A FFICM Final OSCE station on MedMock, start to finish
This is an illustrative FFICM Final OSCE station written by MedMock to show what the station is like: the brief, everything the patient says, the candidate’s answers and the feedback were all written by us, not recorded from a real session. The feedback is laid out the way MedMock marks this exam. It is here to show the format and the standard, not as a model answer to learn by heart.
The brief
You have one minute to read this brief before a seven-minute FFICM Final OSCE station. Patient: Mr Arthur Pendle, aged 74, admitted to Intensive Care 48 hours ago with urosepsis and septic shock on a background of severe COPD (baseline exercise tolerance 30 metres on the flat, home nebulisers, two admissions with hypercapnic respiratory failure in the past year) and ischaemic heart disease. When admitted, a treatment escalation plan was agreed with Mr Pendle and his consultant that high-flow nasal oxygen, vasopressors and renal replacement therapy would be given, but that invasive mechanical ventilation and cardiopulmonary resuscitation would not be in his best interests. Over the past four hours, despite source control (percutaneous nephrostomy), broad-spectrum antibiotics, noradrenaline and high-flow nasal oxygen, he has become progressively exhausted, drowsy and acidotic. Your task: speak to his daughter, Mrs Sarah Pendle, who has just arrived on the unit. Explain her father’s deterioration, why invasive ventilation is not clinically appropriate, and how the team will care for him.
Professionalism & Communication: the full transcript
This is Mrs Sarah Pendle, Mr Pendle’s daughter. You have seven minutes. Please begin.
Hello Mrs Pendle, I’m Dr Patel, one of the intensive care doctors looking after your dad. Thank you for coming in so quickly. Before I update you on what has been happening this afternoon, could you tell me what you already know about how your dad has been since he came to Intensive Care?
When I spoke to the nurse this morning, she said he’d had a tube put into his kidney overnight to drain the infection and that he was on strong blood-pressure medicine and the big oxygen mask. When I walked past his bed just now he looked grey and could barely open his eyes. Is he getting worse?
I’m really sorry to have to tell you this, Sarah, but yes—despite draining the blocked kidney, giving strong intravenous antibiotics, supporting his blood pressure and giving him high-flow oxygen, your dad has become much sicker over the last few hours. The severe infection has put an enormous strain on his lungs and his circulation, and he is becoming very tired and drowsy.
If he’s getting too tired to breathe on that mask, can’t you put him on a proper breathing machine until the antibiotics have had time to work?
I completely understand why you’re asking that. When your dad first came to Intensive Care, and he was still able to talk things through with us and the consultant, we looked very carefully at his severe long-standing lung disease and how limited his breathing already was at home. Putting someone on an invasive ventilator involves an anaesthetic and a tube into the windpipe. With lungs as scarred and fragile as your dad’s, a breathing machine would not be able to reverse this infection or get him back off the machine—it would subject him to invasive procedures in his final hours or days without being able to save his life. Your dad was very clear with us that he would not want to be kept on a machine if he could not recover, and as a medical team we agree that invasive ventilation would not work for him.
So does that mean you’re stopping everything? Is he going to be gasping for breath or in pain?
We are certainly not stopping caring for him, and we will not let him suffer or gasp for breath. Right now we are continuing the oxygen mask and fluids while we watch closely over the next hour or two, and our absolute priority is his comfort and dignity. If his breathing becomes distressed despite the mask, we can give gentle, carefully titrated medicines into his drip to relieve any breathlessness, pain or anxiety so that he stays peaceful. We have moved him into a quiet side room so you and the rest of the family can be with him continuously, with no visiting restrictions. Is there anyone else in the family you would like us to call or help bring in today?
My brother is driving down from Leeds now—he should be here in about an hour. Thank you for being honest with me about what Dad said when he came in. I just don’t want him to be frightened or uncomfortable.
We will look after him closely and make sure he is comfortable and peaceful, and when your brother arrives I will come straight back to speak with both of you together and answer all of his questions too. His bedside nurse is right outside if you need us at any moment.
Thank you. That is the end of the station.
Example feedback
88 / 100
Established what the daughter had already seen at the bedside, acknowledged her distress and paced the bad news sensitively.
Explained in plain English why urosepsis on top of severe COPD was causing exhaustion despite source control, antibiotics, vasopressors and high-flow oxygen.
Owned the clinical decision against invasive ventilation clearly while honouring the patient’s previously expressed wishes and avoiding making the relative feel responsible for refusing a ventilator.
Addressed fear of breathlessness directly, arranged unrestricted visiting and offered to meet the brother on arrival.
What went well
- Checked the daughter’s existing understanding first and delivered a clear, empathetic warning shot and update without intensive care jargon.
- Explained the ceiling-of-treatment decision clearly as a medical decision grounded in physiological futility and her father’s own prior wishes, without placing the burden of that clinical decision on the daughter.
- Reassured the daughter directly that a ceiling on invasive ventilation is never a withdrawal of care, explaining symptom control for breathlessness and distress, side-room privacy and open visiting.
What to improve
- Explicitly mention the DNACPR decision alongside the ceiling on invasive ventilation so the family is not surprised if the nursing team references it.
- Offer spiritual, pastoral or family-support services while they are at the bedside.
Try a FFICM Final OSCE station yourself
The £5 taster is 30 credits: 30 minutes of speaking practice. One-off payment, no subscription.
Start with the £5 taster