Consultants love a good OSCE, and if objective structured clinical examinations are good enough for assessing medical students then they should be good enough for assessing consultants, although they must reflect a typical working day. The OSCE outlined here is designed for the revalidation of middle aged, male doctors, but it can easily be adjusted for age, sex, and specialty.
Station 1
Neurology
Not unreasonably you ask for an ophthalmoscope to examine the retina of a young man with sudden unilateral visual failure. Sister goes off and returns with one from the urology ward. There is no light and it rattles. Sister goes off again and finds you two batteries. There is still no light. Sister goes off again. She does not return. Examine the other cranial nerves.
Station 2
Radiography
The teacher with an early term dizzy turn, nausea, and headache who underwent computed tomography of her head on the medical admission unit two days ago is agitating for the result, in a fierce sort of way—as is her solicitor husband, in a medicolegal sort of way. With an air of calm authority garnered from years at the top you take control, promising to see the scans immediately and “sort everything out.” Your senior house officer (she looks vaguely familiar and you're pretty sure that's who she is) looks less encouraging and spends futile minutes divining the bottom of the notes trolley only to disappear off to the x ray department. She does not return. Go back to the expectant couple and, retaining your dignity, provide a simple explanation.
Station 3
Data interpretation
The troponin-T concentration may (or may not) have been measured in the large tattooed man engaged in the security business who is of the inclination to go home after an episode of central chest pain (“I'm f*****g telling you, I'm f*****g out of here, son”). Sighing rather unnecessarily, the specialist registrar goes away to phone the lab. She does not return. You have 10 minutes to access the biochemistry results on the ward computer without asking the first-day healthcare assistant how to log on. Incidentally, what is the password?
Station 4
Respiratory examination: a case of atypical pneumonia?
You are now alone. Wedged between the back of the patient and a shifting headboard, you tug on the nightdress with one hand and try and switch off the emergency buzzer you sat on with the other. Your bottom starts to feel damp. You give up on the night dress and, with no sign of lurking medical students, you have a quick listen through the patient's clothes. As you do so she starts to tell you about the recent demise of her parrot. You miss this bit. Assuming that (a) her chest x ray film is “not in the trolley,” has “left the x ray department,” but is “not in the post room”; (b) the nurse you track down has “just been on days off” and also “works on the other (blue) team”; and (c) the drug Kardex was “here a few minutes ago,” discuss the clinical significance of quiet basal breath sounds and pan-inspiratory crackles heard through a linen nightdress and two vests.
Station 5
Practical procedures: putting in a venflon without thinking
Put in a venflon without thinking that (a) this is not really my job, (b) it wasn't like this in the olden days, (c) I wish my house physician was doing this, (d) my house physician is in Antigua, (e) I wish I was in Antigua, and (f) I wish I was in Antigua with my house physician.
Station 6
Communication skills: breaking bad news
Your secretary rings you on the round at 9 45 am and breaks the following news: the patients from the clinic that we “cancelled last February in writing” are getting very very agitated—there are 12 so far; at 7 pm you are chairing, as promised (don't you remember?), a questions and answers session at the local fibromyalgia association—30 minutes before the start of your weekly tennis doubles; you have your wife's car keys in your pocket. 
Maintaining a respiratory rate of less than 25 and keeping your ST segments at less than 2 mm below baseline, charm your secretary out of resigning to retrain as a saint and martyr or threatening to stop watering your plants or to trash your mountain of back copies of Thorax.
Station 7
Basic clinical skills
With rising stress and falling blood sugar you have 15 seconds to get three Galaxies out of an unopened box of Celebrations before the sister on the surgical ward (a) explains to you that they are for the nurses (who do all the proper work round here, etc etc), (b) reminds (and surprises) you about your five outliers who have not been seen by “anyone medical” for a “number” of days—possibly longer, (c) loudly cancels three AP resections and a hernia repair because of medical overflow—again, and (d) sticks a pair of surgical scissors through the back of your hand.
Station 8
Role play: communicating with those who have learning difficulties
You are a medical student from Gdansk and, having waited for two hours in sister's office, you track down the consultant who 12 months ago agreed that you could come as a clinical attachment. He seems unsettled, there is blood down his shirt, a plaster on his finger, and he seems to be saying bad things to a blank computer screen. Make him coffee and offer a family sized Mars bar and say the following in perfect English: I hail from Gdansk; I know which way round batteries go in an ophthalmoscope; I can put in a venflon; I can find the on switch on a PC; I have just done a student selected option on fibromyalgia.
Stations 9, 10, and 11
Stations 9, 10, and 11 are not here: station 9 is on Ward 32, station 10 is on Ward 3 (old Ward 24), and station 11 is waiting for you with three other stations in the day room (didn't someone tell you they were there?).
* * *
You have now finished. Collect your revalidation certificate, two (senior house officer and specialist registrar) blank holiday forms (one for last week and one for next week), and three letters of complaint (two in capital letters) before you return to the car park to try and remember where you put your car.
Have a nice day.
Footnotes
Funding: None.
Competing interests: None declared.