Medical How to do better in OSCE exams

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I'm Looking for the best advice to improve my performance on an OSCE Exam. Its an M1 Exam so it is a history and a basic physical.

I am being told that the exam would be a pass, but a lower pass, if I performed the way that I have during our mock sessions. The feedback I get from each facilitator and each SP seems to be a little different.

One said she didn't like my bedside manner and it seemed forced, but I've seen like 10 SPs and only one has ever said that the rest have actually complimented my demeanor excessively. I can point to a few maneuvers on the physical exam that are weaker, but otherwise I am sort of at a loss. Each clinician in the room seems to expect different things. Most want a complete history but others said I "wasted time on getting irrelevant parts" of the social history while another said the same approach showed "genuine interest". Most of them seem to like that I do my histories in a "rolling style" where I hit all parts of the HPI, but kind of chose which part to do based on what the patient says, and cycle back to other things as needed. Most of them liked it but one said it was "disorganized". Each facilitator seems to identify things they don't like, yet they will all chose something different to say they didn't like, which often seems to directly contradict what the person before had said. I want to do the best I possibly can, but its really hard to know how to home my skills when I hear so many different things.

What are some fool proof ways to succeed or techniques/ mannerisms that are universally loved?

First, always start with the basics of introduction. The Studer Group has a very effective framework known as AIDET:

1. Acknowledge: Greet the patient by name. Make eye contact, smile, and acknowledge family or friends in the room.
2. Introduce: Introduce yourself with your name, skill set, professional certification, and experience.
3. Duration: Give an accurate time expectation for tests, physician arrival, and identify next steps. When this is not possible, give a time in which you will update the patient on progress.
4. Explanation: Explain step-by-step what to expect next, answer questions, and let the patient know how to contact you, such as a nurse call button.
5. Thank You: Thank the patient and/or family. You might express gratitude to them for choosing your hospital or for their communication and cooperation. Thank family members for being there to support the patient.

Now for the H&P:

During your early years of learning to be a physician, it's important to develop routine patterns for H&Ps. Over the years, you'll be able to jump forward in your pattern based on patient answers. This is why a MS-3 takes forever to do a H&P and a PGY-3 can do it in a few minutes.

Even as a well-practiced physician, you may encounter patients that have a history where you just can't pin-down the diagnosis. This is where it is useful to have an established pattern that you can fall-back on to ensure you've covered every system and obtained a thorough history and physical.

If you're looking for a good reference for H&Ps, I'm a fan of Seidel's Guide to Physical Examination.​

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