MFOM Part 2 / AFOM OSCE Practice Scenarios

The Objective Structured Clinical Examination (OSCE) component of the MFOM Part 2 / AFOM exam assesses the practical clinical and communication skills required for occupational medicine practice.

The OSCE typically consists of 12 stations lasting 10 minutes each, with a short reading time beforehand. Stations are designed around four key skill areas:

• History taking
• Clinical examination
• Explanation and counselling
• Procedures

These skills are assessed through realistic workplace-related clinical scenarios such as respiratory disease, musculoskeletal injury, dermatology, and mental health.

The following scenarios mirror the types of stations candidates may encounter.

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History Taking Stations

Scenario 1: Schizophrenia in a Nurse

Key Areas to Cover

Presenting condition

• When symptoms began
• Nature of symptoms (hallucinations, delusions, disorganised thinking)
• Current mental state
• Insight into the illness

Treatment and care

• Current medications (e.g. antipsychotics)
• Medication adherence
• Side effects (sedation, cognitive slowing)
• Ongoing psychiatric follow-up

Occupational history

• Current nursing role and responsibilities
• Clinical setting (e.g. ward, community, ICU)
• Safety-critical tasks (medication administration, patient monitoring)
• Work hours and shift patterns

Functional impact

• Ability to concentrate and make decisions
• Fatigue or medication effects
• Confidence in returning to work
• Stress tolerance

Risk and support

• Any recent relapse or hospital admission
• Risk to self or others
• Support from employer or colleagues
• Workplace adjustments to consider

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Examiner Marking Focus

Examiners are typically assessing whether the candidate:

• Conducts a sensitive and non-judgemental consultation
• Explores the nature and stability of the psychiatric condition
• Assesses functional ability rather than just diagnosis
• Considers patient safety and patient care implications
• Demonstrates understanding of fitness-for-work considerations

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Important Occupational Medicine Considerations

When assessing healthcare workers with mental health conditions, the occupational physician must consider:

• Stability of the illness
• Medication side effects
• Impact on clinical decision making
• Risk to patients
• Whether temporary workplace adjustments are required
• Treating specialist/GP input to verify worker's account and stability

Possible workplace adjustments may include:

• Extended phased return to work
• Reduced shifts initially with no night work
• Avoiding high-stress clinical areas
• Regular occupational health follow-up

Scenario 2: Suspected Occupational Asthma

Key Areas to Cover

• Nature of respiratory symptoms
• Timing of symptoms relative to work
• Improvement on weekends or holidays
• Specific workplace exposures (flour dust, enzymes)
• Duration of employment
• Previous respiratory disease
• Smoking history
• Use of respiratory protection
• Workplace ventilation or control measures

Examiner Marking Focus

• Identification of exposure–symptom relationship
• Occupational risk factors
• Relevant medical history
• Logical questioning

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Explanation Stations

Scenario 3: Explaining Fitness for Work After Back Injury

Key Points to Explain

• Nature of mechanical back pain
• Importance of remaining active
• Temporary work limitations
• Modified duties
• Gradual return to work
• Red flag symptoms

Communication Skills Being Assessed

• Use of clear language
• Addressing patient concerns
• Shared decision making
• Practical workplace advice

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Scenario 4: Occupational Contact Dermatitis

Key Points to Cover

• What dermatitis is
• How workplace exposure contributes
• Importance of skin protection
• Appropriate glove use
• Hand care and moisturising
• When referral may be needed

Examiner Marking Focus

• Clarity of explanation
• Patient engagement
• Practical preventive advice

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Examination Stations

Scenario 5: Shoulder Examination

Expected Examination Steps

1. Introduce yourself and obtain consent
2. Inspection of shoulders
3. Palpation
4. Range of movement (active and passive)
5. Special tests (e.g. impingement tests)
6. Thank the patient and summarise findings

Examiner Marking Focus

• Examination technique
• Communication with patient
• Systematic approach

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Scenario 6: Respiratory Examination

Expected Examination Steps

• General inspection from end of the bed
• Respiratory rate and pattern
• Chest expansion
• Percussion
• Auscultation
• Interpretation of findings

Examiner Marking Focus

• Structured exam technique
• Identification of abnormal signs
• Professional interaction with patient
• Appropriate differential diagnoses

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Procedure Station

Scenario 7: Spirometry and Health Surveillance

Key Points to Demonstrate

• Purpose of spirometry
• Patient preparation
• Performing forced expiratory manoeuvre
• Acceptable test criteria
• Interpretation of FEV1 and FVC
• Occupational implications of abnormal results

Examiner Marking Focus

• Knowledge of the procedure
• Clear explanation
• Understanding of occupational health context

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How to Practise These Stations

Preparing with structured OSCE scenarios like these helps candidates demonstrate the clinical reasoning, communication skills, and occupational health judgement expected of a specialist occupational physician.