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Category: AMC OSCE

09Oct

The Script and the Patient: Why a Lithium Script Won’t Carry You Through the AMC Clinical

If you are in the middle of your AMC OSCE preparation, I want to show you a lithium station, and the way most doctors answer it.

The is one of Oyamed’s AMC clinical mock station

Ms Margaret Hill is 21. She has been on lithium for nine months. She is going to Vietnam for a holiday and has come to the GP practice for travel advice. Her recent blood results are below.

Task: take a focused history and advise Ms Hill.

AMC clinical OSCE lithium station: travel advice stem with a lithium level of 1.4, by Oyamed

The scripted version

This is what I hear, almost word for word, week after week.

“Hello Margaret, thank you for coming. When are you going to Vietnam? Who are you going with? For how long? Are you doing any hiking or bushwalking? Any high-risk sexual activity? Do you have enough tablets for the whole stay?

It will be very hot over there and you will sweat a lot, so please drink plenty of water. Don’t take anti-inflammatories like ibuprofen. If you get shaky hands, vomiting or diarrhoea, or feel confused, see a doctor straight away. Carry a letter with your medicines, and we will check your lithium level when you come home.”

It is a good script. Every word of it is true. The doctor delivers it beautifully, and I can tell they have practised it many, many times.

But read the stem again. What exactly is the station?

What should you be looking for?

What the station was really asking

Look at the blood results. Margaret’s lithium is 1.4 mmol/L. In July it was 0.7. Her level has doubled, it is above the range, and her urea and creatinine have crept up too.

The scripted doctor never looked. They saw the word Vietnam and the script began. They sent a young woman with a high lithium level off to a tropical country, and told her to check her lithium level  when she gets back.

The doctor who passes asks one quiet question outside the door: why is the lithium level high? The examiner does not put a lithium level on the page for decoration. The result is the station. Vietnam is the distraction.

So they walk in, and before Vietnam comes up, they find out what has changed. How has she been feeling? Any shaky hands, vomiting, diarrhoea, unsteadiness, muddled thinking? Has she been unwell, or not drinking much? Has anyone started her on something new, an anti-inflammatory, a blood pressure tablet, a water tablet? Has her lithium dose changed? When did she take her last tablet, and when was the blood taken?

Then the plan follows from her answers. If she has any signs of toxicity, she needs to be seen in hospital today. If she is well, the lithium needs reviewing with her prescriber, and the level and kidney function repeated, before she gets on a plane. Either way, the trip waits until her level is safe.

Then they explain it to Margaret in words she can hold on to:

“Margaret, before we talk about Vietnam, I want to go through your blood test with you. Your lithium level has come back higher than it should be, about double what it was in July, and your kidneys are working a little harder than before. I don’t want you travelling to a tropical country with your level like this. Let’s find out why it has gone up, speak to your psychiatrist about your dose, and recheck your bloods. Once your level is safe, we will plan your trip properly.”

Notice something. Almost every fact in the script is still here. Fluids, anti-inflammatories, the warning signs, checking the level. Nothing the doctor learned was wasted. The difference is that this time the knowledge was put to work for the young woman in the room, instead of being recited at her.

The best resources for AMC Clinical will give you the knowledge, so please keep everything you have learned. Just let go of the order/structure/script you learned it in. Read the stem properly, looking at the key informations. Ask yourself why this patient, why these results, and why today. Then let the patient tell you which part of your knowledge she needs.

That is the doctor the examiner is hoping to meet, and it is the habit that helps you pass the AMC Clinical on your first attempt. I believe you already are that doctor. The script just keeps getting in the way.

If you would like to practise this with me, come to Evening OSCE Club on a Friday night, book an AMC clinical mock exam, or talk to me about AMC clinical exam coaching one to one. For the examination stations, join my AMC physical examination face to face workshop in Brisbane. And if you are not already in our Telegram group, please join us. You are not doing this alone.

With love,
Dr Vinu

22Sep
AMC OSCE exam station door — how to open a clinical station, Oyamed guide

How to Open an AMC OSCE Station — and Why “What Brings You In Today?” Can Cost You the Station

My dear doctors, let me tell you about the mistake I corrected more than any other in my years teaching clinical skills at university — and the one I still see most often in candidates preparing for the AMC clinical exam.

It happens in the first ten seconds. Before the history. Before the diagnosis. Before you have shown the examiner a single thing you know.

Not every AMC OSCE station starts at the beginning of the patient’s story.

The scenario every candidate should sit with

Picture this station. A woman in early pregnancy has presented with bleeding. The first doctor has already seen her and arranged an ultrasound. The scan is done. You are the next doctor, and your task is to explain the ultrasound result.

Now imagine walking in and asking, “So, what brings you in today?”

Think about what you have just done. A frightened woman, who may be losing her pregnancy, has already told her story to the triage nurse. Then to the first doctor. Then to the sonographer. And you — the doctor holding her result — have asked her to live through it all again from the beginning, so that you can feel oriented.

We would never accept this in a real hospital. Handover exists precisely so patients don’t have to keep retelling a distressing story. The trauma-informed care literature names this as one of the ways healthcare retraumatises people, and it is why we teach medical students in Australia to pick the story up where it truly is, not where the textbook opening assumes it to be.

The AMC clinical exam is testing whether you practise medicine that way. This is not an etiquette point. It is a safety and communication point, and it is marked.

What the examiner hears in your first sentence

Here is the examiner’s-eye view, because this is the part candidates rarely see.

The station stem told you exactly where this patient is in her story. When you open as though she has just walked in off the street, you have announced — before you’ve even sat down — that you did not really read the station. You are running a memorised script at the patient instead of meeting this patient.

The reverse is also true. A candidate who opens in the right register, at the right point in the story, signals in ten seconds that they read the task, understood the situation, and have worked in a hospital. Examiners feel the difference immediately.

The opening that earns the marks

Introduce yourself and your role, then continue the story rather than restarting it:

“Hello Sarah, I’m Dr X, one of the doctors looking after you today. How are you holding up? I understand you’ve had an ultrasound — can I ask what you’ve been told so far about why you needed it?”

One opening, four jobs done:

  1. You have shown the examiner you read the task.
  2. You have acknowledged what she has already been through — which is where rapport actually comes from, not from a rehearsed pleasantry.
  3. You have discovered what she knows and what she fears, so your explanation starts where she is, not from zero.
  4. You have spared her the retelling.

And for those who like their frameworks: Calgary-Cambridge, the consultation model taught in every Australian medical school, says exactly this — introduce yourself, your role, and the nature of this interview, with an opening question that fits the reason for this consultation. It was never meant to be one fixed line. Candidates memorise the example and skip the principle.

When “what brings you in today?” is exactly right

Let me be fair to the poor sentence — it is completely correct for a fresh, undifferentiated presentation, where you genuinely are the first doctor in the story. The skill is not replacing one script with another. The skill is the question you ask yourself before you knock:

Where is this patient in their story — and which doctor am I in it?

First doctor, fresh presentation: open wide. Second doctor, results in hand: acknowledge, and continue.

Every station type in the AMC clinical has its own front door — the history station, the results station, the parent, the ward call, the distressed patient. Walk through the wrong one and the examiner knows before you’ve spoken your second sentence. Walk through the right one and you have banked your first impression at no cost at all.

That, my dear doctors, is a mark you can earn in ten seconds. There are not many of those in this exam. Take every one.

Dr Vinu Verghis · Oyamed AMC OSCE & RACGP PESCI Coaching · CPD Home Accredited Provider

22Jul
The Hardest Part of the AMC Isn't the Exam. It's the Waiting.

The Hardest Part of the AMC Isn’t the Exam. It’s the Waiting.

If I asked a room full of International Medical Graduates what the hardest part of their journey has been, most would say the AMC exams.

I disagree.

The hardest part is staying focused when nothing seems to be happening.

Every week I sit across from doctors who have done everything right. They have passed the AMC MCQ. Many have spent thousands on preparation. These candidates have rewritten their CV five times. Some have applied for twenty jobs. Fifty jobs. Some tell me they have submitted a hundred.

And then — silence.

No interview. Zero acknowledgement. Without feedback. Sometimes a generic rejection thanking them for their application before letting them know they were unsuccessful.

That silence is more dangerous than any exam question.

Not because it means you are not good enough. Because, over time, it quietly convinces you that you are not.

I have watched excellent doctors — people who would be safe, kind and brilliant on their first Australian ward round — slowly lose their belief in themselves because their inbox stayed empty for six weeks. I want to be very clear with you about what that silence actually is, and what it isn’t.

Rejection Isn’t Personal. It Just Feels That Way.

Australia receives thousands of applications from overseas-trained doctors every year. Some hospital jobs collect hundreds of applications in the first forty-eight hours.

You are not competing against one or two other applicants. You are competing against doctors from every corner of the world — many with Australian experience, many with permanent residency, many who simply happened to apply on the right day for the right role.

Sometimes the successful candidate is not the best doctor. They are the best fit for that particular position.

That is an important distinction, and it is worth reading twice.

Stop Measuring Your Worth by Your Inbox

One of the most common mistakes I see is refreshing email every hour after an application goes in. Every hour of silence chips away at confidence, and the internal script starts to write itself:

  • “My CV must be terrible.”

  • “They think my English isn’t good enough.”

  • “I’ll never get a job here.”

None of that is evidence. It is fear talking.

Hospitals are busy. Recruitment takes weeks — sometimes months. Many employers never contact unsuccessful applicants at all. It is frustrating and it is unfair, but it is the reality of the Australian medical recruitment system. Do not let someone else’s silence write the story of your worth.

The IMG Journey Is a Marathon

Resilience is a word that gets thrown around until it means very little. So let me be specific about what I mean.

Resilience is not pretending everything is fine. It is continuing when you are tired—after another rejection, after another exam attempt, and after another application disappears into what feels like a black hole.

The doctors who eventually walk into their first Australian job are rarely the most brilliant. They are the ones who refused to stop.

I have coached candidates through four attempts. I have watched doctors sit their AMC clinical after every one of their friends has already passed. And I have watched every one of them, eventually, walk into a hospital they earned.

Don’t Put Your Life on Hold

The saddest sentence I hear from IMGs is this one:

“I’ll start living again once I get a job.”

Months become years. Birthdays get missed. Relationships strain. Bodies stop moving. Confidence disappears. And when the job finally arrives, the person who takes it up is exhausted before they have even started.

Please do not do this. Do not make your happiness contingent on an email.

Keep exercising. Spend time with your family. Cook a real dinner. Go on a holiday if you can afford one. Volunteer at a community clinic. Learn something outside medicine. Your career matters, but it is not your identity.

Every Rejection Is Data

I know it does not feel like it, but every application you send teaches you something.

Maybe your CV is not built for the Australian system. Perhaps your cover letter is not showing the strengths you actually have. It could be that your referees need updating. Or maybe you are applying to hospitals that do not usually recruit IMGs.

Every unsuccessful application is a chance to learn something concrete. The only application guaranteed to fail is the one you never send.

Use the Waiting Well

Waiting is unavoidable. Wasting the waiting period is optional. If interviews are slow, this is what a good week looks like:

Practise your communication skills. Work through AMC clinical cases with a study partner. Attend a workshop. Complete an online short course. Do a hospital observership if one is available in your city. Update LinkedIn. Read about the Australian health system — the PBS, MBS, mental health treatment plans, referral pathways. Learn how a GP-registrar conversation actually sounds.

None of these are wasted hours. Each one adds a small piece to your professional profile, and eventually those pieces are what recruiters see.

Don’t Compare Yourself to Everyone Else

Social media has made this harder than it needs to be. Someone posts that they have passed the AMC. Someone else announces a registrar position. A third shares photographs in scrubs on their first hospital day.

What you do not see is the three years of rejection emails. The failed attempts. The financial pressure. The lonely nights. You only see the finish line.

Comparison is one of the fastest ways to lose motivation. Your journey will never look identical to anyone else’s — and it shouldn’t.

Ask for Feedback, But Do Not Obsess Over It

Get someone experienced to look at your CV. Ask whether your interview technique needs work. Sit a mock interview. Absorb constructive criticism when it comes.

But do not spend six months redesigning your resume instead of applying. At some point, good enough really is good enough. Perfection delays progress.

Consistency Beats Motivation

I hear this a lot: “I’ve lost my motivation.”

Of course you have. Motivation is a mood, and moods come and go. Discipline is what carries you through.

The IMGs I have watched succeed do not wake up inspired. They wake up committed. Some mornings they feel positive. Other mornings they wonder why they started. They keep showing up either way. That is the whole trick.

There Is No Shortcut. There Is a System.

Everyone wants the secret — the perfect CV, the perfect interview answer, the perfect hospital, the perfect strategy.

The truth is quieter than that.

Apply. Improve. Apply again. Study. Learn. Show up. Success is rarely one spectacular effort. It is hundreds of small efforts stacked over time.

At Oyamed, this is exactly why our thirty-hour and sixty-hour coaching programmes are not built around a magic bullet. They are built around a repeatable system — the same system that gets our doctors through the AMC clinical and into their first Australian jobs.

Who You Surround Yourself With Matters

This journey can feel lonely. Your support network is not optional.

Spend time with people who encourage you. Step back from those who tell you Australia does not want IMGs, that there are no jobs, that you need ten years of Australian experience before anyone will hire you. None of that is true, and repeating it out loud does nothing but wear you down.

Every week, IMGs secure positions across Australia. The opportunities are real. Your job is to be ready when yours appears.

Remember Why You Started

You did not become a doctor because it was easy. You became a doctor because helping patients mattered.

Between exams, applications and rejection emails, that gets easy to forget. Don’t let it fade.

Everything you are doing right now is temporary. One day you will walk into your first Australian hospital as a doctor. You will have your own patients, your own colleagues, your own responsibilities. The rejection emails will not matter. That silence will not matter. This long waiting will not matter. It will just be part of your story.

The One Piece of Advice I Give Every IMG

Do not let a rejection make the decision for you.

If you decide to stop, let it be because you have genuinely decided that medicine in Australia is no longer the life you want. Not because one hospital did not reply. Not because one recruiter said no. Not because one interview did not go the way you hoped.

One application means very little. One rejection means very little. Even ten rejections mean very little.

Your career will not be defined by the hospitals that did not choose you. It will be defined by the one that eventually does.

Stay focused. Keep improving. Keep applying. And when your opportunity arrives — and it will — make sure you are ready to say yes with a smile on your face.

Dr Vinu Verghis is Academic Lead at Oyamed AMC OSCE Coaching. Oyamed offers thirty-hour and sixty-hour one-on-one AMC OSCE coaching, CPD-accredited masterclasses, and a library of teaching resources for International Medical Graduates preparing for the AMC MCQ and clinical exam. If you’re preparing for a sitting and want a look at the framework we use, reach out at enquire@oyamed.com.

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