Counselling OSCE stations
A counselling station reverses the usual direction of travel. You are not there to work out what is wrong — you already know. You are there to hand information to someone who may not want it, in pieces they can carry, and to notice the moment they stop listening.
What a counselling station asks you to do
Four task types come round again and again. The clinical content changes; the marks sit in the same places every time.
Explaining a result or a new diagnosis
The patient has come for news. What is marked is how you find out what they already suspect, how you deliver it, and what you do in the pause afterwards.
- A warning shot before the headline
- Small chunks, with real pauses between them
- Silence left alone when it arrives
Starting a new medicine
You are handing over instructions the patient has to follow at home without you. Prioritising beats covering everything.
- Why it was started, in words they would use
- How to take it, and for how long
- What to do if a dose is missed
Explaining a procedure or investigation
Marks go to the experiential account — what the patient will see, feel and be asked to do — rather than the clinical description of it.
- What happens, step by step
- Benefits, risks and alternatives in proportion
- Alternatives including doing nothing
Discussing a change they are unsure about
These stations are written so that advice bounces off. The marks are for exploring the patient’s own view first and resisting the lecture.
- Ask permission before you advise
- Draw the reasons out of them, don’t supply your own
- Agree one specific step, together
What makes a counselling station different
In a history station the patient holds the information and you are marked on extracting it. In a counselling station you hold it, and you are marked on how much of it survives the handover. Those are close to opposite skills, and candidates who prepare for one by practising the other tend to discover that in the exam.
The practical difference is who is talking. A strong history is the patient talking while you steer. A strong counselling station is short bursts from you, separated by silences you do not fill. Most of the technique on this page is about earning those silences and then holding them.
Same eight minutes, different job
History: mostly the patient, while you steer.
Counselling: you, but in short bursts they can absorb.
History: a prompt — leave it and they keep going.
Counselling: space to absorb, or the reaction arriving.
History: coverage, structure and the summary back.
Counselling: checking understanding, and what you do when they react.
History: a checklist rhythm the patient can hear.
Counselling: an uninterrupted monologue delivered to the clock.
A structure that works
Five moves, in this order. Under pressure the order is the thing you will fall back on, so rehearse it until it is automatic.
- 1
Find out what they already know
Before you explain anything, ask what they have been told and what they were expecting today. It costs fifteen seconds, it sits on almost every mark scheme, and it tells you which parts of your explanation you can skip.
- 2
Signpost, then ask permission
Say what the conversation is about and roughly how it will run: “I’ve got your results, and I’d like to go through what they show and what happens next — is that all right?” The patient braces, and you have their agreement to continue.
- 3
Chunk and check
One idea, then stop. Check that idea landed before you add the next. A candidate who delivers three ideas and checks once at the end is marked as having checked once.
- 4
Respond to emotion the moment it appears
If the patient goes quiet, tearful or angry, the explanation stops there. Name what you can see, wait, and only carry on when they are ready. Running out of content costs less than talking through a reaction.
- 5
Agree a next step and leave a route back
Close with something concrete: what happens now, who does it, and when you will speak again. Offer written information and a way to ask the questions they will think of on the way home.
Responding to emotion is where the marks are
Counselling stations are written with a reaction built in — a question you cannot fully answer, a silence, tears, anger, or a flat refusal to accept what you have said.
That reaction is not an accident of the acting. It is the discriminator. Everything before it is available to every candidate in the cohort; what you do in the ten seconds after it is what separates the marks.
If you rehearse one thing
Checking understanding without patronising
“Any questions?” is not a check — it is an invitation to say no. These land better, and they read as teach-back on a mark scheme.
- “Just so I know I’ve explained it properly…” — puts the burden on your explaining, not on their understanding.
- “What will you tell them at home when they ask?” — gives the patient a real reason to say it back in their own words.
- “Which part would you like me to go over again?” — assumes something needs repeating, so admitting it costs nothing.
- “I’ve given you a lot at once — where shall we slow down?” — acknowledges the volume and hands them control of the pace.
- “Talk me through what you’ll do tomorrow morning.” — checks the plan rather than the vocabulary.
- “Have I made sense so far, or have I gone too fast?” — offers an easy exit from a nod that meant nothing.
Check after each chunk rather than once at the end. A check that arrives after four minutes of explaining only tells you how much was lost.
Where students lose marks
Rarely on the content. Almost always on the delivery, and almost always in one of these six ways.
The uninterrupted monologue
Everything you know, delivered at speed, with no gap for the patient to speak. It reads as nerves, and it loses the checking marks outright.
Jargon, then a polite nod
A technical word slips through, the patient nods to be agreeable, and the candidate treats the nod as understanding.
Talking over the reaction
The patient becomes upset and you keep going, usually because there is content left to get through. The most expensive error in this category.
“Any questions?” as the check
Closing with an invitation most patients will politely decline, then treating that silence as evidence the message landed.
Everything given equal weight
A flat list with the thing that matters most buried in the middle. Say out loud which part you would keep if they forget the rest.
No agreed next step
The bell arrives with the explanation finished and nothing arranged. Who does what, by when, and how they reach you are separately markable.
All counselling stations
Each station gives you the candidate brief, what the examiner is marking and where candidates usually drop marks. Run any of them as a live consultation with an AI patient, then see the marking afterwards.
Explaining a new diagnosis
Explain a newly confirmed diagnosis to a patient, check what they already understand, and handle their reaction.
Counselling on a new medication
Counsel a patient starting a new medicine: what it is for, how to take it, what to expect, and what to do if something changes.
Lifestyle and behaviour change
Discuss a behaviour change with a patient who is ambivalent about it, without lecturing them.
Explaining a procedure
Explain an upcoming investigation or procedure, covering what happens, why, and what the alternatives are.
Where to go next
Counselling is one half of the medical circuit. The other half asks for the opposite skill.
History taking OSCE stations
The stations where the patient holds the information and you are marked on getting it out — focused histories, red flags and the summary back.
Medical OSCE practice
How the medical circuit fits together: the station bank, AI patient consultations, timed mock circuits and examiner-style marking.
Every OSCE station
24 stations written up across medicine and pharmacy, grouped by category.
Counselling station questions
How is a counselling station different from a history station?
How long is a counselling OSCE station?
Can I practise counselling stations out loud?
These pages describe how OSCE stations are assessed. They are revision aids for exam technique, not clinical guidance, and must not be used to inform patient care. Always follow current national guidance and your own institution’s teaching.
Practise a counselling station now
Explain a diagnosis, a new medicine or a procedure to an AI patient who reacts like a real one — then see where the mark scheme agrees with you.