NMC Midwifery OSCE common mistakes
NMC Midwifery OSCE · Understand the traps and how to avoid them.
Enters the bay, pulls the curtain, touches the notes trolley and the woman's pillow, then performs a vaginal examination or cannulation without cleaning hands at the point of care; afterwards peels off gloves and writes in the notes without repeating hand hygiene.
Candidates rehearse the procedure sequence and treat hand hygiene as a separate item rather than a step embedded at every transition; under station timing pressure it is the first thing dropped.
What to do instead
Rehearse hand hygiene as a spoken trigger attached to every transition (before contact, before a clean/aseptic task, after body-fluid exposure, after contact) and physically place the gel at the trolley edge so it sits in the path of the task.
Draws up oxytocin or checks a prescription against the chart without reading the woman's ID band, does not ask about allergy status, and does not state the indication and dose aloud before administering.
Under time pressure the candidate concentrates on the calculation and injection technique and treats checking as paperwork; the simulated woman's allergy is often recorded only on the wristband or in the notes they never open.
What to do instead
Use a fixed checklist said aloud every time: identity (name, date of birth, number), allergy status, drug, dose, route, time, indication, expiry, second checker for high-risk drugs, then hold the ID band and chart together before drawing up.
Takes a blood pressure with an undersized cuff over clothing, counts respirations for 15 seconds, and records the numbers without calculating an early warning score or repeating the observations after an abnormal value.
Technique is learned on manikins with convenient arms, and the task is framed as 'getting a number' rather than producing a trend that drives action.
What to do instead
Narrate correct technique while doing it (correct cuff size, arm supported at heart level, respirations for a full minute, pain score), then always verbalise the aggregated score, the repeat interval and the escalation plan.
Records maternal heart rate 125, BP 88/50, temperature 38.4 and offensive lochia, then carries on taking a social history without calling for help, starting a fluid balance chart or requesting medical review.
Candidates fixate on completing the station's nominal task and are reluctant to 'interrupt' the scenario; many also under-trust their own recognition of sepsis and postpartum haemorrhage red flags.
What to do instead
Adopt a hard rule that any red-flag observation halts the scripted task: say 'I am stopping to escalate', work through ABCDE, put out a help call, and only return to the original task once escalation is complete and documented.
Looks at a cardiotocograph, says 'there are some decelerations', but does not systematically assess baseline, variability, accelerations, decelerations and contractions, does not assign a category, and attaches no timeframe to escalation.
Interpretation is often learned as pattern-spotting rather than a structured method, and candidates freeze when the trace is equivocal rather than blatantly abnormal.
What to do instead
Work a fixed grid every time, then state the category and a timed action: 'This is pathological, I would escalate now, start conservative measures and prepare for expedited birth.'
Writes a note that lists the plan rather than what was done, omits times, leaves out the woman's consent and response, and records observations on the chart with no narrative or evaluation of the care given.
The station ends before care feels 'finished', so candidates believe there is nothing to evaluate, and notes get written in the final thirty seconds.
What to do instead
Treat documentation as a scored step, begun in real time, using a fixed structure: time, findings, action taken, woman's consent and response, evaluation, plan, signature and designation.
'Consents' the woman with 'alright?' while already snapping on gloves, does not confirm her identity against the band, does not explain the procedure, risks or alternatives, and does not check understanding or offer a chaperone.
Consent is conflated with politeness, and candidates assume the woman in the bed is the named patient and that agreement equals informed consent.
What to do instead
Run a scripted sequence before touching the trolley: identity check, explanation and reason, what she will feel, risks and alternatives, right to stop, chaperone, then 'can you tell me in your own words what I am going to do?'
Improvises when the simulated situation exceeds competence, persisting with a difficult catheterisation, interpreting a complex trace alone, or agreeing to a request that conflicts with the care plan without contacting the coordinator or on-call obstetrician.
Candidates assume that visible independence scores higher than calling for help and fear that escalation will read as failure.
What to do instead
Verbalise the boundary in one calm sentence without apologising: 'This is outside my current competence, I am calling the coordinator now.' Escalation is a scored professional behaviour, so rehearse it until it is automatic.
Delivers the whole explanation to the examiner or the manikin's chest in technical language, ignores the woman's question about pain, and never checks what she has understood.
Candidates seek reassurance from the assessor and default to a rehearsed clinical script; nerves strip out eye contact, turn-taking and plain wording.
What to do instead
Anchor at the woman's eye level, ask one question at a time, use plain words with a check-back ('what will you do if the bleeding gets heavier?'), and answer her concern before returning to the task.
Gives handover as a chronological story ('she came in at two, then we did...') with no headline or request, or discloses a diagnosis of fetal loss in a corridor without privacy, a warning shot, or checking what she already knows.
Candidates narrate to demonstrate how much they did, and under pressure they rush the hardest conversations to get them over with.
What to do instead
Use SBAR with the ask stated first ('I need you to review her within ten minutes'), and open sensitive conversations with a fixed sequence: privacy, sit down, 'what have you been told so far?', a warning shot, then information in small chunks with silence.