The NAC-OSCE is the one of the most difficult exams to research about - there’s just not that much on the internet about it. It was really frustrating for me when I was trying to prepare for this exam simply because I couldn’t find anything!
So I decided to write this post to give people a better idea of the resources I used and what the expect on the day of the exam.
Primary Resources I Used: Master the NAC, Geeky Medics, a friend
I found that (between asking my friends that took the exam before me and my frantic searches on the internet) most people used the NAC Comprehensive- however, scores varied tremendously. So, I went ahead and bought the electronic copy of it- it was extremely detailed and thorough. I felt like for me, it had far too much detail and wasn’t organized in a way that was intuitive to me.
Prior to taking the NAC-OSCE, I had already completed all my core rotations in addition to having taken Step 1, Step 2 CK, and Step 2 CS so I felt that I had a decent background of clinically-based medical knowledge to draw on. I wanted a more concise and organized book to study from for the NAC-OSCE.
I already took Step 2 CS and was used to the First AID CS (FA CS) format. The Master the NAC is formatted similarly to the FA CS. I liked the style of organization of the differential diagnoses, management, and investigations. I also felt that most cases that I saw on my exam were very similar to the ones that I studied from the book.
I did read through the NAC Comprehensive book to cover my bases regarding the management of the cases. I felt that this was best way to optimize my chance of reviewing cases that I was most likely to see on the day of.
Geeky medics was phenomenal in supplementing the physical exam sections of Master the NAC- Geeky Medics went more in depth regarding what to cover and WHY we look for certain things. It was especially fantastic with the videos to really help with visualization of the proper technique of doing the physical examinations. DEFINITELY a key part of my preparations for the NAC.
A key (and arguably the most difficult) portion of the examination is timing. To prepare for this, I got a friend to help me with practicing my timing with histories and physicals. This was easily the most vital part of the examination because timing was (for me at least) very difficult during the exam. Practicing on a real person under timed pressure helped the most while preparing.
The Big Day- Toronto Testing Centre
My test was at the Toronto testing centre and overall, I had a great experience. My exam was in the 12-4:30pm segment so I had plenty of time to arrive early and unwind by walking around Toronto’s beautiful downtown. Lucky for me, TIFF was in town that weekend and I got to stroll around a bit to help soothe my nerves before the exam.
My exam was during the 12-4:30 slot. I came early and when I reached the building, I was greeted by a nice staff member who informed me that once I came into the building, I couldn’t get out. So, I walked around a bit and then came in when I was ready. I went up the elevator to the registration floor. There were staff members everywhere ready to help along with signs- it was pretty impossible to miss. At registration, I showed my papers and my ID and was given a badge with the colour of my designated group.
I sat there until it was time to put our valuables away in a locked room. I would recommend going to the bathroom BEFORE you go to put your stuff away because otherwise, you have to wait until after sequestration is complete to go relieve yourself. From the locked room, we were directed to an empty room to sit in our designated seats organized according to group colour and individual numbers. We waited there and were given a pre-arranged lunch. Lunch was in baggies with several options to select from- vegetarian, chicken, turkey, and egg. After lunch, a quick video about security and privacy was shown.
This pre-exam set up was different from Step 2 CS because test takers were not given the opportunity to see what would be placed in the test room on the day of. You weren’t really sure what equipment you would have- I feel that this is definitely an area of improvement needed for the NAC to give test takers an idea of what to expect in the rooms.
However, similar to Step 2 CS- we were arranged in a line and taken to a corridor full of testing rooms. We were given 2 minutes in front of a door to read the short description of our case and then think about how to approach the case. The prompt indicated if the case was going to be a full 11 minutes (no Q/A session) or if it was going to be 8 minutes with 3 minutes of Q/A. After the 2 minutes were complete, we were permitted to enter the room. There were 12 stations in total. No breaks between the 12 stations. Each station can be just history, just physical, or history+physical. The length of each station varies between 8 minutes or 11 minutes depending on if there is a Q/A section at the station. Depending on the station, there may or may not be imaging or report to analyze during the Q/A session. Each person is given a booklet with one page of stickers with your test taking ID number- when entering a new room, we had to give a sticker to the examiner prior to beginning our examination.
All stations have an examiner seated at a desk with a check list and a standardized patient. As the test taker, we have to give one of our stickers to the examiner and then basically focus on the standardized patient. The examiner doesn’t normally interrupt unless the test taker is going off track and needs to be refocused on the given instructions- ie. attempting to do a physical when only a history is required. If there is a Q/A session after the initial 8 minutes, the standardized patient will stay quiet while the examiner asks 3 questions. You are no longer allowed to ask the standardized patient anything during these 3 minutes. Also, after the examiner has moved onto another question, you cannot go back and add to your previous answer. Additionally, in order to move onto the next question- you must explicitly state that you are done with answering the current question. Otherwise, you will waste time and not complete all 3 questions. The examiner may stand up and look at what you’re doing during the physical exam encounters- just a heads up.
For me personally, there were some areas of difficulty that perhaps should be addressed to the MCC.
1. Timing: It was difficult to see the clock as the clock was resting on the examiner’s desk- which was usually located BEHIND the test taker. This made it enormously difficult to keep track of time.
2. Unfamiliarity of the room: For the most part, this wasn’t a huge issue. However, in the stations that were for physical examinations- it was hard to gauge what you would have in the room with you and you have to take a minute to look around the room and orient yourself accordingly.
The staff at the Toronto testing centre are incredibly nice and friendly. I came early and there was someone at the main door ready to help me out and direct me to the correct floor. Upon arriving at the correct floor, there were several staff members ready to direct test takers to the registration area. It would be honestly very difficult to get lost. Registration was smooth and quick. The manager was very friendly and that helped ease our worries.
Parking/Public Transportation
There is parking near the building however, it was closed on the day that I took my exam. My friend had driven so he had to spend time looking for an open parking garage and ended up spending $40 on parking for the duration of the exam. It might be due to the fact that we took our exam during the TIFF weekend so that may have been a contributing factor.
I took the subway and I’m very happy that I left my home several hours early because there were some unforeseen delays on the TTC.
Overall, I would recommend thoroughly checking for any TTC delays or the presence of any major activities in Toronto when deciding which mode of transportation is the most efficient on your big day.
Toronto downtown has so many fun places to explore so check it out to celebrate the completion of your examination!
