ADC Part 2 practice: rehearse the simulated-patient stations

The ADC practical examination runs over two days. The technical skills day is six tasks on typodonts in manikin heads — conservation, fixed prosthodontics and endodontics. The clinical skills day is a ten-station OSCE, each station in its own room with a defined task and a set time limit, using standardised simulated patients, video scenarios, manikins and other resources.

Those two days test different things, and candidates consistently under-rehearse the second. The clinical skills day is assessed across three domains — clinical information gathering, diagnosis and management planning, and clinical treatment and evaluation — with communication, critical thinking, professionalism and ethics, scientific knowledge and infection control running across all three. In practice that means you can reach the correct diagnosis and still fail a station on how you handled the person in front of you.

Ten standard stations, each built around an archetype that recurs in dental OSCE assessment: taking a focused pain history and separating irreversible pulpitis from a periapical abscess; explaining a diagnosis and management plan in lay terms; taking informed consent for a lower third molar with a genuinely elevated nerve risk; assessing a patient whose medical history complicates treatment; managing anaphylaxis in the chair; explaining radiographic findings and treatment options; delivering preventive counselling to a resistant patient; breaking bad news about an unrestorable front tooth; managing an avulsed permanent incisor through an anxious parent; and declining an inappropriate request for clearance without losing the patient.

Each runs as a conversation. You type to the simulated patient, who answers in character and discloses information when asked rather than volunteering it, and you can order a periapical, bitewing or OPG report where the case calls for one. The patient will not read their own radiograph to you, which is the point — obtaining and interpreting the study is part of what the station assesses.

A consent station and an emergency station fail for completely different reasons, so grading them against the same mark scheme produces feedback that misses the point. An informed-consent station turns on whether you disclosed a material risk proportionately and checked the patient actually understood; an anaphylaxis station turns on whether you gave intramuscular adrenaline without waiting for certainty. Marking the first against red-flag recognition, or the second against rapport, tells you nothing useful.

Each station here therefore carries its own weighted rubric reflecting what that archetype is really testing — the breaking-bad-news station weights the disclosure and the pause that follows it, the avulsion station weights immediate management, the periodontal station weights whether you actually shifted the patient’s beliefs. Several rubrics also name the specific failure that should sink the station even when the clinical content is correct, such as retreating into a list of treatment options to escape a distressed patient.

ADC stations are short, and candidates who have only ever practised untimed consistently run out of station before they reach a management plan. Every station here carries an eight-minute clock matching the timing used in mock circuits, shown in the header and turning amber in the final minute.

The clock does not end the encounter when it reaches zero — it shows the overrun instead. Being cut off mid-sentence teaches you nothing, whereas seeing that you needed eleven minutes for an eight-minute station tells you exactly what to compress next time. Run the same station again and watch where the time goes.

Nothing here substitutes for manikin time. The technical skills day needs a handpiece, and the procedural stations on the clinical skills day — rubber dam application, partial denture design, radiograph positioning technique — need hands and supervision. Any preparation plan that skips those is incomplete regardless of how well the communication stations go.

What this does is remove the constraint on the other half. Simulated-patient practice normally depends on finding a partner, a tutor, or a paid mock circuit, which is why most candidates do far fewer reps of the communication stations than the technical ones. These stations are available whenever you are, repeat indefinitely, and tell you what you missed each time.