vahid Nilforushan M.D. 14

A survey to identify the role of different
factors in success in NAC OSCE
As we know, there are a variety of factors that can contribute to obtaining a
high score in NAC OSCE exam. However, NO QUANTITATIVE DATA is
available that shows the IMPORTANCE AND ROLE OF EACH FACTOR in
success in the NAC OSCE. This leads to more stress and less predictability in
the outcome of NAC OSCE.
To address this issue, I have designed A SURVEY to identify the factors that
have historically been associated with better NAC OSCE results. This will
help the future applicants to have a better understanding of the importance
of each variable in their success, so that they can focus their efforts on the
more important factors and will have a better estimate of their success
before taking the NAC OSCE.

© Vahid Nilforushan M.D. 15

A survey to identify the role of different
factors in success in NAC OSCE (cont’d)
Please take the opportunity to complete this survey after you take your NAC
OSCE. It will take approximately 5 minutes of your time. Your contributions
to this effort are greatly appreciated.
Please also share the survey link with colleagues who might be interested in
this effort.
All responses are kept confidential and are anonymous. For further
information, please go to the survey link at:
https://goo.gl/forms/8hQ8g38AX6vBKv962

© Vahid Nilforushan M.D. 16

 Good luck!

Vahid Nilforushan M.D.

Email: vnilforushan@gmail.com

© Vahid Nilforushan M.D. 17