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