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Clinical examinations are now objective and structured with visitations to multiple stations where all candidates have to perform the same tasks while examiners look on. Apart from history taking and communication skills stations there is minimal opportunity to relate to candidates. I find the “non-talking” stations boring and hardly ever memorable.
In contrast the old style exams often provided memorable incidents. The candidate gave a full history of her patient’s respiratory problems but unfortunately had not realised that he kept racing pigeons. My fellow examiner threw her a verbal lifeline “If I were to tell you he kept racing pigeons would this affect management?” The candidate was visibly grateful. “I would tell him to send them away”. My colleague found himself severing her lifeline as he said “but racing pigeons are homing pigeons”.
Memorable interactions are rarer with station based exams, but do occur in the “talking” stations. The rules were clear. Each candidate had 14 minutes talking to a simulated patient, one minute for reflection, and five minutes discussion with the examiners. I had written a communication skills scenario which involved a forceful businessman who had to be persuaded his diabetes required attention. His scripted opening lines were “I’m a busy man doctor and diabetes seems simple. Tell me about it. And how long is this consultation going to be as I have an important meeting”. The candidate gave a wry smile and replied “Exactly 14 minutes”.