Quick answer: the MRCEM OSCE has 16 stations of 8 minutes, each with 1 minute of reading time, plus two rest stations. Every station tests between one and four skill areas, called domains, such as history taking, clinical examination, practical skills and communication. Each station is scored out of 10, giving a maximum of 160 marks. To pass, read the task carefully, do what it asks, and practise under timed conditions with feedback from colleagues.
The OSCE is the final part of the MRCEM, and it tests something the written papers cannot: how you behave with patients, relatives and colleagues under time pressure. Many candidates with good knowledge fail because they run out of time or answer a different task from the one set. This guide explains how the exam works and how to prepare. The facts come from RCEM’s OSCE exam pages and its guide to domain-based marking.
The MRCEM OSCE at a glance
| Feature | MRCEM OSCE |
|---|---|
| Stations | 16 marked stations, plus 2 rest stations |
| Timing | 1 minute of reading time, then 8 minutes in the station |
| Length | About 2 hours 42 minutes |
| Double stations | None |
| Marking | 1 to 4 domains per station, each station scored from 0 to 10, maximum 160 marks |
| Pass mark | Set for each sitting (borderline regression + 1 SEM) |
| Sessions | Morning or afternoon, allocated about 3 weeks after applications close |
| Dress and equipment | Smart professional clothes or scrubs. You do not need to bring any equipment, including a stethoscope |
Who can sit the OSCE?
You need a pass in the MRCEM SBA before you can apply. You must also have completed Foundation training or equivalent and have 24 months of experience, including six months in emergency medicine above FY1 level. For how the three exams fit together, see our guide to the MRCEM Primary, SBA and OSCE.
What the stations cover
Stations are mapped to the specialty learning outcomes (SLOs) of the RCEM curriculum:
| Learning outcome | Typical stations |
|---|---|
| SLO 1: Complex stable patient | Focused history, system examination, explaining a diagnosis and plan |
| SLO 2: Answer questions | Interpreting results or evidence and explaining them to a patient or colleague |
| SLO 3: Resus | Leading the assessment of a critically ill patient with a structured ABCDE approach |
| SLO 4: Injured patient | Trauma assessment, joint and limb examination, wound management |
| SLO 5: Paediatric emergency medicine | History from a parent, safeguarding concerns, the unwell child |
| SLO 6: Procedural skills | Practical procedures on a manikin or model, often with explanation and consent |
| SLO 7: Complex challenging situations | Breaking bad news, an angry relative, a complaint, capacity and self-discharge |
| SLO 9: Supervise and teach | Teaching a skill or topic to a student or junior colleague |
The examples in the right-hand column are common station styles, given as a guide. RCEM does not publish the stations in advance.
How the OSCE is marked
RCEM uses domain-based marking. There are seven domains in the MRCEM OSCE:
- History taking and information gathering.
- Clinical examination skills.
- Clinical reasoning and decision making.
- Practical skills.
- Communication skills, including conflict.
- Organisation and prioritisation.
- Teaching skills.
Each station tests between one and four of these. The examiner judges your performance in each domain against the minimum level of competence, from well below to well above, and these judgements are converted to a station score from 0 to 10.
The important point is that you are told which domains are being tested. The briefing sheet outside each station gives the scenario, the task, the role of the examiner, and a pie chart showing the domains and their weighting.
Use the reading time well
One minute is short, so use the same routine at every station:
- Read the task twice. Take a focused history, examine the knee and teach the student are three different jobs.
- Look at the pie chart. If communication makes up most of the marks, a long list of differential diagnoses will not score.
- Note who is in the room. The examiner may be an observer, or may be playing a role such as a nurse or a consultant.
- Plan your first sentence and a rough structure for the 8 minutes.
How to prepare
Start with your daily work
The best preparation is clinical work in the emergency department. Ask seniors to watch you take a history, examine a joint or explain a plan, and ask for feedback on what a patient would have understood.
Practise in a group, to time
Work in a group of three: one candidate, one role player and one examiner. Use a timer set to 1 minute and 8 minutes, and rotate roles. Playing the examiner is useful in itself, because you see what makes a performance clear or confusing.
Build a structure for each station type
- History: open question first, then focused questions, red flags, and the patient’s ideas, concerns and expectations.
- Examination: a fluent routine for each system and joint, with clear instructions to the patient and a short summary of findings.
- Resus: ABCDE, treating problems as you find them, and asking for help early.
- Procedures: consent, preparation, the steps in order, and aftercare.
- Difficult conversations: a framework such as SPIKES for bad news, with pauses and checking of understanding.
- Teaching: find out what the learner knows, set an aim, teach in small steps, check understanding and summarise.
Practise the endings
Many marks are lost in the last minute. Practise closing a station: summarise, give a clear plan, safety-net and ask if the patient has any questions.
Common pitfalls
- Not doing the task set: taking a full history when the task was to explain a result.
- Running out of time: spending 6 minutes on the history and never reaching the explanation or plan.
- Ignoring the patient: missing cues, using jargon, or not responding to distress.
- Skipping the basics: introduction, checking identity, consent, hand hygiene and patient comfort.
- Talking to the examiner instead of the patient in stations where the examiner is only observing.
- Carrying a bad station forward: each station is marked separately by a different examiner, so reset during the reading time.
- Using rest stations badly: use them to drink water and reset, not to go over the last station.
On the day
- Check your session time and arrive early. You will be allocated to a morning or an afternoon session.
- Bring the identification RCEM asks for. You do not need a stethoscope or any other equipment.
- Wear smart professional clothes or scrubs that you can examine a patient in comfortably.
- Treat every role player as a real patient or colleague.
Summary
- 16 stations of 8 minutes, with 1 minute of reading time and two rest stations.
- Each station tests one to four domains and is scored from 0 to 10, to a maximum of 160.
- The briefing sheet tells you the task and the domains being tested. Read it twice.
- Practise in groups of three, to time, with honest feedback.
- Finish every station with a summary, a plan and safety-netting.
Frequently asked questions
How many stations are in the MRCEM OSCE?
There are 16 marked stations and two rest stations. Each station lasts 8 minutes, with 1 minute of reading time before it.
How is the MRCEM OSCE marked?
By domain-based marking. Each station tests one to four of seven domains and is scored from 0 to 10, so the maximum score is 160. The pass mark is set for each sitting.
Do I need to bring a stethoscope to the MRCEM OSCE?
No. RCEM says candidates are not required to bring any equipment, including stethoscopes.
How long should I prepare for the MRCEM OSCE?
There is no fixed rule. Most candidates benefit from two to three months of regular timed practice with colleagues, alongside their clinical work.
Next steps
Check the next sittings and booking windows in our MRCEM exam dates 2026–27 guide. If you are still working towards the SBA, read our 12-week MRCEM SBA revision plan and try our 20 free MRCEM SBA sample questions, or see the full question bank and mock tests in our membership plans.
Exam details checked against RCEM’s OSCE exam pages and its domain-based marking guide on 3 October 2026. Always confirm the current regulations with RCEM before you apply.