Mastering the NAC OSCE: Practical Strategies for IMGs
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The secret to success in the NAC OSCE lies in practicing with an appropriate clinical approach while remaining professional, empathetic, and inclusive.
Practice makes perfect! Whether on your own or with people you know and feel comfortable with, such as friends and family, it's important to practice. Additionally, join community pages and active groups to connect with others on a similar path. This will provide you with more exam-focused and up-to-date knowledge, which is essential for having the right clinical approach to common clinical problems and possessing the correct physical exam skills during practice. If you have any doubts about your clinical approach or physical exam skills, consider enrolling in preparatory courses to become familiar with the Canadian system. If you feel confident in your existing skills, be sure to participate in a few mock OSCEs. This will not only help calm your nerves on exam day but also help you understand the OSCE flow, manage your time, and learn how to handle unexpected situations that may arise during the exam.
Keep in mind that while the exam aims to evaluate your clinical knowledge and skills, it also assesses your readiness to join the Canadian Healthcare system. Therefore, in addition to being a medical expert, you should demonstrate professionalism, empathy, cultural sensitivity, and teamwork skills.
Understanding the NAC OSCE Format
It is essential to visit the Medical Council of Canada website and go through the NAC examination candidate guide for the latest details about your NAC OSCE session. The NAC OSCE orientation module, which is mandatory and accessible on their official website, should be completed before the exam. I recommend reviewing it a few weeks prior to your exam date and then again shortly before the exam. This approach will help you practice while considering the OSCE's format and flow, thereby enhancing your exam preparation.
Typically, the OSCE is structured and proceeds as follows:
Total stations: 12 stations (including 2 pilot stations that do not contribute to the final score) plus 2-3 rest stations.
Duration per station: 13 minutes total (2 minutes for reading + 11 minutes inside the room).
Station types: History taking, Physical examination, Counseling, Management, Mixed stations.
Evaluation criteria: Communication, organization, data gathering, clinical judgment, and professionalism.
Top Resources for NAC OSCE Preparation
First Aid for the USMLE Step 2 CS
CanadaQBank Step 2 CS/NAC OSCE cases
Canadian Family Medicine Clinical Cards
Edmonton Manual (if you have time)
I would suggest making your own checklist/template for the below-mentioned most common must-practice clinical scenarios by reviewing the above-mentioned resources. This will provide you with a guideline on how to approach a clinical scenario by having a list of possible differential diagnoses when interviewing, while ensuring to rule out all the red flags. Moreover, the most impactful factor will be PLENTY OF PRACTICE! Engage with friends, colleagues, family, and participate in multiple MOCK OSCE sessions!
Must Practice Clinical Scenarios:
History Taking
Chest pain (Angina, MI, GERD, anxiety, costochondritis)
Shortness of breath (asthma, COPD, CHF, PE, angina, pneumothorax)
Abdominal pain (appendicitis, ectopic, biliary colic, bowel obstruction)
Headache (migraine, SAH, meningitis)
Dizziness (BPPV, vestibular neuritis, stroke, orthostatic)
Fatigue (anemia, hypothyroid, depression, malignancy, autoimmune conditions)
Weight loss (malignancy, hyperthyroid, diabetes, TB)
Polyuria (UTI, pyelonephritis, diabetes, psychogenic, DI)
Altered/loss of consciousness (stroke, aortic stenosis, seizure)
Psych related concerns (always screen for all psych conditions if one is present)
Counselling Stations
Smoking cessation
New diabetes diagnosis
Starting insulin
Inhaler/Asthma counselling
HIV positive result
Domestic violence
Contraceptive options
Breaking bad news (cancer, miscarriage, Medical Assistance in Dying)
Fitness to drive (e.g., seizures, dementia)
Medical errors (discussion with the patient or other healthcare provider)
Physical Examination
Cardiovascular exam
Respiratory exam
Abdominal exam
Neurological exam (cranial nerves, motor/sensory, coordination)
Musculoskeletal exam (shoulder, knee, back)
Thyroid exam
Mental status exam (depression, cognitive decline)
Diagnosis & Management Planning
Either the examiner or the patient themselves can ask the following questions:
· Differential diagnoses
· Most likely diagnosis
· Appropriate investigations
· Interpret results (blood work or imaging)
· Management plan Follow-up and safety netting
Common Mistakes to Avoid
Talking over the patient
Not identifying red flags
Forgetting closure or safety netting
Ignoring the patient’s concerns or emotions
Skipping key parts or not verbalizing key steps of physical exam (hand sanitization, consent, ideal position, taking note of the patient’s vitals, general health and the surrounding)
Time mismanagement (e.g., continuing history when counseling or physical examination is expected)
Final Tip for the NAC OSCE
Remember: The examiners are asking “Is this candidate safe, empathetic, and competent enough to see patients in Canada?”
Not: “Did they memorize Harrison’s textbook?”
Be confident, calm and composed! You have got this! Best of luck! If you found this helpful and want to book a mock NAC OSCE session with feedback:
