enquire@oyamed.com
+61 452 623 696, 1300 17 17 16
Appointment

PROCEDURE SKILLS

AMC clinical procedural exam

Procedural Skills for the AMC OSCE

Urinary Catheterisation | Cervical Screening | Urine Dipstick

A Complete Step-by-Step OSCE Guide for IMGs

Procedural skills stations in the AMC OSCE assess your ability to safely perform clinical procedures while communicating effectively with the patient. You are marked not only on technical accuracy, but also on your professionalism, consent process, infection control, and patient-centred communication.

This guide covers the three most commonly tested procedural skills in the AMC OSCE: urinary catheterisation, cervical screening, and urine dipstick interpretation. For each procedure, we provide a step-by-step checklist, key examiner tips, and the most common mistakes IMGs make.

PROCEDURE 1: Urinary Catheterisation

Urinary catheterisation is a high-stakes procedural station that requires strict aseptic technique, clear patient communication, and sound clinical judgement. In the AMC OSCE, this station is commonly presented as either a male or female patient requiring catheterisation for urinary retention, monitoring of fluid balance, or pre-operative preparation.

  • Correct consent and explanation of the procedure
  • Strict adherence to aseptic non-touch technique (ANTT)
  • Correct identification of anatomical landmarks
  • Safe and confident catheter insertion technique
  • Correct balloon inflation and confirmation of placement
  • Patient comfort, dignity, and communication throughout

Equipment Item

Why It Matters

Catheterisation pack (sterile field, drapes, gauze)

Establishes your sterile field — setting this up correctly signals competence

Appropriate catheter size (12–14 Fr for routine)

Selecting the correct size shows clinical knowledge

10 mL sterile water for balloon inflation

Never use saline — it crystallises and can block the balloon valve

Sterile gloves

Must be donned without contaminating the outer surface

Antiseptic solution (chlorhexidine or normal saline)

Used to clean the urethral meatus

Lignocaine gel (anaesthetic lubricant)

Mandatory for male catheterisation; good practice in females

Drainage bag

Must be attached and secured below bladder level

 

✓

Step

What Examiners Are Looking For

☐

Introduce & ID

Greet the patient, confirm name and DOB, establish rapport

☐

Explain & Consent

Explain the procedure clearly in lay terms, state risks (UTI, trauma, discomfort), obtain verbal consent

☐

Privacy & Dignity

Ensure curtains are drawn, expose only what is necessary, maintain patient comfort throughout

☐

Hand Hygiene

Wash hands or use alcohol gel before opening any equipment

☐

Prepare Equipment

Open catheter pack aseptically onto sterile field, arrange equipment without contaminating

☐

Don Sterile Gloves

Apply without touching the outer surface

☐

Clean the Meatus

Clean with antiseptic in a front-to-back motion for females; retract foreskin and clean in circular motion (inside out) for males

☐

Apply Lubricant

Instil lignocaine gel into the urethra (males: wait 3–5 mins); apply gel to catheter tip for females

☐

Insert Catheter

Insert gently using non-touch technique — advance until urine flows for females; advance to the bifurcation for males before inflating balloon

☐

Confirm Placement

Wait for urine to drain freely before inflating balloon — never inflate if resistance felt or no urine draining

☐

Inflate Balloon

Inflate with 10 mL sterile water, gently retract to confirm anchoring

☐

Secure & Connect

Connect to drainage bag, secure catheter to inner thigh, ensure bag is below bladder

☐

Restore Foreskin

Replace foreskin in uncircumcised males — failure causes paraphimosis

☐

Document & Explain

Note residual volume, catheter size, batch number; explain aftercare to patient

☐

Hand Hygiene

Final hand wash after removing gloves and disposing of waste

💡 Examiner Tip: For male catheterisation, always advance the catheter to the bifurcation (the Y-junction) before inflating the balloon – inflating in the urethra causes severe injury.

💡 Examiner Tip: Verbally narrate what you are doing as you go. Examiners mark what they can see AND hear.

💡 Examiner Tip: If you accidentally contaminate your sterile field, stop and request a new pack. Examiners reward self-awareness.

⚠️ Common Mistake: Inflating the balloon before seeing urine drain – this is one of the most serious errors in this station.

⚠️ Common Mistake: Forgetting to replace the foreskin after catheterising uncircumcised males – this can cause paraphimosis, a urological emergency.

⚠️ Common Mistake: Touching the catheter shaft with contaminated fingers – any breach of ANTT will cost significant marks.

⚠️ Common Mistake: Failing to explain the procedure before starting – consent is as important as technique in the OSCE.

PROCEDURE 2: Cervical Screening (Cervical Smear / Pap Test)

Cervical screening is a sensitive and technically nuanced procedural station in the AMC OSCE. In Australia, the National Cervical Screening Program (NCSP) was updated in 2017, replacing the traditional Pap smear with the Cervical Screening Test (CST) using liquid-based cytology (LBC) combined with HPV testing. IMGs must be familiar with the current Australian guidelines, not older Pap smear protocols.

Parameter

Current Australian Guideline

Who is screened?

Women and people with a cervix aged 25–74 who have ever been sexually active

Screening interval

Every 5 years (previously every 2 years with Pap smear)

Test type

Cervical Screening Test (CST) — liquid-based cytology + HPV co-testing

First screen age

25 years (previously 18 or 2 years after first sexual activity)

Exit screen

At age 74 if last screen was normal; those aged 70–74 are offered a final test

Self-collection

Available since 2022 for eligible patients who are overdue or unlikely to undergo clinician-collected test

💡 Examiner Tip: Knowing that Australia uses the CST (not Pap smear) and screens every 5 years from age 25 is an immediate differentiator in the OSCE. Many IMGs incorrectly describe outdated protocols.

  • Knowledge of current Australian screening guidelines
  • Ability to explain the procedure sensitively and obtain informed consent
  • Correct patient positioning and preparation
  • Correct speculum insertion and visualisation of the cervix
  • Correct sampling technique using the liquid-based cytology (LBC) brush
  • Correct sample preservation and labelling
  • Communication, sensitivity, and patient dignity throughout

• Bivalve (Cusco) speculum – choose appropriate size (small, medium, or large)
• Liquid-based cytology collection brush (Cervex-Brush or Rovers Cervex-Brush Combi)
• LBC vial (e.g., ThinPrep or SurePath) with preservative solution
• Good light source
• Gloves (non-sterile)
• Water-based lubricant (applied to the outer blades only, not the tip – lubricant can interfere with the sample)

✓

Step

What Examiners Are Looking For

☐

Introduce & ID

Greet patient warmly, confirm identity, acknowledge this may be a sensitive procedure

☐

Explain Procedure

Explain what the CST involves, why it is recommended, and what to expect (mild discomfort, pressure)

☐

Explain the Guidelines

Mention that in Australia, screening is recommended every 5 years from age 25, and the test checks for HPV and cell changes

☐

Discuss & Consent

Address any concerns, answer questions, obtain verbal consent. Ask about: last period, pregnancy, previous abnormal results, contraception

☐

Privacy & Positioning

Offer a chaperone. Provide a sheet. Ask patient to undress from the waist down and lie in dorsal or left lateral position

☐

Hand Hygiene & Gloves

Wash hands, don non-sterile gloves

☐

Prepare Equipment

Select appropriate speculum size, warm the speculum with water (not lubricant), have LBC vial open and labelled

☐

Insert Speculum

Part the labia, insert speculum at 45° angle downward, rotate to horizontal, open blades to visualise the cervix

☐

Visualise Cervix

Identify the transformation zone (squamo-columnar junction) — this is where sampling must occur

☐

Collect Sample

Insert brush into the os, rotate 5 times clockwise. Ensure the outer bristles contact the ectocervix throughout

☐

Preserve Sample

Rinse or detach the brush head into the LBC vial according to the device instructions. Do not wipe the brush on the vial rim

☐

Remove Speculum

Close blades slightly, rotate, and withdraw gently. Warn the patient before removal

☐

Label & Request

Label the vial at the bedside with patient details. Complete the pathology request form including clinical information

☐

Debrief Patient

Explain when results will be available, what a normal/abnormal result means, and when to re-screen

☐

Document

Record the procedure in clinical notes including date, indication, and findings

In the OSCE, how you communicate is as important as what you do. Practice saying something like:

“Today I’d like to perform a Cervical Screening Test. This is a routine check that looks for a virus called HPV, which can sometimes cause changes to the cells on your cervix. We recommend this every five years for women from age 25. I’ll use a small instrument called a speculum to gently open the vagina so I can see the cervix, and then I’ll use a soft brush to collect a small sample of cells. It may feel a little uncomfortable but should not be painful. Do you have any questions before we start?”

💡 Examiner Tip: Always offer a chaperone – in Australia this is considered best practice, and failing to offer one is a mark deduction.

💡 Examiner Tip: If you cannot visualise the cervix, state out loud what you would do: ‘I would try repositioning the patient, asking her to place her fists under her buttocks, or using a different speculum size.’

💡 Examiner Tip: Mention self-collection as an option for patients who are overdue or uncomfortable with a clinician-collected test – this shows you are up to date with current Australian practice.

⚠️ Common Mistake: Describing Pap smear technique or 2-yearly screening intervals – Australia changed to the CST in 2017. Using outdated protocols signals you are not prepared for Australian practice.

⚠️ Common Mistake: Applying lubricant to the tip of the speculum – lubricant can contaminate the sample. Use water only, or apply lubricant to the outer blades only.

⚠️ Common Mistake: Not offering a chaperone – this is a patient safety and professional standard issue in Australia.

⚠️ Common Mistake: Forgetting to label the vial at the bedside before leaving – mislabelled samples are a clinical incident.

PROCEDURE 3: Urine Dipstick Testing & Interpretation

Urine dipstick testing is one of the most practical and frequently tested procedural stations in the AMC OSCE. It appears simple, but examiners are looking for a thorough, systematic interpretation of results linked to a clinical diagnosis – not just a list of findings.

  • Correct specimen collection technique (midstream urine)
  • Proper dipstick technique including timing
  • Systematic and accurate interpretation of each parameter
  • Ability to link dipstick findings to likely diagnoses
  • Knowledge of when further testing is required (MCS, imaging, bloods)
  • Clear communication of findings to the patient and proposed next steps

Always instruct the patient on correct midstream urine (MSU) collection technique. This is frequently tested as a communication task within the station.

  1. Clean the urethral area with a moist wipe (front to back for females)
  2. Begin urinating into the toilet
  3. After the initial stream, collect the midstream portion into the specimen cup without stopping
  4. Replace the lid firmly and label the cup immediately

💡 Examiner Tip: If the patient has a urinary catheter, collect urine from the sampling port – never from the drainage bag.

  1. Check the expiry date on the dipstick container
  2. Ensure the urine sample is fresh – dipstick should ideally be performed within 2 hours of collection
  3. Dip the strip fully into the urine for 1–2 seconds, covering all reagent pads
  4. Remove and tap the edge (not wipe) against the container rim to remove excess urine
  5. Hold the strip horizontally and read each parameter at the exact time specified on the container (typically 30–60 seconds per parameter)
  6. Compare each pad against the colour chart on the container in good lighting

⚠️ Common Mistake: Do not read the strip flat on a surface – fluid can run between pads and give false results. Always hold it horizontally.

Parameter

Normal Result

Abnormal Result

Clinical Significance

Leucocytes

Negative

Positive (trace to +++)

Suggests pyuria — UTI, urethritis, pyelonephritis. Can be false-positive with contamination

Nitrites

Negative

Positive

Gram-negative bacteria (e.g. E. coli) convert nitrates to nitrites. High specificity for bacterial UTI

Blood (Haematuria)

Negative

Positive (trace to +++)

UTI, urolithiasis, glomerulonephritis, malignancy, trauma. Menstruation can cause false positive

Protein

Negative / trace

Positive

UTI, glomerular disease, pre-eclampsia, nephrotic syndrome. Trace can be normal after exercise

Glucose

Negative

Positive

Diabetes mellitus (commonest), pregnancy, renal tubular disease. Requires fasting blood glucose

Ketones

Negative

Positive

DKA, starvation, prolonged vomiting, low-carbohydrate diet

Bilirubin

Negative

Positive

Obstructive jaundice, hepatocellular disease. Urine appears dark/tea-coloured

Urobilinogen

Normal (0.2–1.0)

Elevated

Haemolytic anaemia, hepatitis. Absent in complete biliary obstruction

pH

5.0–8.0

Alkaline (>8) or Acidic (<5)

Alkaline: UTI with urease-producing organisms, renal tubular acidosis. Acidic: high protein diet, DKA

Specific Gravity

1.010–1.030

<1.005 or >1.030

Low: diabetes insipidus, overhydration. High: dehydration, SIADH, glucosuria

In the OSCE, you must integrate the dipstick results with the clinical presentation – not just read the numbers. Here are the most common clinical scenarios:

Urinary Tract Infection (UTI)
  • Positive leucocytes + positive nitrites = most likely bacterial UTI
  • Positive leucocytes alone (negative nitrites) = sterile pyuria – consider chlamydia, TB, partially treated UTI, or contamination
  • Blood and protein may also be present

💡 Examiner Tip: If leucocytes and nitrites are both positive in a symptomatic woman under 65, Australian guidelines support empirical antibiotic treatment without waiting for MCS results.

Diabetes Mellitus
  • Glycosuria (glucose 2+ or more) in a non-pregnant adult should prompt a fasting blood glucose or HbA1c
  • Ketones + glucose = DKA until proven otherwise – this is an emergency
  • Glycosuria in pregnancy can be normal – renal threshold for glucose decreases in pregnancy
Haematuria
  • Positive blood without leucocytes or nitrites = non-infective cause – consider urolithiasis, malignancy, or glomerulonephritis
  • Macroscopic haematuria in a patient over 50 = urological malignancy until proven otherwise – refer urgently
  • Microscopic haematuria on two or more occasions warrants urology referral and CT urogram
Proteinuria
  • Trace protein can be normal, especially after exercise or fever
  • Persistent proteinuria (2+ or more) requires urine albumin-creatinine ratio (ACR) and renal function testing
  • Proteinuria + haematuria + hypertension = glomerulonephritis until proven otherwise
  • Significant proteinuria in pregnancy should raise suspicion for pre-eclampsia

✓

Step

What Examiners Are Looking For

☐

Introduce & ID

Confirm patient identity and reason for the test

☐

Explain the Test

Briefly explain what the dipstick measures and why it is being done

☐

Confirm Specimen Quality

Check it is an MSU, freshly collected, correctly labelled, and within 2 hours

☐

Check Dipstick Expiry

Check expiry date on the container before use

☐

Visual Inspection First

Note the colour and clarity of urine: dark = concentrated or bilirubin; cloudy = infection; red = haematuria or myoglobin

☐

Perform Dipstick

Dip for 1–2 seconds, tap edge, hold horizontally, read at correct times

☐

Systematic Interpretation

Read each parameter from top to bottom: leucocytes, nitrites, blood, protein, glucose, ketones, bilirubin, urobilinogen, pH, specific gravity

☐

Integrate with History

Link findings to the patient’s presenting complaint

☐

State Likely Diagnosis

Give a most likely diagnosis and differential based on the combined findings and clinical context

☐

Propose Next Steps

State what investigations or management you would initiate (MCS, bloods, imaging, empirical treatment, referral)

☐

Communicate Results

Explain results to the patient in plain language and outline the next steps

💡 Examiner Tip: Always perform a visual inspection of the urine first before dipping – this shows clinical thoroughness and examiners notice it.

💡 Examiner Tip: When you present your findings, do not just list each parameter. Group the positive findings and link them to a diagnosis: ‘The positive leucocytes and nitrites together strongly suggest a urinary tract infection, which fits with this patient’s symptoms of dysuria and frequency.’

💡 Examiner Tip: Know the difference between haemolysis (positive dipstick blood, no red cells on microscopy) and true haematuria (positive dipstick + red cells on MCS).

⚠️ Common Mistake: Reading the dipstick too early or too late – timing matters. Use a clock or count the seconds if needed.

⚠️ Common Mistake: Presenting each parameter individually without integrating findings – this reads like a checklist, not clinical reasoning.

⚠️ Common Mistake: Forgetting to mention next steps after interpreting the dipstick – always close with a management plan.

⚠️ Common Mistake: Not commenting on the visual appearance of the urine before dipping – this is a mark that many candidates miss.

How Oyamed Helps You Master Procedural Skills

At Oyamed.com, we know that procedural stations are where IMGs can gain or lose significant marks. Our procedural skills training gives you the tools to perform confidently under exam conditions.

  • Video demonstrations of all three procedures performed to AMC OSCE standard
  • Downloadable step-by-step checklists to use in your own practice sessions
  • Timed mock OSCE stations with actor patients and structured examiner feedback
  • Guidance on current Australian clinical guidelines including the updated NCSP
  • One-on-one coaching with experienced AMC OSCE tutors who know exactly what examiners look for
  • Access to a full library of procedural, communication, and clinical examination stations
🚀 Ready to Ace Your AMC OSCE Procedural Stations?

Join thousands of IMGs who trust Oyamed to get them exam-ready. Start today at oyamed.com

Book a Free Strategy Call – Identify your highest-yield domains and create a personalized study plan.

PROCEDURE SKILLS