Reflections on Medical Education: Mastering OSCEs and other clinical assessments: your mindset helps!

It's the beginning of "OSCE season" at UOW and for the next 2 months we will be evaluating the clinical skills of our medical students in these high stakes assessments. Clinical exams, especially OSCEs, challenge more than just knowledge—they also can test your ability to think under pressure, communicate effectively, and maintain composure in high-stress scenarios. They require students to perform procedures and demonstrate clinical skills, interact dynamically with patients, and showcase medical understanding along with confidence, competence and professionalism.

However, the pressure of being watched, the fear of forgetting key details, and the worry of making clinical errors can all contribute to performance anxiety. But the good news? These feelings are normal—and entirely manageable with the right approach.

Why do OSCEs feel so stressful?

Unlike traditional exams, OSCEs require real-time clinical decision-making, interaction with simulated patients, and structured problem-solving under scrutiny. This environment often triggers performance-related anxiety, which can lead to:

Racing thoughts or self-doubt ("What if I forget everything?")
Physical symptoms (sweating, shaking, shallow breathing)
Freezing under pressure ("I know this, but I can’t recall it!")

But anxiety doesn’t mean failure—it’s a natural response to high-stakes situations. The key is learning to control it, so it enhances focus rather than disrupts performance.

Reframing OSCE anxiety - from fear to performance

One of the most effective ways to manage OSCE stress is reframing the way you perceive the exam - from a test of failure vs. success to a demonstration of skills.

Think like a clinician, not a student. OSCEs are designed to mimic real clinical encounters—if you approach them as patient interactions rather than exams, they become less intimidating. Instead of viewing it as a gruelling trial, see it as a demonstration—an opportunity to show what you know rather than prove perfection.
The examiners want to see competence, not perfection. They don’t expect flawless responses—what they assess is clinical reasoning, communication, and professionalism. If you make a mistake, acknowledge it calmly and adjust.
Watch your self-talk. Replace “I must perform perfectly” with “I will do my best and adapt as needed.” This shift in thinking removes the fear of failure and encourages a more natural, confident approach . “I’m trained for this—I just need to demonstrate what I’ve learned”.

💡 Try this mind shift exercise

Every time you catch yourself thinking “I must perform perfectly”, replace it with “I will do my best and adapt as needed”.

Fear-based thinking: "If I forget a step, I’ll fail!"
Adaptable thinking: "If I forget something, I’ll calmly recover and focus on the next step."

Practicing under realistic exam conditions

Students often prepare for OSCEs by reading cases and mentally rehearsing responses. While this helps, it’s not enough—real improvement comes from live practice.

💡 Set Up Exam-Like Practice Sessions:

Set up a mock OSCE environment—timed scenarios, examiner feedback, role-playing with peers.
Wear the right attire—what you wear affects confidence levels; for an authentic practice, dress as you would for the actual exam.
Practice with simulated stress—deliberately rehearse under high-pressure conditions (e.g., have someone interrupt or ask tough questions).

💡 Why this works:

Your brain gets used to handling pressure, making actual exam stress feel more familiar and manageable rather than overwhelming.

Managing exam-day nerves

Even well-prepared students feel anxious on exam day, but structured rituals can help bring control and confidence.

Arrive early, breathe deeply, and settle in. Don’t rush—give yourself time to mentally adjust.
Have a calming pre-exam routine. This could be listening to music, stretching, or using visualization (imagine yourself handling a case smoothly)., small habits can ease nerves.
Use confident body language. Studies show that upright posture and a strong stance reduce anxiety—so stand tall, smile, make eye contact and own the room before stepping into the station.

If anxiety feels overwhelming beyond exam settings, speaking to a psychologist can provide valuable coping strategies tailored to your needs. Learning techniques to manage stress early doesn’t just help for OSCEs—it strengthens resilience in clinical settings, ensuring confidence and composure when dealing with real patients in the future.

💡 Treat every OSCE station like a fresh clinical encounter. Just as a difficult patient interaction in real practice shouldn't cloud your next consultation, a challenging station shouldn't carry over into the rest of the exam. If something didn’t go well, take a deep breath, mentally wipe the slate clean, and focus on the next case as a new opportunity to demonstrate your skills.

Controlling physical symptoms of anxiety during OSCEs

Performance anxiety can trigger physical symptoms like a racing heart, shaking hands, or difficulty concentrating. The key is not to eliminate these feelings—but to control them.

Controlled breathing technique (4-7-8 method): Inhale deeply for 4 seconds, hold for 7 seconds, and exhale slowly for 8 seconds. This activates the parasympathetic nervous system, reducing tension.
Grounding exercises: If you feel overwhelmed, use the 5-4-3-2-1 method—identify 5 things you see, 4 things you hear, 3 things you feel, 2 things you smell, and 1 thing you taste. This pulls your focus back into the present moment.
Progressive muscle relaxation: Before the exam, tense muscle groups one by one (starting with your hands and working up to your shoulders), then release. This reduces nervous tension.

If physical symptoms of performance anxiety are really problematic, some students find beta blockers (like propranolol) can help control the physiological effects of stress, such as racing heart, tremors, and excessive sweating. However, beta blockers aren’t for everyone, and they don’t address cognitive anxiety, self-doubt, or exam confidence. Psychological techniques—like breathing exercises, reframing mindset, and structured practice +/- the input of a psychologist—should always be explored first. If medication is considered, discuss it with your GP to ensure suitability.

Handling unexpected situations with confidence

No OSCE runs perfectly—patients may have unclear symptoms, you may forget a detail, or an examiner might challenge your reasoning. The best way to handle uncertainty is to stay composed and focus on problem-solving rather than panicking.

💡 Key strategies for handling uncertainty:

Verbalize your thought process—Even if unsure, talk through clinical reasoning (“One possibility is X, but I want to rule out Y first…”)
If stuck, return to first principles—Use clinical frameworks like SOCRATES (for pain history), ABCDE (for emergencies) etc to keep you focused
If you forget something or misspeak, don’t freeze—redirect calmly. Instead of panicking, say “Let me clarify that again” and return to fundamentals.

Confidence comes from preparation, not just talent

The students who perform best in OSCEs aren’t necessarily the ones with perfect knowledge—they’re the ones who are mentally prepared to handle stress and uncertainty.

🚀 The key isn’t eliminating nerves—it’s channeling them into focus and performance.

🚀 You are capable, trained, and prepared—trust yourself, speak with clarity, and approach each station like a real patient interaction.

You’ve got this. Go in feeling ready, leave feeling accomplished!

📦 Want to learn more?

Reflections on Medical Education

Tuesday, 13 May 2025

Mastering OSCEs and other clinical assessments: your mindset helps!