Here is my personal selection for the worst thing that you can do in the NAC-OSCE exam:

Dismissing the Simulated Patient's Perspective (verbal and non-verbal cues)

It is crucial to exhibit strong active listening skills and appropriately respond to the simulated patient's concerns and gestures as they arise in the moment in the NAC-OSCE exam. Recognizing, acknowledging, and understanding the simulated patient's experience is a key part of taking a proper patient-centered history and physical for the successful completion of an exam station.

Here is a common example of a candidate interaction where the simulated patient's verbal and non-verbal cues are dismissed:

Candidate: Are there any health conditions that run in your family?

SP: Yes, breast cancer. My mother was recently diagnosed with breast cancer (spoken slowly, in a sad tone while looking at the floor)

Candidate: Does anyone have diabetes?

SP: No

Candidate: Has anyone ever been diagnosed with heart problems?

In this case, the candidate hasn't noticed the simulated patient's apparent distress. Instead, they have continued with their history taking agenda thereby failing to recognize, acknowledge and understand the simulated patient's underlying concern. They may have missed the entire objective of the station. How is the patient's mother doing? How is the patient coping? How is the patient's family coping? Do they need support? Could your patient be depressed?

In order to avoid this misstep in the NAC-OSCE exam, it is critical to practice effective active listening skills and respond appropriately to the simulated patient's concerns and gestures as they arise in the moment.

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