A guide to understanding the OSCE

October 21, 2022

If you don’t know where to begin with the Nursing & Midwifery Council OSCE, this post will give you an overview of the essentials. It’s not an in-depth study guide, but it will get you started with what you need to know. I should note that this will cover the format of the OSCE from 2021 onwards which is the newest format of the exam.

What is the OSCE?

The NMC Objective Structured Clinical Examination for nurses and midwives. Now that’s a mouthful… From here on we’ll just call it the OSCE.

The NMC OSCE is an in-person exam which American nurses must pass to receive their nursing license in the United Kingdom. An OSCE is known in the UK clinical environment and is essentially a simulation-based testing format which is used to assess clinical skills, attitudes, and behaviors.

I can only liken it to an amped up version of nursing school check offs.

-> Just starting to look at becoming a nurse in the UK? Read ‘6 steps American nurses must take to get a license in the UK.’

Where can I take the OSCE?

You must “sit” the OSCE in the UK. There are only 5 approved testing centers which is an improvement on the 2 that were available when I took the exam in 2018. There is talk of approving more sites for administering the exam, but the newest ones were only added recently.

As of 2022 the list of approved OSCE providers is:

Oxford Brookes University
University of Northampton
Ulster University
Northumbria University
Leeds Teaching Hospitals NHS Trust

How much does the OSCE cost?

The fee for the OSCE is £794. This may or may not be a fee that you have to pay yourself depending on whether you have found an employer which is willing to foot the bill. Many NHS hospitals are providing this as a benefit to their internationally educated nurses and I imagine most of the private ones would, too. However, if you are planning to get your license before applying to jobs, then you will have to pay this fee. Read more about the costs associated with getting your UK license here.

At what point do I have to take the OSCE?

The OSCE is officially known as the NMC Test of Competence Part 2 OSCE. For those wondering, the NMC Test of Competence Part 1 is the CBT (computer-based test) and you can read more about it here. With such long names and so many ‘parts’ you can see how it can get confusing. The website says you can take them in whichever order you like, but I think it is only under rather unusual circumstances that anyone would take the OSCE before the CBT. More often than not, the OSCE will be your final step before receiving your license.

What topics does the OSCE cover?

The OSCE is divided into 3 distinct sections referred to generally as APIE, Skills, and Written Stations.

I’ve created a little diagram to help show how the tests fit together and the information they cover.

The NMC OSCE APIE

Staying true to healthcare form, we have a list of acronyms.

APIE stands for Assessment, Planning, Implementation and Evaluation. For this section of the test you will have 1 patient that stays the same all the way through. The Assessment station requires you to do an A-E assessment and take their vital signs. In the Planning station you need to write up 2 nursing care plans. The implementation station is a drug round that requires you to go through the written drug chart and administer the appropriate medications. And finally, the Evaluation station is a verbal handover of your patient.

The skills

There is a long list of skills that the test centre could ask you to demonstrate for your OSCE. Thankfully, from that long list you will only have to do 4 of them – more specifically 2 pairs of skills.

Generally the skills are related, but they don’t necessarily have to be i.e. catheter care and catheter specimen of urine in one station and peak expiratory flow rate and administration of inhaled medication in the other.

The written stations

There are 2 more stations included in the OSCE and they are both ‘written stations’. The first tries to assess your ability to interpret research and apply it to practice (evidence-based practice). And the second is gaining insight into your professional values and behaviors by asking you to comment/reflect on a specific scenario. The NMC code will be your friend for this one.

What makes it so difficult?

Depending on the area of nursing you’ve been working in, the OSCE may not seem so difficult on the face of it. Whoever you are, if you do truly exist, I’m envious. Coming from a labor and delivery background, I was worried about the general medical, surgical, neurological patients that might present themselves in my exam. I learned to be a nurse in a very specialized area and even though I knew that I had a solid foundation of nursing knowledge, the unfamiliarity of it all made me anxious.

To add to that, there is a large range of patient scenarios and skills that you could encounter for your OSCE and the testing centres are always updating and adding to their repertoire. You should always stay alert to any changes which may be on the horizon. For example, at the time of writing this, the newest scenarios and skills are scheduled to be added in November 2022.

If all of that is sounding ok, then there may be nothing to worry about… unless you’re camera shy? You may or may not know already, but the testing centres videotape you throughout your exam. If there is ever any question about your performance or how you’ve been marked, then the recordings can be accessed and reviewed. I think they hardly ever are, but just knowing that the cameras are on makes my palms go all sweaty.

Anybody else reliving that mortifying moment in nursing school when the entire class watched the recording of you being the nurse in the simulation lab? No? Just me?

The other unnatural component of the OSCE is having to say everything that you are thinking or doing, understanding exactly which elements they are honing in on, and figuring out how to use the equipment that the NHS has available. The dressing packs, the trolleys, the trays. It only makes sense once you’ve been shown what is expected.

Lastly, but perhaps most importantly, this exam is the last step to getting your NMC nursing license. It determines whether or not you can stay in the UK. The amount of pressure that adds can’t be underestimated.

I don’t want to scare you off, but knowing what’s ahead and preparing for any potential wobbles along the way will help you cope with the nerves on that long ride to the testing centre be it on the train, plane, taxi or bus.

How do I prepare for it?

There are a few different ways to prepare for the OSCE and it really depends on your experience, the way you learn, and how adaptable you can be in practice (think new culture, new system, etc).

I opted to go through my employers OSCE preparation programme because I knew they would know what the test providers were looking for and I wanted the extra guidance. The clinical educators booked everything for me which meant that I had to sacrifice some control over my journey. For me that was made more obvious by the fact that I had gotten myself through all the previous steps. For some, that may not be an area of concern.

There are some courses you can pay for which last a varying amount of time. I don’t have any personal experience with any of them, but have heard from others that they have been helpful.

You can do it all yourself and use resources like the Royal Marsden to study. If you feel confident enough and you have the cash to pay for the exam and any resits that you may need, then this may be a viable option.

Resources

OSCE Handbook

NMC Webpage about the OSCE

NMC Preparation Materials (including webinars)