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

Tag: amc osce

08Sep
Oyamed teaching graphic showing an eighteen question budget for a five minute AMC Clinical OSCE history, broken down by section

The 18-Question Rule: How Many Questions You Can Actually Ask in an AMC OSCE History

The short version

  • Five minutes is three hundred seconds.
  • One question and its answer costs about seventeen seconds.
  • That gives you eighteen questions. Not forty. Not thirty. Eighteen.
  • SOCRATES is eight of them — and in a chest pain case, closer to twelve.
  • You are not choosing what to ask. You are choosing what to leave out.

Nobody teaches the second one. It is the whole game.

 

The four-minute moment

You are four minutes in. The patient is still describing the pain. You have not asked about medications, you have not touched family history, and there is a clock behind you that you cannot see.

I have watched this from the examiner’s chair more times than I can count, and I want to be clear about something. The candidate is not lost. She knows the case. She would manage this patient safely on a real ward tomorrow morning.

She is spending money she does not have.

That is what running out of time actually is. Not ignorance. A budgeting problem. And nobody hands candidates the budget, so here it is.

 

How long does one question actually take?

Sit down with a stopwatch and time yourself asking a real patient a real question. Not reading it aloud. Asking it, hearing the answer, taking it in, and moving to the next one.

Three seconds to ask it. Eight to ten for the answer, if the patient is brief. Three or four to register what they said and choose where to go next.

Seventeen seconds.

That is my working figure from coaching, not a laboratory measurement. Time yourself and see how close you land.

And seventeen assumes a cooperative patient. It assumes they do not pause, do not ask you something back, do not tell you about their sister’s operation. The moment a patient says something that matters and you respond to it properly — which you must — that one exchange costs thirty to forty seconds. Two of those and a fifth of your history is gone.

 

Why eighteen is smaller than it sounds

Eighteen sounds generous until you start spending it.

One goes on the opening. Your name, their name, permission to ask some questions.

One goes at the end on is there anything I haven’t asked about that you think I should know. That is the highest-yield question in medicine and you never cut it.

Sixteen left for the actual history.

Now put SOCRATES against that. Site, Onset, Character, Radiation, Associated symptoms, Timing, Exacerbating and relieving factors, Severity. Eight questions. Half of what remains, spent characterising one symptom.

This is not an argument against SOCRATES. It is an argument for knowing what it costs before you reach for it.

 

Where the eighteen go

A working budget for a station whose task is a focused history, then a differential with reasons:

  • 1 — opening and consent
  • 7 — SOCRATES, minus the A
  • 5 — the differential sweep, which is what the A actually costs
  • 2 — risk factors for your leading differential
  • 1 — past history and medications
  • 1 — impact on the patient
  • 1 — the closing catch-all

Eighteen. Nothing spare.

The line that matters is the five. In SOCRATES, “associated symptoms” looks like one question. It is not. It is where your differential lives, and it costs five — one for each thing you are trying to move up or down.

Treat the A as a single question and you have not taken a history. You have characterised a symptom.

Notice what is missing. No systems review. No family history unless it is a risk factor for what you suspect. No occupational history unless the occupation is the point. Those are not forgotten. They are deliberately not asked, because the arithmetic does not allow it.

 

A worked example: Mr Tomás Ferreira, 54, a concreter

Central chest pain, two hours. Take a focused history, then give your differential with reasons.

The stem has already given you his age, his job, and how long this has been going on. Ask any of those again and you have paid seventeen seconds for something that was printed on the door.

The stem has also told you what the examiner wants. A differential. Not a diagnosis.

So this is not a cardiac history.

Positional. Pleuritic. Cardiac. Ribs. Skin.

That is the differential in five words, and it is the discipline this station is testing. Run a cardiac work-up on a fifty-four-year-old with chest pain and you will describe angina beautifully. You will also walk past the pericarditis, the pulmonary embolus, the costochondritis and the shingles.

Here is the spend.

“Good morning Mr Ferreira, my name is Dr ___. Is it alright if I ask you some questions about the pain?”

Then: where exactly is it · when did it start and what were you doing · what does it feel like · does it go anywhere · how bad out of ten · does anything make it better or worse · is it constant or does it come and go.

That is seven. SOCRATES without the A.

Now the A, which is five questions and not one:

  • Positional — is it worse lying flat, and better sitting forward?
  • Pleuritic — does it hurt more when you take a deep breath or cough?
  • Cardiac — are you short of breath, sweaty or nauseated with it?
  • Ribs — is it sore if you press on it, and have you lifted or strained recently?
  • Skin — any rash or blistering over that area, any burning in the skin?

Five questions. Five diagnoses moving up or down. The examiner is watching you build the differential they are about to ask for.

Then: do you smoke, and how much · has anyone in the family had a heart attack young.

Then: any medical conditions, and what are you taking.

Then: how is this affecting you — are you frightened.

Then: is there anything I haven’t asked that you think I should know.

Eighteen questions. Not a cardiac history. A chest pain history, with five causes ruled in or out, and three minutes still in hand for the differential.

SOCRATES cost you twelve of the eighteen, because the A was never one question. Knowing that before you walk in is the difference between finishing and running out.

 

Three ways the budget leaks

The second open question. “Tell me about the pain” is right. “Tell me more about that” thirty seconds later is a second open question, and open questions are expensive — thirty seconds, and the patient decides what you get. One open question. Then close down.

The systems review on autopilot. Bowels, bladder, weight, appetite, sleep, asked of every patient because that is how you learned to clerk on the ward. In a five-minute station that is five questions, more than a quarter of everything you have, and in a chest pain case it buys you nothing.

Re-asking the door. The stem gave you the age, the duration and the complaint. Open with “and how old are you?” and you have paid seventeen seconds for information you already had.

 

When the patient will not stop talking

You will get one. This is where most candidates lose the station, because interrupting feels rude and they were taught not to do it.

Interrupt. Warmly, and with a reason.

“Can I stop you there — that’s helpful, and I want to make sure I ask you a few specific things before we run out of time.”

Five seconds. Buys back forty. And it reads as competent rather than rude, because you gave the patient the reason.

 

Does this apply to every station?

No. And this is where candidates get caught by advice that was true somewhere else.

Five minutes for the history belongs to the eight-minute station whose task is a history plus something else — a differential, a management plan, an explanation. Five for the history, three for the rest.

A psychiatric history station gives seven minutes for the history itself, with the diagnosis and differential asked for afterwards. Seven minutes is about twenty-five questions, and you need all of them, because a psychiatric history has a risk assessment sitting inside it that cannot be cut.

The AMC sets a time guideline per task. It varies by station and it is signalled during the station. Read the door and budget to what that stem gives you.

The arithmetic travels. The number does not.

 

Frequently asked questions

How many questions can you ask in a five-minute OSCE history?

About eighteen. Five minutes is three hundred seconds, and a question with its answer takes roughly seventeen seconds with a cooperative patient. That figure drops fast if the patient gives long answers or tells you something that deserves a proper response.

Is SOCRATES too long for an OSCE station?

No, but it is more expensive than it looks. Eight questions on paper, and closer to twelve in a chest pain case, because “associated symptoms” is not one question — it is the five you need to separate positional, pleuritic, cardiac, rib and skin causes. It is the right tool for pain. It is the wrong tool when the problem is not pain, and reaching for it out of habit is a common way to lose a station.

Should I do a systems review in an OSCE history?

Usually not. A full systems review is five or more questions and in most focused stations it returns nothing you can use. Ask only the systems questions that separate your differentials.

Is it acceptable to interrupt a simulated patient?

Yes, if you give a reason. “Can I stop you there, I want to make sure I ask a few specific things before we run out of time” reads as time management. Letting a patient talk for ninety seconds because interrupting felt impolite reads as a candidate who has lost control of the station.

 

If you want to see this in a real station rather than on a page, the Oyamed Telegram channel carries free teaching cards and worked cases each week, and the Evening OSCE Club runs on Friday evenings with a trained simulated patient who will not slow down to help you. If you want the questions themselves, station by station, the Oyamed case vaults set them out in the order they should be asked.

 

You do not have five minutes.

You have eighteen questions.

Dr Vinu Verghis · MBBS, MSc, MPH, FHEA · Academic Lead, Oyamed · University OSCE examiner · Brisbane.

Oyamed provides one-to-one AMC Clinical OSCE coaching, mock examinations with written feedback, and small-group masterclasses.

Sources: the seventeen-second figure is a coaching estimate drawn from observed practice sessions, not a published measurement. Time guidelines are set per task by the Australian Medical Council and vary between stations, as stated in the Clinical Examination specifications.

Oyamed Pty Ltd is an independent education provider and is not affiliated with, endorsed by or connected to the Australian Medical Council.

19Aug
Oyamed table of Australian IV fluid bag compositions - sodium, potassium, chloride and glucose per litre for saline, Hartmann's and maintenance fluids

How to Chart IV Fluids: A Step-by-Step Guide for the AMC OSCE

Fluid charting comes up as a station. Most candidates have never been taught it properly; they learned by copying whatever the registrar wrote.

This is the method. Follow it in order and you can do it every time.

The short version:

  • Water: 25 to 30 mL/kg/day, or 20 to 25 if older, frail, renal impairment or cardiac failure
  • Sodium, potassium, chloride: 1 mmol/kg/day Glucose: 50 to 100 g/day
  • Australian maintenance bag: sodium chloride 0.3% + glucose 3.3% (Na 51, Cl 51, glucose 33 g per litre)
  • No premixed 0.3%/3.3% with potassium exists here. Use 18%/4% + 20 or 30 mmol KCl
  • Peripheral potassium ceiling: 40 mmol/L, 10 mmol/hour

What do you check before you chart anything?

Never chart from the last prescription. Look at:

  1. Can she drink? If she can, she may not need a drip at all. Ask this first, out loud.
  2. Her weight. Every calculation depends on it. Ideal body weight if she is obese.
  3. Her renal function. Urea, creatinine, and today’s electrolytes.
  4. Her urine output. Below 0.5 mL/kg/hour is oliguria.
  5. Her fluid balance chart. Yesterday’s totals, and whether she is behind.

Then examine her. Say all of this out loud in a station, it is marked.

Which type of fluid does she need?

Name it before you prescribe. There are three you will use.

Resuscitation — she is shocked or acutely hypovolaemic. Bolus of isotonic crystalloid, then reassess. In haemorrhage, control the bleeding first; do not pour in litres.

Replacement — she is losing fluid now. Vomiting, diarrhoea, stoma, drains, burns. Replace what is going out.

Maintenance — she simply cannot drink. Smallest volume of the three. Most often over-prescribed.

She may need two at once. Say so: “She needs replacement for her losses on top of her maintenance.”

Two more worth naming if asked: redistribution (fluid is in the wrong compartment — sepsis, liver failure, heart failure) and reassessment (unstable patients every 2 to 4 hours, everyone else at least daily).

How do you calculate maintenance fluids?

Four steps.

Step 1. Water.

  • Healthy adult: 25 to 30 mL/kg/day
  • Older, frail, renal impairment, cardiac failure, malnourished: 20 to 25 mL/kg/day

For a 70 kg healthy adult that is 1750 to 2100 mL. Not three litres. Above 2.5 L/day you start causing hyponatraemia.

Step 2. Electrolytes.

  • Sodium, potassium, chloride: 1 mmol/kg/day each
  • Glucose: 50 to 100 g/day

Write these numbers down. You will check your prescription against them.

Step 3. Deficit.

If she is behind on the chart, add it. Replace half over the first 8 hours and half over the next 16. If cardiac reserve is poor, slow that to half over 12 hours and half over 24.

One thing to watch. Fluid balance charts record only what can be measured. Insensible losses are often written as zero. They are not zero — an adult loses at least 800 mL a day through skin and breathing, roughly 50 mL an hour, offset by about 400 mL of metabolic water. If the chart totals as though insensible loss were nil, she is more behind than it says. Point that out.

Step 4. Pick your bags and add up what you have given.

What is in each IV fluid bag?

Per litre. Learn this table.

Bag Na K Cl Glucose
Sodium chloride 0.9% 154 – 154 –
Hartmann’s (compound sodium lactate) 131 5 111 –
Plasma-Lyte 148 140 5 98 –
Glucose 5% – – – 50 g
Sodium chloride 0.3% + glucose 3.3% 51 – 51 33 g
Sodium chloride 0.18% + glucose 4% 31 – 31 40 g
Sodium chloride 0.45% + glucose 5% 77 – 77 50 g

 

Two things to notice.

One litre of 0.9% saline contains 154 mmol of sodium. A 70 kg adult needs 70 mmol for the whole day. That is why saline is a poor maintenance fluid and a good replacement fluid.

The bag Australian guidance names for adult maintenance is 0.3% sodium chloride with 3.3% glucose. UK resources use 0.18%/4%. Both exist here. If you memorised numbers from an overseas guide, they are for a different bag.

 

What's in each IV Fluid bag

Australian IV fluid bag compositions, sodium potassium chloride and glucose per litre

The potassium problem: what you can actually order

There is no premixed bag of 0.3%/3.3% with potassium in Australia. So the worked examples you will read describe a bag you cannot order.

What you can order off the shelf:

Premix Potassium
Sodium chloride 0.9% + KCl 20, 30 or 40 mmol/L
Sodium chloride 0.18% + glucose 4% + KCl 20 or 30 mmol/L
Glucose 5% + KCl 20 or 30 mmol/L
Modified Hartmann’s about 29 mmol/L
KCl 10 mmol in 100 mL sodium chloride 0.29% isotonic, safe peripherally

 

Do not add potassium to a bag yourself. Use a premix. Ward preparation is permitted in some states only when premix and pharmacy compounding are both unavailable, under protocol, with a second check. Concentrated ampoules are not ward stock. Never add potassium to a bag that is already hanging.

So if she needs maintenance fluid with potassium, the practical Australian answer is usually 0.18% sodium chloride with 4% glucose plus 20 or 30 mmol KCl — because that premix exists.

What the actual chart looks like

There is no national IV fluid chart in Australia. The NIMC does not have a fluid section — it has a tick-box that says “Additional charts: ☐ IV fluid”, which is the national chart telling you to go and get a different one. Fluid charts are state forms.

In NSW there are two, and you need both.

The Adult Fluid Order (SMR120003) — this is where you prescribe. The columns you fill in, left to right:

Column What goes in it
Date dd/mm/yyyy
Fluid type The bag, in full, including strength
Volume (mL) Usually 1000 or 500
Additive (dose/volume) Potassium, stated in mmol
Rate (mL/hr) Not “over 8 hours” — the chart wants mL/hr
Route IV or subcut
Prescriber’s name print and signature, pager no. Legible, and your pager
Date/time started · Date/time finished Nursing
Administered print/sign · Checked print/sign Two nurses

 

Note what the top of the form asks for before any of that: Facility, Allergies/ADR, and Instructions. The allergy box comes before the prescription, same as on the NIMC.

Note also the two right-hand columns. Every fluid order is independently checked by a second nurse. If your handwriting is ambiguous or you have written “over 8 hours” where the chart wants a rate, you have created work at the bedside and a chance to get it wrong.

 

Adult Fluid Order chart - Not Filled

Blank adult IV fluid order chart showing the columns a prescriber completes: date, fluid type, volume, additive, rate, route, prescriber, and the nursing administration columns

The Daily Fluid Balance (SMR120001) — this is where you find out whether you were right. It runs by time down the left, and it asks for Weight in kg at the top of the page, which tells you how seriously to take daily weights.

  • Intravenous input: three lines, A, B and C, each with Site, Solution and Volume, then a progressive total (P)
  • Oral input: oral mL, enteral mL, progressive total (OE)
  • Progressive total in: P + OE = X
  • Output: urine, vomitus/gastric/aspirate, drain 1, drain 2, other/faecal, progressive total (Y)
  • Progressive balance: X – Y

Look at the output columns. Urine, vomit, drains, faeces. There is no column for insensible losses, because they cannot be measured — which is exactly why the balance at the bottom of that page is not the patient’s true balance, and why you add roughly 800 mL a day back in your head.

Two practical notes. Your patient may have three infusions running, which is why there are three line columns and why the site is recorded next to each one. And the order chart and the balance chart are separate pieces of paper — writing on one does not populate the other.

 

Daily Fluid Balance chart - not filled

Blank daily fluid balance chart showing intravenous input for three lines, oral and enteral input, progressive totals, output columns and running balance

In digitised NSW districts you will meet the eMR fluid module instead of these forms. The fields are the same.

Worked example 1: a well 80 kg adult

Mr Dilan Fernando, 34, day 1 after appendicectomy. Nil by mouth. Well. 80 kg. Chart shows even measured balance, insensible recorded as zero.

Water: 80 × 25 to 30 = 2000 to 2400 mL

Electrolytes: 80 mmol each. Glucose 50 to 100 g.

Deficit: chart says even, but insensible is recorded as zero, so he is a few hundred mL behind. Stay at the upper end rather than add a separate deficit.

Fluid Volume Over Na K Cl Glucose
NaCl 0.18% + glucose 4% + KCl 30 mmol 1000 mL 12 h 31 30 61 40 g
NaCl 0.18% + glucose 4% + KCl 30 mmol 1000 mL 12 h 31 30 61 40 g
Total 2000 mL 24 h 62 60 122 80 g

 

83 mL/hour. One litre 12-hourly.

Check it. Volume 2000 against 2000 to 2400 — good. Glucose 80 g — good. Sodium 62 against 80, potassium 60 against 80 — both slightly under.

That is fine, and say why: “This under-delivers his sodium and potassium slightly, which I am comfortable with overnight in a well 34-year-old with normal kidneys. Adding a third bag would take him to 3000 mL, which is nearly 38 mL/kg and too much. I will check his electrolytes in the morning and stop the drip once he is drinking.”

 

Worked example of an adult fluid order chart

Worked example fluid order chart for an 80 kg adult: two bags of sodium chloride 0.18 per cent with glucose 4 per cent and 30 mmol potassium chloride at 83 mL per hour

 

Worked example of a Daily Fluid Balance chart

Worked example daily fluid balance chart over twelve hours showing progressive totals and a balance of plus 131 mL, with insensible losses not recorded

Worked example 2: a frail 82-year-old

Mrs Beatrice Ashgrove, 82, day 2 after fractured neck of femur repair. Drowsy on analgesia, barely drinking. 52 kg. Frail. Creatinine up on baseline.

Same method. Different numbers.

Water: 52 × 20 to 25 = 1040 to 1300 mL

Note what just happened. The healthy-adult figure would have given up to 1560 mL. The frailty rule took 250 to 500 mL a day off her prescription. That is the whole point.

Electrolytes: 52 mmol each.

Fluid Volume Over Na K Cl Glucose
NaCl 0.18% + glucose 4% + KCl 20 mmol 1000 mL 20 h 31 20 51 40 g

 

50 mL/hour, and review before the bag finishes rather than writing up a second one now.

Check it. This under-delivers against the formula deliberately: “She is 82, frail, with a rising creatinine. The risk of overload and hyponatraemia is greater than the risk of a day of slightly low sodium. I will weigh her daily and check her electrolytes in the morning. My first priority is getting her drinking — I would review her analgesia, because the reason she is not drinking is that she is drowsy.”

That last line matters. The best fluid decision here is to fix the opioid, not to hang another bag.

 

Another worked example of an Adult Fluid Order

Worked example fluid order chart for a frail 82 year old: one bag at 50 mL per hour with review before the bag finishes

The numbers to know

Potassium. Peripheral maximum: 40 mmol/L concentration, 10 mmol/hour rate, via pump. Beyond either, you need cardiac monitoring, frequent bloods and a large vein. Higher concentrations need central access.

Hyponatraemia. Assess volume status first. Hypovolaemic gets sodium chloride; euvolaemic or hypervolaemic gets fluid restriction and a search for the cause. Correct by no more than 8 mmol/L in 24 hours. Overcorrection causes osmotic demyelination syndrome.

Hypernatraemia. No more than 0.5 mmol/L per hour, 10 mmol/L per day.

Oliguria. Below 0.5 mL/kg/hour.

Hyperkalaemia. ECG first. Calcium is indicated by ECG change, not by the number. Insulin with glucose shifts it — the glucose is there to prevent hypoglycaemia, not to treat. Then remove potassium from the body and review the medications that caused it.

Three things that have changed since you learned this

Balanced versus saline. The Australian and New Zealand PLUS trial found no difference in mortality or kidney injury. Prefer a balanced solution for large volumes or prolonged use because of hyperchloraemic acidosis — but they contain potassium, so think again in renal impairment. Explain your choice; do not pick a side.

Colloids are out. Hydroxyethyl starch has a TGA boxed warning and is contraindicated in critically ill and septic patients. Gelatins are available but not recommended for resuscitation. Use crystalloid.

Glucose 5% is not a resuscitation fluid. It behaves as free water once metabolised and drops the sodium.

Five common mistakes

  1. Charting the next bag without seeing the patient.
  2. Giving a number, not a prescription. “A litre of saline” is not an answer. Fluid, volume, rate, reason, duration.
  3. Not asking whether she can drink.
  4. Using the healthy-adult figure in a frail patient. The most common arithmetic error, and the one that causes harm.
  5. Ignoring the medication chart. A vomiting patient on an SGLT2 inhibitor needs ketones checked even if her glucose is normal — euglycaemic ketoacidosis. Withhold the SADMANS drugs in acute illness. Watch the triple whammy: ACE inhibitor or ARB plus diuretic plus NSAID.

Frequently asked questions

How do I calculate maintenance fluids for an adult?

Water at 25 to 30 mL/kg/day on ideal body weight, or 20 to 25 mL/kg/day if the patient is older, frail, malnourished, or has renal impairment or cardiac failure. Then 1 mmol/kg/day each of sodium, potassium and chloride, and 50 to 100 g/day of glucose. For a 70 kg healthy adult that is 1750 to 2100 mL and about 70 mmol of each electrolyte.

Which bag is the Australian maintenance fluid?

Sodium chloride 0.3% with glucose 3.3% — 51 mmol/L sodium and chloride, 33 g/L glucose. The 0.18%/4% bag used in UK resources is also available here and is usually what you reach for when you need potassium, because it comes premixed with 20 or 30 mmol KCl and the 0.3%/3.3% bag does not.

Can I add potassium to a fluid bag myself?

Use a premix. Ward preparation is permitted in some states only when premix and pharmacy compounding are both unavailable, under an endorsed protocol with a second-person check, and is more tightly restricted in others. Concentrated ampoules are not ward stock and potassium is never added to a hanging bag.

Why does the fluid balance chart show zero insensible losses?

Because it records only measured losses. Look at the output columns on the NSW Daily Fluid Balance (SMR120001) – urine, vomitus/gastric, two drains, other/faecal. There is no insensible column, because insensible loss cannot be measured. An adult loses at least 800 mL a day through skin and breathing, roughly 50 mL an hour, offset by about 400 mL of metabolic water. A chart totalled as though insensible losses were zero understates the deficit.

How much potassium can run through a peripheral line?

40 mmol per litre and 10 mmol per hour, via pump. Beyond either you need cardiac monitoring, frequent bloods and a large vein. The isotonic 10 mmol in 100 mL premix is designed for peripheral use.

If you want an honest read on where you are, or a full-dress rehearsal before exam day, you can try a session free or book a mock exam.

Dr Vinu Verghis is the Academic Lead of Oyamed AMC OSCE Coaching, a CPD Home Accredited Provider based in Brisbane. She holds an MBBS, MSc, MPH, FHEA and Cert Clin Ed, examines OSCEs at university level, and has personally walked the AMC pathway. Visit oyamed.com.

Sources: Australian Commission on Safety and Quality in Health Care, Intravenous fluid therapy: Principles for safe, appropriate and sustainable use (2026); Queensland Health, Guidelines for Prescribing Intravenous Fluids for Adults, and Prescribing Guidelines for HYPO- and HYPER-Electrolyte Disturbances in Adults (updated May 2026); NICE CG174, adopted in Australian practice; NSW Clinical Excellence Commission Safety Information 001/24 (2024) and High-Risk Medicine Standard: Potassium (Intravenous) (2025); WA Health Intravenous Potassium Standard (2025); Baxter Healthcare Australian Product Information; Finfer et al., PLUS trial, New England Journal of Medicine (2022); TGA safety advisory on hydroxyethyl starch; ADS/ADEA/ANZCA/NZSSD alert on ketoacidosis with SGLT2 inhibitors (2022).

Oyamed Pty Ltd is an independent education provider and is not affiliated with, endorsed by or connected to the Australian Medical Council.

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.

1 2 3 … 5