Ask any emergency medicine trainee who has just passed the MRCEM OSCE what surprised them, and a version of the same answer comes back: it was not the medicine that separated candidates, it was the talking. The stations are built around the reality of the emergency department — a frightened patient, a busy senior, an anxious relative, a colleague who has made a mistake — and they reward the phrasing that keeps those conversations safe and humane while the clock runs.
None of what follows is a script to recite word for word; examiners can smell a rehearsed line from across the room. Think of these instead as reliable moves, the phrases that consistently nudge the interpersonal domain in your favour because of the thinking they reveal.
1. "What's worrying you most about this?"
This single question does an enormous amount of work. It surfaces the patient's real agenda — which is often not the one written in the scenario — and it demonstrates to the examiner that you treat the person, not just the presenting complaint. A man with a sprained ankle may actually be terrified he cannot work and pay rent. Name that, and the whole station changes shape.
2. "Let me make sure I've understood you correctly."
Reflecting back is the quiet workhorse of good communication. It shows you have listened, it catches misunderstandings before they grow, and it buys you a moment to organise your own thoughts. In a resus or handover station it also demonstrates closed-loop communication, which is exactly the safety behaviour examiners are primed to reward.
3. "I can see this is really frightening for you."
Naming an emotion out loud — fear, anger, grief — is one of the most powerful things you can do in a difficult conversation, and one of the most under-used by nervous candidates. It does not commit you to anything; it simply tells the patient they have been seen. An angry relative who feels acknowledged almost always softens. One who feels managed almost always escalates.
You cannot reason a frightened or furious person out of an emotion they have not yet had acknowledged. Name it first, then problem-solve.
4. "I don't have that answer yet, but here's what I'm going to do to find out."
Candidates panic about uncertainty, but the OSCE frequently rewards honest uncertainty handled well. You will not always have a diagnosis, and pretending otherwise is unsafe. Admitting the gap while showing a clear plan to close it is the mark of a trustworthy clinician. Honesty plus a plan beats false reassurance every time.
5. "Can I check what you already know about what's happened?"
Before you explain anything — a diagnosis, a result, bad news — find out where the patient is starting from. It prevents you from either talking over their head or patronising them, and it tells the examiner you are pitching your explanation to this particular person rather than reciting a paragraph. In breaking-bad-news stations this question is very nearly compulsory.
6. "To make sure nothing gets missed, I'm going to hand over to you as..."
The colleague-facing stations — a phone call to the medical registrar, a handover to a nurse in charge — reward structure above all. Reach for SBAR: Situation, Background, Assessment, Recommendation. Announcing that you are giving a structured handover, then delivering one crisply, signals to the examiner that you communicate safely under pressure. Vague, rambling handovers are where marks quietly leak away.
7. "I'm sorry this happened. Let me explain what we know and what we'll do next."
Duty of candour is not optional, and the OSCE tests it. When something has gone wrong — a delayed diagnosis, a drug error — a genuine apology, an honest account, and a clear plan for putting things right and investigating are what a professional does. Crucially, apologising for a situation is not the same as accepting personal blame, and you can be warm and honest without falling on your sword.
How to make these your own
Reading a list of phrases changes nothing on its own. The trainees who benefit are the ones who take two or three of these into every practice station until they surface naturally, without conscious effort, even when the scenario is unfamiliar and the adrenaline is up. That is the real test — not whether you can produce the words in a quiet room, but whether they still come out when a simulated patient is shouting or crying and the examiner is watching.
- Practise on your feet, out loud, with a partner playing an awkward or emotional patient — not just reading scripts.
- Deliberately rehearse the uncomfortable stations: the angry relative, the mistake, the uncertain diagnosis. These are where marks are won.
- Ask your practice partner one blunt question afterwards: "Did you feel listened to?" If the answer is no, no amount of correct medicine will rescue the station.
Get the communication right and the clinical content of the MRCEM OSCE becomes far more forgiving, because an examiner who trusts the way you handle people will extend you a great deal more goodwill on the medicine. The phrases are simply a way in; the habit of genuinely attending to the human in front of you is the thing they are really pointing at.