Test of

Competence 2021:
Marking guidance

Midwifery

V 1.0
Table of contents
Important information ................................................................................................................................ 3
OSCE assessment .................................................................................................................................... 4
Assessment process.............................................................................................................................. 4
Marking guidance .................................................................................................................................. 4
APIE stations............................................................................................................................................. 5
Assessment marking guidance: Antenatal APIEs .................................................................................. 6
Planning marking guidance: Antenatal APIEs ........................................................................................ 6
Implementation marking guidance: Antenatal APIEs.............................................................................. 7
Evaluation marking guidance: Antenatal APIEs ..................................................................................... 7
Assessment marking guidance: Labour and birth APIEs ........................................................................ 7
Planning marking guidance: Labour and birth APIEs ............................................................................. 8
Implementation marking guidance: Labour and birth APIEs ................................................................... 8
Evaluation marking guidance: Labour and birth APIEs .......................................................................... 8
Assessment marking guidance: Postnatal APIEs ................................................................................... 9
Planning marking guidance: Postnatal APIEs ........................................................................................ 9
Implementation marking guidance: Postnatal APIEs .............................................................................. 9
Evaluation marking guidance: Postnatal APIEs ................................................................................... 10
Clinical skills stations............................................................................................................................... 11
Birth ..................................................................................................................................................... 12
Postnatal check ................................................................................................................................... 12
Systematic physical examination of the newborn marking guidance .................................................... 13
Postnatal Sepsis marking guidance ..................................................................................................... 13
Shoulder dystocia marking guidance ................................................................................................... 14
Postpartum haemorrhage marking guidance ....................................................................................... 14
Unexpected Breech Birth marking guidance ........................................................................................ 15
Neonatal blood glucose monitoring marking guidance ......................................................................... 15
Intramuscular injection marking guidance ............................................................................................ 16
Removal of urinary catheter marking guidance .................................................................................... 16
Professional values station ...................................................................................................................... 17
Professional Values marking guidance ................................................................................................ 18
Evidence-based practice station .............................................................................................................. 20
Evidence-based practice marking guidance ......................................................................................... 21

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Important information
This document is intended to provide candidates with additional information to help them to
prepare for the test of competence (Part 2).

You are advised to access the following required materials to begin your preparation:

NMC (2018) ‘The Code’:https://www.nmc.org.uk/standards/code/

The NMC blueprints: https://www.nmc.org.uk/registration/joining-the-register/toc-review/
The test specifications : https://www.nmc.org.uk/registration/joining-the-register/toc-review/

This document should be read in conjunction with the candidate information booklet,
recommended/core reading, and the mock OSCE documentation.

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OSCE assessment
Assessment process
Each station is marked against unique criteria matched to the skill being assessed. Stations are
marked holistically and candidates who demonstrate safe, competent practice should pass the
individual stations.

Marking guidance
When marking against the criteria, the examiner will assess your competency across a number
of areas related to the skill being assessed. Most of the stations will involve a simulated woman
or baby (manikin). You should interact with these manikins as you would a real woman or baby,
including requesting consent to perform any relevant clinical examinations. Please make sure
you verbalise what you are doing (including any pre-procedure checks), as you are doing it.

We expect you to be able to accurately and competently carry out a maternal and fetal
assessment, as well as a systematic physical examination of the newborn.

The marking guidance that follows highlights the important aspects to consider for each of the
stations you may encounter during your OSCE assessment.

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 APIE stations

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 Assessment marking guidance: Antenatal APIEs

Marking guidance
Establishes a rapport and safely prepares for the assessment

Accurately reviews medical history, situation and background

Safely and competently performs a full antenatal clinical assessment

Completes all relevant documentation accurately, and identifies any cause for concern

Acts professionally throughout the procedure in accordance with NMC (2018) ‘The Code:
Professional standards of practice and behaviour for nurses, midwives and nursing associates’.

Planning marking guidance: Antenatal APIEs

Marking guidance
Accurately documents the situation, background and assessment findings

Accurately documents an appropriate and evidence based plan of care

Completes all relevant documentation accurately and legibly

Acts professionally throughout the procedure in accordance with NMC (2018) ‘The Code:
Professional standards of practice and behaviour for nurses, midwives and nursing associates’.

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Implementation marking guidance: Antenatal APIEs

Marking guidance
Safely prepares for drug administration, completing appropriate pre procedure checks and gains
consent prior to procedure
Safely and competently considers and undertakes drug administration as required

Completes all relevant documentation accurately

Acts professionally throughout the procedure in accordance with NMC (2018) ‘The Code:
Professional standards of practice and behaviour for nurses, midwives and nursing associates’.

Evaluation marking guidance: Antenatal APIEs

Marking guidance
Accurately states the situation
Accurately states the background
Accurately states the assessment findings

Identifies current plans and referrals for promoting fetal and maternal wellbeing

Uses the SBAR tool to facilitate clear and appropriate communication

States what is required of the person taking the handover and proposes a realistic plan of action.
Acts throughout in accordance with the values and requirements of NMC (2018) ‘The Code:
Professional standards of practice and behaviour for nurses, midwives and nursing associates’.

Assessment marking guidance: Labour and birth APIEs

Marking guidance
Establishes a rapport and safely prepares for the assessment

Accurately reviews medical history, situation and background

Safely and competently performs a full clinical labour assessment

Discusses findings with the woman and identifies any cause for concern
Acts professionally throughout the procedure in accordance with NMC (2018) ‘The Code:
Professional standards of practice and behaviour for nurses, midwives and nursing
associates.’

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 Planning marking guidance: Labour and birth APIEs

Marking guidance
Accurately documents the situation, background and assessment findings

Accurately and logically documents an appropriate and evidence based plan of care

Completes all relevant documentation accurately and legibly

Acts professionally throughout the procedure in accordance with NMC (2018) ‘The Code:
Professional standards of practice and behaviour for nurses, midwives and nursing
associates’.

Implementation marking guidance: Labour and birth APIEs

Marking guidance
Safely prepares for drug administration, completing appropriate pre procedure checks and
gaining consent prior to procedure
Safely and competently considers and undertakes drug administration as required

Completes all relevant documentation accurately

Acts professionally throughout the procedure in accordance with NMC (2018) ‘The Code:
Professional standards of practice and behaviour for nurses, midwives and nursing associates’.

Evaluation marking guidance: Labour and birth APIEs

Marking guidance
Accurately states the situation

Accurately states the background

Accurately states the assessment findings, and states any concerns for maternal wellbeing

Outlines care and interventions completed and identifies current and ongoing care needs,
plans and referrals for promoting fetal and maternal wellbeing

Uses the SBAR tool to facilitate clear and appropriate communication

States what is required of the person taking the handover, and proposes a realistic plan of
action.
Acts throughout in accordance with the values and requirements of NMC (2018) ‘The Code:
Professional standards of practice and behaviour for nurses, midwives and nursing
associates’.

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 Assessment marking guidance: Postnatal APIEs

Marking guidance
Establishes a rapport and safely prepares for the assessment

Accurately reviews medical history and background

Safely and competently performs a holistic postnatal assessment

Completes all relevant documentation accurately, and identifies any cause for concern
Acts professionally throughout the procedure in accordance with NMC (2018) ‘The Code:
Professional standards of practice and behaviour for nurses, midwives and nursing
associates’.

Planning marking guidance: Postnatal APIEs

Marking guidance
Accurately documents the situation, background and assessment findings

Accurately and logically documents a woman centred, evidence based plan of care

Completes all relevant documentation accurately and legibly

Acts professionally throughout the procedure in accordance with NMC (2018) ‘The Code:
Professional standards of practice and behaviour for nurses, midwives and nursing
associates’.

Implementation marking guidance: Postnatal APIEs

Marking guidance

Safely prepares for drug administration, completing appropriate pre procedure checks and
gaining consent prior to procedure
Safely and competently considers and undertakes drug administration as required

Completes all relevant documentation accurately

Acts professionally throughout the procedure in accordance with NMC (2018) ‘The Code:
Professional standards of practice and behaviour for nurses, midwives and nursing associates’.

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Evaluation marking guidance: Postnatal APIEs

Marking guidance
Accurately states the situation

Accurately states the background

Accurately states the assessment findings, and states any concerns for maternal wellbeing

Outlines care and interventions completed

Uses the SBAR tool to facilitate clear and appropriate communication

States what is required of the person taking the handover, and proposes a realistic plan of
action.
Acts throughout in accordance with the values and requirements of NMC (2018) ‘The Code:
Professional standards of practice and behaviour for nurses, midwives and nursing
associates’.

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 Clinical skills stations

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Skills stations marking guidance

Birth

Marking guidance

Provides appropriate support to the labouring woman

Carries out relevant and appropriate steps to safely monitor fetal wellbeing
Carries out relevant and appropriate steps to safely deliver the baby
Carries out appropriate care of the neonate in the immediate postnatal period

Articulates and carries out relevant and appropriate steps to safely deliver the placenta

Articulates and safely carries out appropriate steps to care for the mother in the immediate
postnatal period
Verbalises the importance of completing all relevant documentation
Acts professionally throughout the procedure in accordance with NMC (2018) ‘The Code:
Professional standards of practice and behaviour for nurses, midwives and nursing
associates’.

Postnatal check

Marking guidance

Safely prepares for a postnatal check

Safely and competently carries out a holistic postnatal check of the woman
Completes all relevant documentation accurately
Effectively implements a holistic plan of care for mother and baby

Acts professionally throughout the procedure in accordance with NMC (2018) ‘The Code:
Professional standards of practice and behaviour for nurses, midwives and nursing
associates’.

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 Systematic physical examination of the newborn marking
guidance

Marking guidance

Safely prepares for the clinical procedure, gaining consent prior to procedure

Safely and competently undertakes a holistic, systematic assessment of the newborn

Completes all relevant documentation accurately

Acts professionally throughout the procedure in accordance with NMC (2018) ‘The Code:
Professional standards of practice and behaviour for nurses, midwives and nursing associates’.

Postnatal Sepsis marking guidance

Marking guidance

Completes all relevant clinical charts accurately

Uses the completed clinical charts to make an accurate assessment of the woman’s condition
Demonstrates the ability to verbally outline appropriate next steps for care, in a clear and
appropriate manner.
Acts professionally throughout the procedure in accordance with NMC (2018) ‘The Code:
Professional standards of practice and behaviour for nurses, midwives and nursing associates’.

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Shoulder dystocia marking guidance
Marking guidance

Recognises the emergency and takes appropriate action

Considers immediate next steps regarding the woman's care

Carries out relevant and appropriate steps to deliver the baby

Carries out appropriate care in the immediate postnatal period

Verbalises the importance of completing all relevant documentation

Acts professionally throughout the procedure in accordance with NMC (2018) ‘The Code:
Professional standards of practice and behaviour for nurses, midwives and nursing
associates’.

Postpartum haemorrhage marking guidance

Marking guidance

Recognises the emergency and takes appropriate action

Considers immediate next steps regarding the woman's care planning and management, and
care of the newborn
Safely and competently carries out a clinical assessment of the woman
Articulates and carries out relevant and appropriate steps to manage the bleeding
Carries out appropriate care in the immediate postnatal period
Verbalises the importance of completing all relevant documentation
Acts professionally throughout the procedure in accordance with NMC (2018) ‘The Code:
Professional standards of practice and behaviour for nurses, midwives and nursing
associates’

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 Unexpected Breech Birth marking guidance
Marking guidance

Recognises the emergency and takes appropriate action

Gains consent to provide care and recognises the importance of clear communication in an
emergency situation.
Considers immediate next steps regarding the woman's care planning and management
Articulates the principles of physiological breech birth, and carries out relevant and appropriate
steps to safely deliver the baby
Articulates and carries out clinically indicated procedures to assist with delivery of the baby with
extended legs and nuchal/extended arms
Articulates and carries out clinically indicated procedures to assist with delivery of the
aftercoming head
Verbalises appropriate care of the neonate in the immediate postnatal period
Articulates the importance of documentation
Acts professionally throughout the procedure in accordance with NMC (2018) ‘The Code:
Professional standards of practice and behaviour for nurses, midwives and nursing associates’.

Neonatal blood glucose monitoring marking guidance

Marking guidance

Safely prepares for the clinical procedure, explaining and gaining consent prior to procedure
Safely and competently obtains the blood sample
Considers the result of the blood sample and any action required
Demonstrates safe post clinical procedure practices
Completes all relevant documentation accurately
Acts professionally throughout the procedure in accordance with NMC (2018) ‘The Code:
Professional standards of practice and behaviour for nurses, midwives and nursing associates’.

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 Intramuscular injection marking guidance

Marking guidance
Safely prepares for clinical procedure, including pre-procedure checks and gaining consent
Safely and competently administers the IM injection
Demonstrates safe post clinical procedure practices
Completes all relevant documentation accurately
Acts professionally throughout the procedure in accordance with NMC (2018) ‘The Code:
Professional standards of practice and behaviour for nurses, midwives and nursing
associates’.

Removal of urinary catheter marking guidance

Marking guidance
Safely prepares for removal of urinary catheter
Safely and competently removes the urinary catheter
Demonstrates safe post clinical procedure practices, including client aftercare following urinary
catheter removal
Acts professionally throughout the procedure in accordance with NMC (2018) ‘The Code:
Professional standards of practice and behaviour for nurses, midwives and nursing
associates’.

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 Professional values station

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Professional Values marking guidance

Marking guidance

1 Recognises the importance of building a respectful and trusting relationship, acting in the
woman’s best interests.

2 Provides clear, balanced information allowing the woman adequate time in order to make
an informed choice about her care, following up in a timely manner.

3 Provides individualised care and review mother and child regularly to ensure a holistic
assessment of wellbeing and care requirements.

4 Recognises the importance of providing respectful, empathetic, dignified care and

promoting continuity of care and carer.

5 Recognises the importance of advocating for the woman’s care choices and works in
partnership with the woman and the multi-disciplinary team, as required, to support these
choices/mother and child.

6 Recognises individual circumstances relating to the transition to parenthood, positive

family attachment and bonding.

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 Evidence-based practice station

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 Evidence-based practice marking guidance

Marking guidance

1 Summarises the main findings of the article summary and draws conclusions, making
recommendations for practice

1a Recognises the importance of building a respectful and trusting relationship, acting in the
woman’s best interests at all times.

1b Provides clear, balanced information regarding risks and benefits to facilitate an informed
choice.

1c Recognises individual circumstances relating to the transition to parenthood, positive

family attachment and bonding.

1d Recognises the importance of advocating for women’s choices and working in partnership
with women (and the multidisciplinary team, as required), to support these choices.

1e Recognises that the woman should receive individualised care that promotes and
optimises normal physiological processes.
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