OSCE Station 1: Assessment (APIE) Walkthrough

The first APIE station sets the stage for the next three. You’re introduced to a patient scenario (typically through a brief handover or written brief) and asked to assess. Everything you do here flows into the Planning station (Station 2) that follows.

What the station looks like

You enter the station and find one of three scenarios:

• A simulated patient (an actor or a high-fidelity mannequin) presenting with a clinical issue.
• A handover from the previous nurse with documentation provided.
• A written scenario with documentation to review.

You have time to read the brief (usually a minute or two) before the station starts. The examiner observes but doesn’t usually intervene during the station unless safety is at stake.

What gets tested

Systematic assessment. Did you use a recognised framework (ABCDE for acutely unwell, whole-person assessment for stable patients)? Did you cover physical, psychological, social and spiritual where relevant?

Vital signs interpretation. Did you take the relevant observations and calculate NEWS2 where appropriate? Did you recognise the meaning of the numbers?

Priority identification. Did you identify the most urgent issue and the actions it implies?

Communication. Did you introduce yourself, gain consent, communicate clearly with the patient throughout?

Documentation. Did you record findings accurately?

ABCDE framework

For acutely unwell patients, ABCDE is the expected framework. The Resuscitation Council UK is the UK reference:

• A, Airway: is it patent? Any obstruction or compromise?
• B, Breathing: rate, depth, effort, oxygen saturation, breath sounds.
• C, Circulation: pulse rate and rhythm, blood pressure, capillary refill, skin colour, temperature.
• D, Disability: level of consciousness (AVPU or GCS), pupil response, blood glucose.
• E, Exposure: look-feel-listen for any other issues; check temperature; examine for rashes, injuries, signs.

For an acute scenario, examiners expect you to address each letter in order. Don’t jump ahead.

NEWS2 in the station

When the scenario produces vital signs, calculate NEWS2 and act on it.

Key NEWS2 escalation triggers (refer to the official RCP NEWS2 score for the binding chart):

• Any single parameter scoring 3: urgent escalation.
• Total score of 5-6: urgent escalation.
• Total score of 7+: emergency escalation.

State the score aloud. Identify the escalation trigger. Verbalise what you’d do next.

Full-person assessment for stable patients

Not every scenario is acutely unwell. For a stable patient, the assessment shifts:

• Presenting issue: what brought them to your attention.
• History: relevant medical, surgical, medication history.
• Functional assessment: how this is affecting daily life.
• Psychological: mood, anxiety, concerns.
• Social: home situation, support, accommodation needs.
• Spiritual: religious or cultural needs that bear on care.

For a stable patient, demonstrating breadth of thinking is what the examiner is looking for. ABCDE on a stable patient looks mechanical and wastes the station’s time.

Common failure patterns

Disorganised approach. Jumping between systems without a structure. Examiners write “lacked systematic approach” on marking sheets when this happens.

Forgetting introduction and consent. Some candidates dive straight into the clinical work without introducing themselves, identifying the patient, or gaining consent. Marks lost on Code Section 4 (consent) and Section 7 (communication).

Not calculating NEWS2 when relevant. A scenario with three abnormal observations and no NEWS2 calculation is a clear marks loss.

Identifying everything as equal priority. The station ends with the candidate needing to verbalise the priorities. “Everything is a priority” is the wrong answer. Identify 1-3 clear priorities and explain why.

How to use the time

Typical 14-20 minute breakdown:

• Minutes 0-2: introduction, consent, brief patient context.
• Minutes 2-12: systematic assessment (ABCDE or full-person).
• Minutes 12-16: documentation, NEWS2 calculation if relevant.
• Minutes 16-20: priorities, verbalise next steps for handover to Station 2.

You don’t have to finish at the time. Most candidates run slightly over their planned time on one section and short on another, which is fine if the overall coverage is there.

Handover at the end

Some centres ask you to verbalise a handover at the end of the station, ready for the Planning station. The handover format is SBAR:

• S, Situation: who the patient is, what’s happening now.
• B, Background: relevant history, medications, recent events.
• A, Assessment: your findings, NEWS2 if calculated, priorities.
• R, Recommendation: what you’d suggest next.

A clean SBAR closes the station strongly. It’s also what Station 2 (Planning) builds from.

The next chapter covers Station 2, Planning, which takes your assessment forward into a structured care plan.