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The Rough Guide to taking the OSPHE

by PH trainees Abhijit Bagade and Stuart Lines

The OSPHE (Objective Structured Public Health Examination) is the new Part B exam for membership of the Faculty of Public Health. It replaces the previous Part II membership exam and indicates the Faculty's move to a more skills-based assessment midway through training rather than an exit exam. It is intended that the OSPHE will be taken around six to nine months after passing Part A (previously Part I), the knowledge-based assessment for membership.

The OSPHE consists of six ‘stations'. A different scenario is presented to the candidate at each station. Several sittings have been organised for 2006 in order to accommodate ‘the bulge' of trainees who have not taken Part II and who may be nearing their CCT dates.

The first sitting of the new OSPHE was held on Friday 3 February 2006. Twenty-three candidates sat the exam (11 in the morning and 12 in the afternoon). This article outlines the experience of two trainees from the Eastern Deanery who sat the first OSPHE. It offers their advice and tips on what to expect on the day, how to prepare and how to approach the scenarios.

Application procedure

The application procedure for the first sitting was very smooth. The Faculty website offers comprehensive information on available dates and on the application procedure itself.

Application forms can be downloaded from the website. Preferred dates for sitting the exam need to be specified on the form, but there is scope for taking it earlier if you indicate that you are willing to accept a late availability place. Some candidates at the first sitting had been offered a place in the couple of weeks before the exam. Should you have a preference it may also be worth requesting either a morning or afternoon sitting.

The instructions on the website specify the standard fee (£540) to be paid with the application form; the fees are much less (£135 for the first attempt only) for those who have subscribed to the five year trainee member package. Candidates should make sure which fee applies to them before sending in the application. Surprisingly, neither the form nor instructions say who to make the cheque payable to. ‘Faculty of PH' is the obvious answer, but you should check before sending the form.

The Faculty is very efficient in responding to the application form and allocating the exam date. Detailed exam instructions, including candidate number, directions to the centre and exam procedures, are sent to you around two to three weeks before the exam. This was considered to be a very well organised and comprehensive pack.

On the day of the OSPHE

GMC reception / waiting hall

The organisation of the exam is very professional and smooth.

The exam is held in the new GMC building at 350 Euston Road , which has a purpose-built assessment centre for the PLAB exam. The GMC building is very modern. You present yourself at the main reception and you are given a visitor's identification badge, which you hang around your neck. If you are in the morning sitting, and if you arrive early, you may well bump into examiners, so be polite to everyone you encounter! You will then be collected and taken in the lift to the first floor.

Arrive in good time! If you arrive too late you won't be admitted.

For the morning the schedule was:

09:30 – Reporting time
09:30 – 10:30 Registration
10:30 – 11:00 Briefing
11:00 – 13:00 Exam

For the afternoon the schedule was:

12:00 Reporting time
12:00 – 13:00 Registration
13:00 – 14:15 Briefing (with lunch)
14:15 – 16:15 Exam

You can arrive earlier and sit in the waiting area overlooking Euston Road . The waiting area is comfortable and quiet enough if you want to read through notes before the exam. The facilities include a free tea/coffee machine, water and toilets. Candidates are able to sit and chat while waiting. This may be a good idea as it could help ease nerves and will also get the mouth and tongue moving. If you wanted to, you could also do some vocal warm-up exercises here. Some people choose to read through notes quietly, but how useful this will be is up to the individual. There is a period of waiting: make the most of it – try to relax by talking, walking around etc.

Registration

The candidates are taken from the waiting area to another room for the registration process where names are checked (take your passport) and you are given a slip of paper with your name and candidate number, which you put into the plastic badge wallet around your neck.

While waiting here you will be taken to a locker room where you leave coats and bags. All belongings are to be kept in the lockers, including pens and pencils. You are not allowed to take anything with you into the exam except the locker key. You can keep any amount of luggage in the secure locker room and the valuables go into the locker. If in any doubt you can ask any of the GMC or Faculty staff who will be around and are constantly helpful.

OSPHE briefing

From the registration room, where there is also water, and tea and coffee machines, you will be taken to the next door room for the briefing. All 12 candidates sit in rows of four and each seat has a laminated instruction sheet placed on it. You are then taken through this sheet by the Faculty representative and can ask questions. They explain how the exam will be conducted and show you the floor plan of the exam rooms and how you move around. The briefing only takes a few minutes and you are then left to wait.

You will also be given details of the marking schedule – that you need to secure adequate or above marks for each competency in at least three stations. Each of the five competencies is assessed over the six stations. The pass mark overall was 6.0 out of 10. For candidates in the first sitting this was the first time that the marking schedule had been outlined; it would have been preferable to know this earlier. Some information about the marking is now available on the Faculty website under ‘Guidance for candidates: Marking the OSPHE'.

In the afternoon session this is where you will be given lunch if you have requested it. You are not allowed to bring your own food because of GMC regulations. A word or warning – there may be lots of food available but don't be tempted to eat too much! In the morning session candidates ate bananas or cereal bars, which they had brought with them and sipped water while waiting. This will also be the last chance to go to the toilet, as there will be no opportunity to do so during the exam.

 

The exam

The Exam Circuit

Around five to ten minutes before the exam is due to start you will be lined up in candidate number order and given your own ‘candidate preparation pack'. This is a collection of all six scenarios in a file with dividers marking the number of the station from one to six. You take this pack with you around the exam circuit and are able to mark it and make notes on it (but it must be left behind at the end of the exam).

Although each preparation station and each exam station have a laminated copy of the scenario for that particular station you tend not to look at them and only focus on your ‘own' copy. A word of advice – the organisation is excellent overall, and the scenarios in this pack are (or should be) exactly the same as the ones in the preparation stations, but it may be worth just checking to make sure there are no pages missing, or extra ones put in, and that they are in the correct order in your pack!

The preparation pack is an excellent idea. The most important benefit is that you don't have to make notes on a separate piece of paper and waste valuable time. You can also show the maps and tables from the pack to the actor as part of your discussion during the exam.

GMC staff will then take you to the exam circuit and stand you outside the first preparation room, i.e. outside 3P if you are candidate number three. The arrangement for moving around the stations is efficient and professionally managed by the GMC staff.

While you are waiting outside the stations, black TV screens with white writing at each end of the corridor count down the seconds to the start of the exam. A recorded voice will then ask you to enter and the first six go in with their candidate preparation packs. Inside the station, the tannoy will announce when you have, ‘one minute left' and then to ‘leave the station' when the time is up. The second group of six are brought from the waiting room and wait in the corridor outside until the first group move out to go into the exam stations. The cycle continues until everyone completes all six stations.

We were told during the pre-exam briefing that we could refer to our notes or the briefing pack during the waiting period to revise and organise our thoughts.

Preparation stations

As you enter the first preparation room you suddenly realise that this is all real. The first thing you may notice is the incredibly loud tick of the clock. Otherwise all is very quiet and cell-like.

You are confronted by a desk with paper, a clipboard, pens, pencils and a laminated preparation pack. There may also be flipchart paper and marker pens (at the first sitting there were two stations with flipchart paper – one was clearly for optional use and one appeared to require you to use it). The briefing beforehand stated that the use of flipcharts would be optional. You have to leave the pens / markers, etc. in the preparation room for the others to use.

The preparation material is from one to five pages long. The information and material for five stations was appropriate. For one of the stations the preparation material was confusing and not easy to understand, rather than it being lengthy. In one of the stations the scenario was probably too clinical and the role we had to play was thought to be irrelevant for PH practitioners.

Eight minutes of preparation time passes quickly. If you want to use the flip chart, start writing on it simultaneously as you read your material.

There should be a sufficient supply of pens on the desk but, bearing in mind it is human nature to always hold a pen and take it with you, you may find that, towards the end of the circuit, there could be less pens available. Candidates should immediately ask GMC staff outside the exam rooms for pens, water or any other thing they need. The staff will provide you with what you need straight away.

There is water available - either a small water bottle or a water cooler and some plastic cups. The water bottle is a small one so it can be empty when you go into the station. There were not enough clean cups in some stations. Towards the end of the circuit your mouth may be getting very dry, so sips of water are a good idea.

There is also a clock in the preparation station – a very small table clock or one on the wall, it may or may not be easily visible when you are sitting at the preparation table.

After seven minutes a recorded voice will announce that there is one minute remaining. After this it will then ask you to leave the room. You then leave and a member of staff directs you to the examination room for this station, which is usually the next room. You look at the black and white screen at the end of the corridor and watch it count down the seconds until you go in. There is a minute gap between the preparation and examination rooms and you may be waiting in the corridor for anything between 50 and 20 seconds. The recorded announcement then asks you to enter the next room.

Exam stations

Upon entering the exam room you are greeted by the examiner who may then check your name and candidate number. They will then introduce you to the role player and also to the observer if present. They may also assist you in putting up your flipchart paper if you are using it.

The examiner may, but not always, introduce the scenario to you, starting with a standard introduction of, “Imagine you are …” However, your cue may only be, “This is the chief executive of X – you can start now.” Some actors then start the conversation, but most of them wait for you to start the discussion.

You are then in role. You can refer to any notes that you made either on plain paper or in your candidate pack. If you have used extra paper to make notes or the flip chart you will be asked to leave these behind at the end of that station.

The most important factors to bear in mind while in role are to remember who you are speaking to, what they want, or, more importantly, need to know, who you are in the role-play, and to adopt the right pitch or tone. It may be useful to prepare some key introductory sentences and phrases that you could use each time and adapt as necessary. You should introduce yourself, say why you are meeting them and say what you are going to do. Further notes on this are given below under ‘Some Advice'.

Almost all the actors are friendly and their behaviour is appropriate to their role. However, there was one station where we thought that the actor was a little too aggressive, which was not appropriate to the role.

The examiner or any observers (in some stations) do not participate at all and they are usually out of your line of vision. So, they do not cause any interference in your role-play.

The recorded voice will announce when you have one minute remaining. You should try to use this time to draw the discussion or presentation to a conclusion. You should again hammer home your key messages and summarise an action plan. Remember to thank (in role) the person you have been speaking to. The tannoy will then announce that you are to leave the room. Remember the pleasantries – be courteous and say goodbye to all those present.

You will then be back in the corridor and waiting for your next preparation room. The cycle thus goes on until you finish your six stations. If you are in the first group of six, after you come out of the exam station, you will be asked to wait until the minute is up and the second group of six have entered their final examination room before the GMC staff will lead you out of the exam circuit and back to the briefing room.

After the exam

After you come out of the sixth exam station the preparation pack is taken away from you and you are asked to go back to the briefing or registration room.

An evaluation form is given to you to be completed and posted to an independent evaluator. Most of the candidates filled in the forms then and there. This was a one side of A4 and was not very comprehensive – mainly asking about adequacy of timings etc.

You will then be able to return to the locker room and collect your things. You are then free to go, but if you waited eight minutes then the second group of six would then join you. If you are a morning candidate the afternoon candidates will by this time be in the briefing room. Of course, no contact will be permitted with them.

Results

The results will be posted to you within a week of the exam. If you have passed – well done! If you have failed you will be sent an OSPHE Feedback Request Form. You need to complete your estimated average score for each competency and send it back to the Faculty. The form will then be sent back to you with your actual average scores for each competency and overall average mark. A word of warning – you can pass each competency with a score of 6.0 or above but still fail because you did not demonstrate a particular competency well enough in three or more stations. Feedback on individual stations is not given.

Some Advice

Here is a summary of some advice given in this article, together with some ‘tips and tricks' you may find useful:

  • If you have a preference, it may be worth requesting either a morning or afternoon sitting when you send in the application form. The Faculty will do their best to accommodate your preference.
  • Arrive in good time for the exam. Whilst waiting try to do some vocal warm-up exercises (humming, mouth stretches, chat to other candidates).
  • Do some breathing exercises to combat nerves and help with speech. These can be done before the exam as well as in each preparation station and in the waiting corridor. An easy method is – breathe in deeply for a count of five, hold for a count of 15 and exhale for a count of 10, repeated as necessary.
  • Have sips of water to combat a dry mouth, but not too much if you are someone who needs the toilet frequently.
  • It may be worth checking your candidate preparation pack to make sure there are no pages missing, or extra ones put in, and that they are in the correct order in your pack!
  • Think about how you would use the props you are given – how you would use a flipchart in eight minutes (you might want to transcribe your framework on to it) and how you might refer to tables, maps, graphs and references (the role player should have their own copy of all of these and so you should be able to refer to them relatively easily).
  • Remember that you are in role. You must try to embrace, relish and enjoy the part you are playing in order to let it flow as naturally as possible. You should aim to engage, enthuse and even entertain to a degree in order to get your message across.
  • Try to switch off totally once you are out of one exam station and switch on for a fresh start in the next preparation station.
  • General preparation for the exam: Use DH and NHS documents of all important PH issues to prepare for this exam in addition to the daily work projects in your department. Practice reading and understanding four to five pages of these documents in eight minutes and then practice presenting each document separately to a Chief Exec, PEC Chair, PH manager, members of the public and as a Media interview or press release in three to four minutes.
  • Consider using a generic framework that can be adapted for most situations. A couple of very simple ones are as follows:  
    • INTROS
      I
      introduce yourself/scenario; impact and the big picture
      N – what the audience needs to know
      Ttimings – say how long you will talk for
      Rresponses – say how you will take questions
      Ooutline what you are going to say
      Ssay three to four key points and then summarise
    • Three Rs
      Regret – express regret for an event that has happened
      Reasons – state why it happened
      Response – say what you are going to do about it

Overview

The OSPHE does seem to be an appropriate method of examination as it does attempt to reflect what public health practitioners actually do. Of course, the scenarios are still artificial, but the OSPHE appears to be an improvement over the old Part II in respect of attempting to replicate what might be encountered in the real world. However, there are some drawbacks. For example, the scenarios cannot take account of long-established relationships that will exist in the real world and you will inevitably be ‘starting from scratch' with the role player who is being your chief executive for example.

This is intended to be an objective exam and hopefully the Faculty has a robust system in place to make sure that it is assessed objectively. However, it may be appropriate to consider making the marking more robust by having a second examiner present and/or using video or tape recordings of each exam. This would also help hugely in giving feedback to those who fail. It is not clear whether the role player, who may be a public health professional and not a professional actor, would discuss the marking with the examiner after the candidate has left the room. It is felt that further clarification from the Faculty on the objectivity of the marking would be beneficial, as would more detailed feedback.

In conclusion, the exam is conducted in a very professional manner, the arrangements are excellent and, most importantly, it represents a huge step in the right direction.