Do you often find yourself asking irrelevant questions when you do OSCE role play?
Do you walk out of a station knowing you asked something, but not the right things?
Do you ever finish a practice station and think:
“Why on earth did I ask that?”

If you are an IMG doctor preparing for the AMC Clinical (OSCE) exam, then this is one of the most common — and most damaging — patterns I see.
And no, it is not because you don’t know medicine.

Rather, it is because panic makes you abandon structure.

For that reason, I’m writing this directly to you — the IMG doctor who freezes, overthinks, and starts asking random questions the moment the timer starts.
If this sounds like you, then please read on.

You Are Not the Problem

First and foremost, let me say this clearly.

You are not stupid.
You are not unsafe.
And you are not failing because you lack medical knowledge.

Instead, you are failing because panic hijacks the way you use what you already know.

Importantly, I say this as someone who:

• Passed the AMC Clinical (OSCE) exam on my first attempt

• Teaches AMC Clinical (OSCE) one to one

• Examines OSCEs for Australian medical faculties

• Has coached many repeat sitters who were convinced they would never pass

Over the years, I have watched extremely capable doctors fall apart in OSCE stations.
However, I have also watched those same doctors pass — once their panic was contained.

The Pattern I See Again and Again

To illustrate this, let me describe a very typical AMC Clinical (OSCE) scenario.

You walk into the station already tense. You have memorised guidelines, differentials, and management plans.
However, the moment the simulated patient starts talking, your brain begins to race.

As a result, you suddenly:

• Ask too many questions

• Jump between diagnoses

• Lose the focus of the station

• Run out of time

• Walk out knowing you messed it up

Later, you tell me:

“I knew all of that. I don’t know what happened.”

What happened was loss of containment.

Ultimately, the AMC Clinical (OSCE) is not testing how much medicine you know.
Rather, it is testing whether you can behave like a safe Australian intern under pressure.

Why IMG Doctors Panic More in the AMC Clinical (OSCE)

Not surprisingly, IMG doctors panic more — and there are very real reasons for this.

Firstly, fear of failing again.
Many of you have failed once, sometimes more. Each attempt adds pressure.

Secondly, the stakes are extremely high.
Your visa, career, finances, and family plans may depend on this exam.

Thirdly, cultural overcompensation plays a role.
Many IMGs feel they must impress the examiner to prove they are “good enough.”

Finally, there is simply too much unfiltered knowledge.
You know medicine — but OSCE is not real-life medicine.

In reality, the AMC Clinical (OSCE) is a performance exam.
And panic destroys performance.

Examiners are not marking brilliance.
Instead, they are marking safe, structured clinical behaviour.
Consequently, a calm, average answer often scores higher than a clever but chaotic one.

The Brutal Truth About Random Questions

At this point, I need to be very honest with you.

In the AMC Clinical (OSCE), random questioning is not harmless.
In fact, it actively loses you marks.

When you ask questions that are irrelevant to the task — for example, taking a sexual history from a patient presenting with acute chest pain — it is usually because you are anxious, not because it is clinically indicated.

Unfortunately, what the examiner sees is this:
“This candidate is unfocused and unsafe.”

Clearly, that is not the impression you want to give.

Panic Is Not Ignorance

Panicking candidates often say to me:

• “My mind went blank.”

• “I asked all the wrong questions.”

• “I knew it afterwards, but not in the station.”

What is really happening, however, is cognitive overload.

Too many possibilities compete for attention. As a result, your brain jumps from one idea to another, and you lose the story of the station.

So the real question becomes:
How do you contain your thinking and stay structured in the AMC Clinical (OSCE)?

Step 1: Change the Story You Tell Yourself

To begin with, the first thing I work on is your internal narrative.

I want you to replace this:
“I need to be impressive.”

With this:
“OSCEs reward structure, not intelligence.”

This single shift immediately reduces panic.
In other words, thinking less — but thinking clearly — scores more.

Step 2: Use One Rigid Structure for Every Station

Panicking doctors struggle because they have too many options in their head.

Therefore, I deliberately reduce choice.

Every AMC OSCE station should follow the same basic sequence:
Opening → Agenda → Core task → Safety → Closure

No creativity.
No improvisation — at least not initially.

For example, in a history-taking station:

1. Introduction and identity check

2. One open-ended question

3. Focused, relevant history only

4. Brief ICE (Ideas, Concerns, Expectations)

5. Summary and plan

If you feel lost, simply return to the sequence.
The sequence will save you.

Step 3: Learn What Not to Ask

Most panicking candidates are constantly thinking:

• “Should I also ask about this?”

• “What if the examiner wanted that?”

• “What if it’s actually something else?”

This is precisely where you lose marks.

OSCE success depends just as much on knowing what not to ask as what to ask.
In short, relevance beats completeness every time.

Step 4: Calm the Body to Calm the Mind

Importantly, panic is not just psychological — it is physical.

Before every station, try this simple ritual:

• Feet flat on the floor

• One slow breath in for four seconds

• One slow breath out for six seconds

• A silent phrase: “One patient. One task.”

It takes less than ten seconds.
Nevertheless, examiners absolutely notice the difference.

Calm body language communicates competence before you even speak.

Step 5: Use Time Anchors

When you panic, you either rush — or you freeze.

Time anchors help prevent both:

• First minute: rapport and main complaint

• By five minutes: core history or examination completed

• Last two minutes: summary and management plan

Remember: safety scores marks.
Perfection does not.

Step 6: Speak So the Examiner Can Follow You

Anxious doctors often speak to themselves.

However, examiners want to hear your reasoning.

Simple phrases make a huge difference:

• “My main concern here is…”

• “I would like to rule out…”

• “At this stage, the most likely diagnosis is…”

• “The immediate priorities are…”

You don’t need fancy medicine.
You need clear thinking — spoken out loud.

A Note for Repeat Sitters

Finally, if you are sitting the AMC Clinical (OSCE) for the second, third, or fourth time, I want to speak to you directly.

Repeated attempts do not mean you are unsafe or incapable.
More often, they mean the same pattern is repeating under pressure.

Each failed attempt increases anxiety.
Consequently, structure collapses faster.
Unless that cycle is interrupted, more studying alone will not fix the problem.

This is exactly where targeted, structured coaching makes the difference.