ADC Communication OSCE: 10 Common Mistakes Overseas Dentists Make

A candidate can know the diagnosis, the investigations and the treatment options — and still have a weak Communication OSCE.

That is one of the hardest things for experienced dentists to accept when they first start preparing for the ADC practical examination. In clinical practice, knowledge and experience can carry a consultation a long way. In an OSCE, however, the examiner also needs to see how you communicate: whether you listen, whether the patient can follow you, whether you respond to what matters to them, and whether the decision at the end of the consultation is genuinely shared.

The ADC makes this quite explicit in its published communication marking rubric. Communication is assessed across five broad areas: demeanour, use of language, engagement with the patient, organisation of information, and joint decision making.

If you are new to this part of the exam, read our guide to what the Communication OSCE is first. If you already understand the format but your roleplays still feel inconsistent, the problems below are a better place to look.

1. Treating the station like an oral viva

This is probably the most common shift overseas-trained dentists need to make.

The candidate walks into the station thinking, I need to show the examiner everything I know. So the consultation becomes a performance for the examiner rather than a conversation with the patient.

You hear long explanations. Every possible complication is listed. The candidate keeps talking because silence feels dangerous.

But the patient is not there to receive a lecture.

A useful question to ask yourself during practice is:

If there were no examiner in the room, would I still speak to a real patient this way?

If the answer is no, change it.

Your knowledge still matters. It simply needs to appear at the right moment and in a form the patient can use.

2. Asking questions without actually listening to the answers

A structured history is important. A mechanical history is not.

Candidates sometimes become so focused on reaching the next question that they miss the significance of what the patient has just said.

For example:

Patient: “I have been putting this appointment off because my last extraction was awful.”

Candidate: “Okay. Do you have any allergies?”

The allergy question may be necessary. The problem is that the patient has just handed you important information — fear, previous experience and probably one of the reasons they are seeking reassurance — and you have walked straight past it.

A better response could be:

“That sounds like it was a difficult experience. Before we talk about treatment today, can you tell me what happened last time?”

That one sentence does several things. It acknowledges the patient, gathers clinically relevant information and changes the tone of the consultation.

Active listening is not waiting quietly for your turn to ask the next question. It is allowing the patient’s answer to change what you do next.

3. Using empathy phrases instead of showing empathy

Most candidates know they are expected to demonstrate empathy. That is why phrases such as “I understand your concern” appear so often in practice sessions.

The problem is that empathy can sound rehearsed when it is disconnected from what the patient actually said.

Compare these two responses.

Generic:

“I understand your concern.”

Specific:

“You’ve had pain for nearly a week, and now you’re worried the tooth might have to come out. I can see why you would be concerned about that.”

The second response feels different because it proves you were listening.

You do not need dramatic language. In fact, overdoing empathy can make a consultation feel less natural. A brief acknowledgement at the right moment is often enough.

The ADC rubric specifically refers to empathy, appropriate non-verbal communication, relevant pauses and avoiding interruption. Those behaviours are easier to demonstrate when you respond to the patient rather than inserting a memorised sentence.

4. Giving the patient an information dump

Dentists are trained to process a lot of information quickly. Patients are not necessarily doing the same thing — especially when they are anxious, in pain or hearing an unfamiliar diagnosis.

A common OSCE mistake is to explain the diagnosis, treatment, alternatives, risks, cost considerations and aftercare in one uninterrupted block.

By the end, the candidate has technically said everything. The patient may have retained very little.

Break information into manageable pieces.

For example:

1. Explain what you found.
2. Pause.
3. Check whether that makes sense.
4. Move to the treatment choices.
5. Pause again.
6. Explore questions or concerns.

This is the practical idea behind chunk and check. We have a separate example showing how chunk and check works in a difficult clinical conversation.

The key point is simple: communication is not measured by how much information leaves your mouth. It is measured by how effectively information is shared.

5. Explaining every possible treatment instead of the relevant options

Candidates sometimes worry that leaving out an option will cost marks, so they list everything they can think of.

That can make the consultation less patient-centred, not more.

A real treatment discussion needs context. Which options are clinically appropriate for this patient? Which ones are realistic? What are the advantages, disadvantages and likely consequences? What matters to the patient?

Suppose a patient is choosing between retaining a tooth with further treatment and having it extracted. The useful discussion is not simply a catalogue of dental procedures. It is a conversation about prognosis, treatment burden, risks, alternatives, cost, time, the patient’s priorities and what happens after extraction if that option is chosen.

More options do not automatically mean better consent.

Relevant options, explained clearly, are more useful than an impressive list.

6. Using dental language without realising you are doing it

Dental terminology becomes normal when you use it every day. That is exactly why it slips into OSCE conversations unnoticed.

Words such as:

• irreversible pulpitis
• periapical lesion
• periodontal pocket
• radiolucency
• occlusion
• endodontic treatment
• recurrent caries

may be perfectly ordinary to a dentist and completely unhelpful to a patient.

You do not need to remove all clinical terminology. Sometimes it is appropriate to name the condition. But if you use a dental term, translate it.

Instead of:

“The X-ray shows a periapical radiolucency associated with 36.”

try:

“The X-ray shows a dark area around the end of the root of this tooth. Together with your symptoms, that suggests there is infection around the root.”

Clear language is not “dumbing things down”. It is a clinical skill.

The ADC communication rubric specifically looks at whether explanations are clear, whether jargon is minimised and whether language is adapted to the patient’s level of understanding.

7. Treating informed consent as a list of risks

When candidates hear “consent”, many immediately start listing complications.

Pain. Swelling. Bleeding. Infection. Damage to adjacent structures. Failure. Further treatment.

Risks matter, but consent is bigger than a risk recital.

A useful consent conversation usually needs to cover:

• what you believe is happening
• what you recommend and why
• realistic treatment options
• important benefits and limitations
• material risks
• the option of no treatment where relevant
• what the patient is concerned about
• whether the patient has understood
• whether they want time, support or further information
• what they actually choose

Notice how much of that is two-way.

The ADC rubric includes joint decision making for a reason. Candidates are expected to encourage patient participation, address concerns, present realistic options and seek agreement.

The aim is not to finish a speech with, “Do you consent?” The aim is to arrive at a decision with the patient.

8. Memorising complete scripts

Scripts feel safe during preparation because they remove uncertainty.

They also create a problem: real conversations are not predictable.

A roleplayer may interrupt. They may misunderstand something. They may be angry about cost rather than worried about pain. They may say they do not want the treatment you expected them to choose. They may reveal information halfway through the station that changes the direction of the consultation.

A memorised candidate often responds to the station they rehearsed, not the patient in front of them.

This is why we prefer candidates to memorise structure, not sentences.

Know what you need to achieve:

• open the consultation
• understand the problem
• explore the patient’s perspective
• explain findings
• discuss relevant options
• check understanding
• reach a plan
• close safely

The words should be allowed to change.

If you have read our ADC practical exam day walkthrough, this is one of the reasons we emphasise realistic roleplay. A good roleplayer responds to what you actually say. That is exactly what makes the practice useful.

9. Forgetting to find out what matters to the patient

Two patients can have the same diagnosis and need very different conversations.

One may be worried about cost.

Another may be terrified of extraction.

Another may have an important event next week and care about appearance.

Another may simply want the pain to stop today.

If you never ask, you can deliver a clinically accurate explanation that completely misses the patient’s actual concern.

Useful questions include:

“What is worrying you most about this?”

“Is there anything in particular you were hoping we could do today?”

“Before we decide, is there anything that would make one option easier or harder for you?”

These are not filler questions. The answers can change the treatment discussion.

Patient-centred communication is not about being endlessly agreeable. It is about understanding the person well enough to make a clinically appropriate decision with them.

10. Running out of time without properly closing

Candidates often spend too long gathering information or explaining the first treatment option, then suddenly notice the station is almost over.

The final minute becomes:

“So yes, that’s basically everything, do you have questions, okay thank you.”

A strong close does not need to be long. It needs to be clear.

Before the station ends, try to establish four things:

1. What have we agreed?
2. What happens next?
3. What should the patient do if things change or worsen?
4. Does the patient have a final concern or question?

A brief summary also gives you one last opportunity to notice whether the patient has misunderstood something important.

Time management is easier when it is built into practice from the beginning. If you only start using a timer in the final week, you often discover that your “good” consultation is twelve minutes long when the station gives you considerably less.

A 60-second self-check after every roleplay

After a practice station, resist the urge to ask only, “Did I pass?”

Instead, ask yourself:

1. Did I understand what the patient was actually worried about?
2. Did I respond to what the patient said, or did I follow my prepared sequence regardless?
3. Did I explain in short, understandable sections and check understanding?
4. Did the patient participate in the decision, or did I make the decision for them?
5. Did I finish with a clear plan and safe next step?

Then ask one more uncomfortable question:

How much of the station did I spend talking?

If your roleplays consistently feel like monologues, that is useful information.

What to practise instead of “perfect answers”

The best Communication OSCE preparation is not collecting hundreds of model scripts. It is developing repeatable behaviours that survive unfamiliar scenarios.

Practise:

• opening without sounding rehearsed
• asking one good open question before narrowing down
• responding to emotion without overacting
• translating dental language into everyday language
• explaining one idea at a time
• checking understanding naturally
• discussing options without pushing the patient toward your preferred choice
• recovering when the roleplayer says something unexpected
• closing on time

If you can do those things consistently, the exact wording matters much less.

Our Communication OSCE coaching is built around this kind of repeated roleplay and feedback rather than memorising fixed scripts. When you are closer to the examination, a full mock exam is useful for testing whether the same communication holds together under station timing and exam pressure.

📧 info@lavanika.academy 📲 WhatsApp: +61468434447

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The ADC publishes the current Communication Marking Rubric and practical examination materials on its Handbooks & Materials page. Those official materials should always take precedence over third-party preparation advice.