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" ROYAL

OSCE Station: Urinalysis

Candidate Name:..,..............

Instruction: You are a GP trainee. You are asked to dipstick the urine of a patient who describes a 2 dayhistory of frequency and dysuria.

Mark SchemeAppropriate introduction including name and gradeBriefly describes and gives reason for procedure and obtains consent to proceedChecks patients name and date of birthWashes hands or uses alcohol gel, puts on gloves and gownTakes urine sample and assesses appearance (colour, turbidity) and odourImmerses all pads of urine dipstick in urine specimen bottle for 1-2 secondsStarts timing and keeps urine dipstick horizontal at all timesCloses urine specimen bottle and puts aside

Reads dipstick against colour chart on bottle at time indicated on chartDoes NOT touch urinalysis bottle with dipstickAfter reading, discards urine dipstick and gloves appropriately in clinical wasteWashes hands or uses alcohol gelDiscusses findings with patient and further managementDocuments the findings in the patients in the patients notes +/- offers to send urine formicroscopy if appropriateCloses consultation appropriatelySummarises findings to the examinerProfessionalism

Pass Borderline Fail

Comments:

Global Score:

Clear Pass

3 2 1


K srimaran uzttssennais zuuy

OSCE Station: Measurement of Ankle Brachial Pressure Index

"'ROYAL

SOCJETYj/"

MEDICINE

Candidate Name:

Instruction: Mr Jones is a 67 year accountant with a history of right foot rest pain. He is diabetic,

hypertensive and has chronic renal failure. Please measure his ankle pressure brachial indices.

\ Mark Scheme1 Appropriate introduction including name and grade

Explains procedure and obtains verbal consentWashes hands or uses alcohol gelPositions and adequately exposes patient (supine with shoes, socks and proximaliy constricting clothingremoved)Ensures that legs have been rested for >20 rainsSelects appropriate sized BP cuff and places around armPalpates brachial artery and applies ultrasound gelUses Doppler probe (at approx 45 degrees) to locate brachial pulseInflates cuff till Doppler signal disappears, deflates and records pressure at which signalreturnsCleans gel and offers to repeat process for other armStates would use higher of 2 brachial systolic readings to calculate ABF1Selects appropriate size cuff for patients calf and places above the malleoliLocates Dorsalis Pedis (DP) pulse by palpation or applies ultrasound gel and uses DopplerContinues as for brachial pulse and records DP pressureRepeats for Posterior Tibial (PT) pulse and records PT pulse pressureUses the higher of the two readings when calculating ABPIs for the ankleOffers to repeat for other legCleans ultrasound gel from skin and restores patients' modestyWashes hands or uses alcohol gelCalculates and documents ABPIs in patient's notesClosure:- Advises patient of their results in the context of their symptoms.- Addresses any questions or concerns- Thanks the patientPresentation of findings with interpretation of resultsAwareness of patients needs throughout examinationProfessionalism


Comments:

Global Score:

K. SHtharan OSCEswntiala 2OOP

': : ' '"" ROYAL

Socj ETY -jMEDICINE

OSCE Station: Communication - Drug Addict

Candidate Name:

Instruction: You are a FYl doctor in General Practice and have been asked to see Mr Jones. He appearsto be quite agitated and is demanding to speak to a doctor urgently. You have 7 minutes to take a historyand provide appropriate management.

Mark SchemeAppropriate introduction including name and grade

Establishes and maintains rapport with patientAcknowledges and responds to patients' feelings appropriatelyEstablishes patient's agendaEstablishes own agendaNegotiates compromiseElicits details of past historyElicits details of drug useElicits details of past treatmentAppropriate use of open/clarifying/closed questionsFluency/avoids jargon and repetitionProfessionalism


Comments:

Global Score of Negotiating Plan:

4 3 2

Patient Global Score of Communication Skills:

4 3 2

Clear ±-ass rass Doraeruue

08 \ Winter 7000

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QSCE Station: ABDOMINAL EXAMINATION

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MEDICINE

Candidate Name:

Instruction: Mr Smith is 54 year gentleman who has a history of weight loss and change in bowel

habits. Please examine his abdomen.

Mark SchemeAppropriate introduction including name and gradeObtains verbal consentWashes hands or uses alcohol gelPositions and adequately exposes patientGeneral InspectionExamines Hands for peripheral stigmata of abdominal disease (for clubbing, leuconychia,koilonychias, palmar erythema, Dupuytren's contracture, spider naevi, purpura, liver flap - >2 for pass)Examines Eyes (for jaundice, anaemia, xanthelasma, Kaiser-fleischer rings)

Examines oral cavity (for ulcers, angular stomatitis, telangiectasia, candidiasis, Peutz-Jehger's spots, dentition,glossitis, fetor)Offers to examine cervical lymph nodes (particularly left supraclavicular LN)

Inspects chest (for gynaecomastia, spider naevi)

Inspects abdomen (for scars, distension, striae, herniae, peristalsis, stomas, pulsations, capul medusae)

General Palpation (light and deep)Liver Examination (palpation + percussion)Spleen ExaminationRight and Left Kidney ExaminationExamination for AAA (pulsatility + expansion abdominal aorta)Examination for bladderExamines for ascites (shifting dullness or/and fluid thrill)Auscultation for bowel sounds and bruitsOffers to perform digital rectal examinationOffers to examine hernial orifices and external genitaliaWashes hands or uses alcohol gelPresents Summary of findingsAwareness of patients needs throughout examination + treats patient with respectProfessionalism

Comments:

Pass Borderline Fail i

I

I

Global Score:

;ROYAL

SOCIETY^MEDICINE

OSCE Station: Upper Limb Neurological Examination

Candidate Name:

Instruction: Mr Roberts is a 70 year old retired accountant who reports weakness in his right arm.

Examine this patient's upper limb neurological system.

Mark SchemeAppropriate introduction including name and gradeObtains verbal consent to perform examinationWashes hands or uses alcohol gelPositions and adequately exposes patientGeneral Inspection of upper limb (for wasting, fasciculations, asymmetry, abnormal movements)

Assesses for pyramidal/pronator driftAssesses tone in both arms (for rigidity and spasticity)Assesses power in both arms:

Shoulder abductionElbow extensionElbow flexionWrist flexionWrist extensionFinger extensionFinger flexionFinger abductionThumb abduction

Assesses reflexes in both arms:Triceps reflexBiceps reflexSupinator reflex

Assesses co-ordination in the upper limbs (i.e. dysdiadochokinesis and finger-to-nose test)Assesses sensation in both armsWashes hands or uses alcohol gelClosure: Thanks patient and restores modestyPresents findings

Awareness of patients needs throughout examinationProfessionalism


Comments:

Global Score:

OSCE Station: CARDIOVASCULAR EXAMINATION

™« ROYALSOCIETY-/MEDICINE

Candidate Name:

Instruction: Mr Brown is a 56 year old gentleman with a history of angina on exertion and palpitations.

He is a known hypertensive and heavy smoker. Please examine his cardiovascular system.

Mark SchemeAppropriate introduction including name and grade

Obtains verbal consentWashes hands or uses alcohol gelPositions and adequately exposes patientGenera! InspectionExamines hands for peripheral stigmata of CVS disease (for clubbing, splinter haemorrhages,peripheral cyanosis, Janeway lesions, capillary refill time, nicotine staining,tendon xanthoma) ->2Examines radial pulse (comments on rate, rhythm and volume, collapsing pulse, radio-femoral delay)

Offers to measure BP

Examines eyes (for anaemia, xanthalassma, corneal arcus)

Assesses carotid pulse (comments on volume, character and bruits)

Assesses jugular venous pressure (differentiates between arterial and venous pulsation)

Inspects precordium (for scars, visible apex beatPalpates precordium (for heaves and thrills)Localises apex beatAuscultates in correct 4 areasAuscultates with the bell at the apex and with patient turned on left side for MSAuscultates with the diaphragm and with patient leaning forward for ARAuscultates the lung bases (for inspiratory crepitations)Examines for dependent oedema i.e. sacral and ankleOffers to assess peripheral pulsesClosure: Thanks patient, offers to dipstick urine etcWashes hands or uses alcohol gelPresents summary of findings

Aware of patients' needs throughout examination + maintains patients dignityProfessionalism


Comments:

Global Score:

K. Sritharan OSCEssentials 2009

•:'-;v''.

OSCE Station: Hip Examination

"•' ROYALSOCIETY?/MEDICINE

Candidate Name:

Instruction; Mr Jones is a 48 year old labourer who complains of a painful hip on weight bearing.

Please examine Mr Jones' hips.

Mark SchemeAppropriate introduction including name and gradeObtains verbal consentAsks patient about site of pain, degree of pain and effect on mobilityWashes hands or uses alcohol gelPositions (standing initially) and adequately exposes patientInspection of patient standing up (for scars, sinuses, muscle wasting, increased lumbar lordosis, scoliosis)

Performance of Trendelenberg testAssessment of GaitPositions patient lying down and ensures patient is comfortablePalpation of greater trochanter for tendernessMeasurement of real and apparent leg lengthAssessment for fixed flexion deformity (Thomas' test)Measurement of hip flexionMeasurement of hip extensionMeasurement of hip external rotationMeasurement of hip internal rotationMeasurement of hip adductionMeasurement of hip abductionOffers to examine joint above and joint belowOffers to examine the neurological and vascular supply of the lower limbWashes hands or uses alcohol gelClosure: Thanks patient and restores modestyPresentation of findingsAwareness of patients needs throughout examinationProfessionalism


Comments:

Global Score:

Sritharar: OSCEssentials 2009

ROYAL

MEDICINEOSCE Station: Lower Limb Neurological Examination

Instruction: Mrs Smith is a 67 year old artist who reports weakness and numbness in her right leg.

Examine this patient's lower limb neurological system.

Mark SchemeAppropriate introduction including name and gradeObtains verbal consentWashes hands or uses alcohol gelPositions and adequately exposes patientGeneral Inspection of legs (for wasting, fasciculations, hypertrophy, asymmetry)

Assesses tone in both legs including clonusAssesses power in both legs:

Hip FlexionHip ExtensionKnee flexionKnee extensionPnreiflnviop nf fnrt

Plantar flexion of feetAssesses reflexes in both legs:

Knee reflexAnkle reflex

Assesses plantar response in both feetTests co-ordination (heel-shin test) in both legsAssesses sensation in both legsAssesses gaitPerforms Rhomberg's testWashes hands or uses alcohol gelClosure: Thanks patient and restores modestyPresents findingsAwareness of patients needs throughout examinationProfessionalism


Comments:

Global Score:

K. Sntharan OUCHssentmls 2009

.•

™. ROYALSOCIETY?/'MEDICINE

OSCE Station: Peak Expiratory Flow Rate Measurement

Candidate Name:

Instruction: Miss Pollen, a 26 year old PE teacher, has recently developed a nocturnal cough and

wheeze suggestive of asthma. Please measure her Peak Expiratory Flow Rate and discuss her further

management.

Mark SchemeAppropriate introduction including name and gradeObtains verbal consent and outlines nature of the consultationChecks patients' understanding of PEFR and asthmaExplains reason for measuring PEFR and how to measure PEFRWashes hands or uses alcohol gelShows patient how to prepare PEFR meter (mentions disposable mouthpiece + zeroes meter)Positions patient i.e. standingExplains that patient should take a deep breath and form a tight seal with their lips aroundthe mouthpieceDemonstrates technique of blowing Imo ihe metei as haid and fast as possible7 whilstholding meter horizontal and takingj:are not to obstruct scale with fingersExplains how to read meter and the need to zero dial prior to next attemptChecks patient understanding of techniqueAsks patient to perform PEFR and checks techniqueRecords best of 3 PEFR readings (in 1/min)Interprets recorded PEFR against predicted value using chartComments on value of PEFR obtained and explains results to patient in context of asthmaExplains need to keep PEFR diary and advises when to take readingsWashes hands or uses alcohol gelClosure:

Addresses any questions or concernsArranges a follow-up appointmentOffers information leafletsThanks patient


Pass Borderline Fail!

1

Comments:

Global Score:

• ROYAL

MEDICINE

OSCE Station: Knee Examination

Candidate Name:

Instruction: Mrs Bean is a long distance runner who complains of left knee pain and crepitations.

Please examine her knees.

Mark SchemeAppropriate introduction including name and gradeObtains verbal consentWashes hands or uses alcohol gelPositions and adequately exposes patientInspection whilst Standing (for scars, sinuses, swelling, deformity, quadriceps wasting)

Assessment of gaitPosition the patient lying down and ensure the patient is comfortableInspection whilst lying down (for scars, sinuses, swelling, deformity, quadriceps wasting)

Palpation of knee (for temperature, joint line tenderness, swelling in posterior fossa)

Assessment f"r nn gffyH»nr P^teHar f ?p o»- hnFgp T?<tMeasurement for quadriceps wastingMeasurement of knee flexion + assessment of crepitusMeasurement of knee extensionAssessment of extensor lag on straight leg raisingAssessment for posterior sagPerformance of anterior draw or Lachman's test and posterior draw testPerformance of valgus and varus stress testPerformance of McMurray's testOffer to examine the hip and ankle joints and assess the neurovascular status of the legsWashes hands or uses alcohol gelClosure: Thanks patient and restores modestyPresentation of findingsAwareness of patients needs throughout examinationProfessionalism


Comments:

Global Score:

OSCE Station: Cranial

Instruction: Please examine

i •

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Verves Examination

the patients' cranial nerves.

Mark Scheme

1I-i« ROY

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SOCIETY °rMEDICINE

Appropriate introduction including name and gradeObtains verbal consentWashes hands or uses alcohol gelPositions and adequately exposes patient

General Inspection (for facial asymmetry, ptosis, squint, exophthalmos)

Asks about sense of smellOffers to test visual acuityTest of visual fields (including assessment for a central scotoma)

Test of pupillary light reflexTest of accommodation reflexOffers to perform fundoscopyAssessment of eye movements (looks for nystagmus + asks about diplopia)Tp«t nf s£nsatioj] to light touch in all three divisions of the trigeminal nerveOffers to test corneal reflexAssessment of jaw reflexAssessment of muscles of mastication (pterygoids, masseter and temporalis)Assessment of muscles of facial expressionOffers to assess taste over the anterior 2/3 rds of the tongueOffers to perform otoscopy, assess hearing and perform Weber's + Rinne's testsAssessment of movement of soft palateOffers to test the gag reflexInspection of the tongue for wasting, fasciculationsExamination of tongue movements

Assessment of sternocleidomastoid and trapezius musclesWashes hands or uses alcohol gelClosure: Thanks patientPresentation of findings


Comments:

Pass Borderline FailI

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i

Global Score:

::\: • • •".. ROYALSoci ETY °/MEDICINE

OSCE Station: Thyroid Examination

Candidate Name:

Instruction: Miss Jones is a 38 year old lady who is complaining of weight loss, heat intolerance and

visual problems. Please examine her thyroid gland.

Mark SchemeAppropriate introduction including name and gradeExplains examination and obtains verbal consentWashes hands or uses alcohol gelPositions and adequately exposes patient (to clavicles)General + Local Inspection (for scars, sinuses, swellings, skin changes, facial asymmetry) + Inspection onTongue protrusion + Swallow testInspects Hands (for sweating, palmar erythema, thyroid acropachy, onycholysis, vitiligo, tremor and HR)

Palpates neck lump from behind (and repeats palpation with swallow tests + tongue protrusion and from thefront to confirm findings if necessary)Palpates for centrally located tracheaTalri 'Ufj rfuinii.il l i m i i l i milk .

Percusses for retrosternal extensionAuscultates for a thyroid bruitExamines for thyroid eye disease (for lid lag, lid retraction, chemosis, proptosis, hair loss eyebrows andophthalmoplegia)Offers to examine for:

Pretibilal myxoedemaProximal myopathyReflexes

Washes hands or uses alcohol gelClosure: Thanks patient and restores patients' modestyPresents findings and comments on further managementAwareness of patients needs throughout examinationProfessionalism

Comments:

Global Score:


Clear Pass

3 2 1


K Sritharan OSCEssentials 2009

ROYALSOCl ETY «/

MEDICINE

OSCE Station: LOWER LIMB VASCULAR EXAMINATION

Candidate Name:

Instruction; Mr Jones, a 65 year builder, complains of short distance intermittent calf claudication. He

is a known diabetic and hypertensive. Examine his lower limb vascular system.

Mark SchemeAppropriate introduction including name and gradeObtains verbal consentWashes hands or uses alcohol gelPositions and adequately exposes patientInspection (for gangrene, ulcers, skin colour, hair loss, amputation, scars)

Palpation for skin temperature transition comparing both sidesAssess capillary refill timePalpation of both femoral pulsesAuscultation for femoral bruitsPalpation of both popliteal pulsesPalpation of both dorsalis pedis pulsesPalpation of both posterior tibial pulsesPerformance of Buerger's test (comments on Buerger's angle)Offers to:

Examine remainder of peripheral vascular systemExamine the abdomen for a AAAMeasure ABPIsPerform a neurological examination of the lower limbPerform a urinalysis

Washes hands or uses alcohol gelClosure: Thanks patient and restores modestyPresentation of findingsAwareness of patients needs throughout examinationProfessionalism

Pass Borderline tail

Comments:

Global Score:4

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ROYALSOCIETY^MEDICINE

OSCE Station: EGG Interpretation

Candidate Name:

Instruction: Mr Smith is a 56 year old gentleman who presents to A&E with chest pain. You are asked

to interpret his ECG. Discuss your findings with the A&E Registrar.

Mark SchemeConfirms the following before proceeding:

Patient's name and DOBDate and time investigation performedPatient's symptoms at time of investigation i.e. chest pain or painfree

Checks calibration of the ECG i.e. strip recorded at a setting of 25mm/secCalculates RateComments on RhythmDetermines AxisCuiiunciits. ou morphology of the ORS complexComments on:

PR intervalST segmentsQT interval

T-wavesSummarises findingsCorrect interpretation of ECGComments of further management

Comments

Pass

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Borderline

HBB

Fail

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Global Score:

Clear Pass

3 2 1


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n, ROY\L

SOCJJETYjf

MEDICINE

OSCE Station: VARICOSE VEINS EXAMINATION

Instruction: Mrs Forrester is a 33 year old teacher who complains of prominent veins and swelling of

her ankles notably at the end of the day. Perform an examination of her varicose veins.

Mark SchemeAppropriate introduction including name and gradeObtains verbal consent

Washes hands or uses alcohol gelPositions (standing) and adequately exposes patient both legsAsks if patient has any painGeneral Inspection (for varicose veins, spider veins, venous eczema, lipodermatosclerosis, ankle swelling, scars,ulcers - gaitor) from front and behindSpecific Inspection of Long Saphenous VeinSpecific Inspection of Short Saphenous VeinPalpates for temperature, oedema, and along course of long and short saphenous veinsExamination for saphenovarix at SFJ and feels for cough impulse at SFJ and SPJPerforms Tap TestPerforms Tourniquet TestAuscultates any obvious varicosities for bruits (AV malformation)Offers to use hand-held Doppler to assess for SFJ and SPJ incompetenceOffers to perform Perthes TestOffers to examine lower limb pulses and ABPIs.

Offers to perform an abdominal, digital rectal and PV examinationClosure: Thanks the patient and restores their modestyWashes hands or uses alcohol gel

Presents summary of findings

Awareness of patients needs throughout examination + treats patient with dignityProfessionalism -- -

Pass Borderline

Comments:

Global Score:

Fail

K Sritbaran OSCEssattiah 2009

ROYALSOCIJTYj/

MEDICINE

OSCE Station: BREAST EXAMINATION

Candidate Name: ....................................

Instruction: Mrs Jones is a 40 year old lady who has recently noticed a lump in her breast. She is clearly

concerned. Perform an examination of her breasts.

i1!

Mark SchemeAppropriate introduction including name and gradeObtains verbal consentWashes hands or uses alcohol gelPositions and adequately exposes patient (requests chaperone)Inspects breasts With patient sitting relaxed (for scars, asymmetry, skin changes, discharge)

Inspects breasts with patients' hands behind their headInspects breasts with patients' hands pushing into their hipsAsks the patient about any pain or lumps in either breast prior to commencing palpationrnmmnnf.es palpation with pfttipnt in thp rnrrecf position (i.e. Iving on COUCh with hand ofbreast to be examined behind their head)Systematically palpates both breasts starting with 'normal breast' first (4 quadrants, axillarytail and nipple)Examines both axillae (normal side first)Palpates for supraclavicular fossa lymphadenopathyExamines for hepatomegallyPercusses axial spine for tendernessOffers to percuss and auscultate chestClosure: thanks patient, addresses any questions or concerns and is sensitive of patient'smodestyWashes hands or uses alcohol gelPresents summary of findingsAwareness of patients needs throughout examinationProfessionalism


Comments:

Global Score:

•- -, ROYAL

MEDICINEOSCE Station: Verification + Certification of Death

Candidate Name:

Instruction:1. You are the FYl doctor on-call and are bleeped to the ward to verify the death of a patient.

The date is today.2. You are the patient's usual doctor and are asked to complete a death certificate with the

information provided. You are based at Hope Hospital and the consultant is Dr Dye.

Mark Scheme Pass Borderline Fail

Appropriate introduction to nursing staff including name and grade

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Elicits appropriate details: time of death; persons present; when last seen alive; duration ofdeathRequests hospital notes and drug chartConfirms patient's identity bandExamines patient to assess:- Responsiveness (i.e. gentle shake/sternal rub) + absence of spontaneous movements- Looks for absent respiratory effort (1 minute)- Palpates major pulse (carotid/femoral) for 1 minute- Auscultates praecordium for heart sounds (for 3 minutes)- Auscultates lungs for breath sounds (for 3 minutes)- Inspects eyes for fixed, dilated pupils + absent corneal reflexes (requests pen torch)- Requests opthalmoscope to perform fundoscopy for tracking/rail reading- Examines trunk for other features of death i.e. muscle tone for rigor mortis (does not appearuntil 3 hours after death), post-mortem staining (due to hypostasis) and decreased temperatureDocuments above in notes (includes above details, time, date and signature)

Legible writing/avoids abbreviationsCorrect patient details/Date/time and signaturePart la (disease causing death)Part Ib/c (disease underlying this -if not in la)Part 2 (contributory diseases)Residence and consultant

Comments:

Global Score:

.

. •"••ROYAL

MEDICINEQSCE Station: Communication: Explaining a Procedure

Candidate Name:

Instruction: You are an FY1 in General Practice. Mr Bird has been referred for acolonoscopy/bronchoscopy/OGD/ERCP and you have been asked to explain the procedure to him. Theexaminer will advise you which procedure the patient will be undergoing.

Mark SchemeAppropriate introduction including name and gradeEstablishes and maintains a rapport with the patientExplains the purpose of the consultationChecks patient's prior understanding of the procedure/operationElicits patient's concernsAcknowledges patients' feelings/concerns and responds appropriatelyExplains indication for the procedure/operationExplains preparation required before procedure/operationExplains procedure/operation

Explains risks and benefits of the procedureExplains likely outcome after the procedure i.e. discharge date, follow-up, when results willbe available and restrictions on lifestyle (i.e. driving, exercise, work)Checks patient's understanding of the procedure/operationSummarises the key points of the consultationEncourages and addresses questions and concernsDiscusses and negotiates a subsequent management planOffers information leaflets

Listens effectivelyAppropriate use of non-verbal and verbal cuesFluency of consultation + avoids jargon and repetitionProfessionalism


i

Comments:

Global Score:

4 3

Actor Global Score of Consultation:

4 3

1

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SOC1 ETY °!

MEDICINE

OSCE Station: Communication - Colon Cancer

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Instruction: As an FY1 in General Practice, you are asked to see Mr Mukhurji. Represented with fatigueand painless bright red rectal bleeding 2 weeks ago. An outpatient barium enema was performed anddemonstrated an 'apple core ' lesion in his sigmoid colon. Please discuss these results with the patient andthe necessary follow up. You have 7 minutes to discuss the results and further management.

1

!

Mark SchemeAppropriate introduction including name and gradeEstablishes and maintains rapport with patientListens effectively

Establishes patient's ideas, concerns and expectationsAcknowledges patients' feelings/concerns and responds appropriatelyShows appropriate skills in breaking bad newsAppropriate use of body language

Checks patient's prior understanding of colonoscopy and bowel cancerExplains reason for colonoscopyDescribes colonoscopy clearly (preparation required, the procedure & complications)Discusses and negotiates subsequent management planSummarises key points of consultation and checks patient's understandingOffers information leaflets and arranges follow-upAddresses any questions and concernsAppropriate use of open/clarifying/closed questionsFluency/avoids jargon and repetitionProfessionalism

Comments:


I!

<

Global Score in Breaking Bad News:

4 3

Global Score in Negotiating Management Plan:

4 3


4 3

"'ROYAL

SOCIETY«/

MEDICINE

OSCE Station: Communication - Alcohol Abuse

Candidate Name:

Instruction: You are a FY1 doctor in General Practice. You are asked to see Mr Adam Smith, He cameinto the practice a week ago with vague abdominal discomfort and was seen by the senior partner. Bloodtaken at that time snows a mild anaemia, nign ML.V ana a raised gamma-Lrl . tie ic

smells of alcohol.You have 7 minutes to discuss the results and negotiate management.

Mark SchemeAppropriate introduction including name and gradeEstablishes and maintains rapport with patientListens effectivelyAcknowledges and responds appropriately to patients' feelingsEstablishes patient's ideas, concerns and expectations (ICE)Elicits CAGE/ Alcohol historyA sirs brief mprlir-il inr\ pvyrhiatrir history

Elicits social/forensic historyDiscusses lifestyle and potential stressorsOffers information and negotiates further management (i.e. counselling, rehabilitation andfollow-up)Summarises key points in the consultation and checks patient's understandingAppropriate use of open/clarifying/closed questionsFluency/avoids jargon and repetitionProfessionalism

IOKS tir

Pass

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Borderline

ana

Fail

Comments:

Global Score:

1

Actor Global Score for Communication Skills (ability to empathise, establish a rapport and offer explanation):

4 3 2 1

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ROYALSOClJTYf

MEDICINE

OSCE Station: Urinary Catheterisation

Candidate Name:

Instruction: Mr Smith is post-op day 1 incisional hernia repair and is clinically in acute urinary

retention. Please insert a urethral urinary catheter.

.

:

Mark SchemeAppropriate introduction including name and gradeExplains procedure and obtains verbal consentChecks indication for urinary catheter insertionWashes hands or uses alcohol gelPositions and adequately exposes patientEnsures privacy and patients dignity is preserved (requests chaperone if female patient)Prepares procedure trolley/equipment maintaining asepsisWashes hands or uses alcohol gel and puts on sterile glovesPerforms catheter insertion maintaining asepsisWarns patient prior to introduction of LA into urethra ..States that ideally would allow Smins for LA to take effect prior to catheter insertionAdvances catheter to hub/till urine flowsInflates catheter balloon with water in accordance with manufacturer's guidelinesAttaches catheter to leg bag/drainage systemEnsures patient is comfortable (foreskin is replaced), the area is dry and assists patient withclothingClears and disposes of clinical waste appropriatelyWashes hands or uses alcohol gelClosure:

Advises patient of further managementAddresses any questions or concernsThanks patient

Documents procedure in notes (including date, time, catheter type, amount of water instilled in balloon,complications, replacement of foreskin where appropriate and residual volume)Awareness of patients needs throughout examinationTechnical performanceProfessionalism


Comments:

Global Score:


The Royal Society of MedicineYoung Fellow's Committee

OSCE DAY 2009 ROYAL

MEDICINE

OSCE Station: Communication - Autopsy

Candidate Name:

Instruction: You are an FY1 doctor in A&E and have been involved in an unsuccessful resuscitation on a7-year old boy (David) who collapsed whilst playing football. You are asked to speak to Mr Steinberg, the

father, about the autopsy. You have 7 minutes to discuss this matter with the father.


Appropriate introduction including name and gradeEstablishes and maintains rapport with patientOffers condolences and ensures appropriate environment for consultationAcknowledges and responds to patients' feelingsEstablishes patient's agendaEstablishes own agendaNegotiates compromiseDiscusses reasons for coroner PM/demonstrates knowledgeExplains in terms acceptable to relative what a post-mortem will involveDoes not guarantee an autopsy will be doneElicits and addresses parent's concerns and suggests appropriate support

| Appropriate use of open/clarifying/closed questionsFluency/avoids jargon and repetitionProfessionalism

Comments:

Global Score for Negotiating Plan:

4 3 2 1

Patient's Global Score of Communication Skills/Consultation:

4 3 2 1

Clear Pass Pass Borderline Fail



OSCE DAY 2009 ROYALSOCl ETY •?/•

MEDICINE

OSCE Station: Digital Rectal Examination

Candidate Name:

Instruction: You are an FYl doctor. You have been asked to perform a digital rectal examination on a40 year old female/male with per rectal bleeding.


Appropriate introduction including name and gradeExplains need to perform procedure, what it entails and obtains verbal consentRequests chaperone (if appropriate)Washes hands or uses alcohol gelPrepares equipment — gloves + lubricating jelly + tissuePositions patient appropriately (left lateral decubitus position with knees drawn to chest)

Examines perianal region (for skin tags, warts, flstulae, excoriation, prolapsed piles)

Technical performance Of rectal examination (examines anterior, posterior and lateral walls)

if clinical waste riatehAssists patient with clothing and ensures they are comfortable following the procedureWashes handswasnes uaims

Discusses the findings + further management with the patient; Addresses patients ICESninmarv nf rrmsii ltnf innSummary of consultationOffers to documents findingsAwareness of patients needs throughout consultation and maintains their dignityProfessionalism

Comments:

Global Score:

Clear Pass

3


K Sritharan OSCEssendais 2009


OSCE DAY 2009 ROYAL

MEDICINE

OSCE Station: History Taking

Candidate Name:

Instruction: You are a FYl doctor. Mr(s) Jones has come into A&E. Please take a full history. Presentyour history to the examiner when you have finished.

:

Mark SchemeAppropriate introduction including name and gradeExplains the purpose of the consultationEstablishes and maintains a rapport with the patientIdentifies presenting complaintExplores presenting complaint and associated symptomsAcknowledges seriousness and severity of symptomsAcknowledges patients' feelings/concerns and responds appropriatelyDetermines past medical historyDetermines drug historyIdentifies any allergiesExplores social and family historyPerforms appropriate systems enquiryAppropriate use of open, closed and clarifying questionsListens effectivelyAddresses patient's ideas, concerns and expectationsAppropriate use of body languageAppropriately closes consultationSummarises historyOffers differential diagnosis and suggests options for further managementProfessionalism


Comments:

Global Score:


4 3



OSCE DAY 2009

OSCE Station: RESPIRATORY EXAMINATION

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MEDICINE

Instruction: Mr Patel is 38 year gentleman who has a history offerers, weight loss and a persistent

cough. Please examine his respiratory system.

Mark SchemeAppropriate introduction including name and gradeObtains verbal consentWashes hands or uses alcohol gel

Positions and adequately exposes patientGeneral Inspection (including comfort, respiratory rate, use of accessory muscles, resp. paraphernalia)

Examines hands for peripheral stigmata of respiratory disease (for clubbing, nicotine staining,peripheral cyanosis, hypercapnic flap >2 for pass)Examines eyes (for anaemia, Homer's syndrome)

Examines for central cyanosisOffers to examine cervical lymph nodes (esp. scalene LN)Inspects chest (for scars, deformity, asymmetry, use ot accessory muscles)Checks central position of tracheaChecks position of apex beatPalpates for chest expansion

Percusses chest (correct technique + areas)

Assesses for vocal + tactile fremitusAuscultes chest (correct technique + areas)Adequate Closure: may offer to check sputum pot, check PEFR, thanks patient.Washes hands or uses alcohol gelPresentation of summary of findings

Aware of patients needs throughout examination + treats patient with respectProfessionalism

Comments:

Global Score:4 3 2 1


K. Sritharan OSCEssennals 2009