" 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 day history of frequency and dysuria. Mark Scheme
Appropriate introduction including name and grade Briefly describes and gives reason for procedure and obtains consent to proceed Checks patients name and date of birth Washes hands or uses alcohol gel, puts on gloves and gown Takes urine sample and assesses appearance (colour, turbidity) and odour Immerses all pads of urine dipstick in urine specimen bottle for 1-2 seconds Starts timing and keeps urine dipstick horizontal at all times Closes urine specimen bottle and puts aside Reads dipstick against colour chart on bottle at time indicated on chart Does NOT touch urinalysis bottle with dipstick After reading, discards urine dipstick and gloves appropriately in clinical waste Washes hands or uses alcohol gel Discusses findings with patient and further management Documents the findings in the patients in the patients notes +/- offers to send urine for microscopy if appropriate Closes consultation appropriately Summarises findings to the examiner Professionalism Pass Borderline Fail

Comments:

Global Score:

3
Clear Pass Pass

2
Borderline

1
Fail

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"'ROYAL SOCJETYj/"

OSCE Station: Measurement of Ankle Brachial Pressure Index

Candidate Name:

MEDICINE

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 Scheme
Pass Borderline Fail 1 Appropriate introduction including name and grade Explains procedure and obtains verbal consent Washes hands or uses alcohol gel
Positions and adequately exposes patient (supine with shoes, socks and proximaliy constricting clothing removed)

Ensures that legs have been rested for >20 rains Selects appropriate sized BP cuff and places around arm Palpates brachial artery and applies ultrasound gel Uses Doppler probe (at approx 45 degrees) to locate brachial pulse Inflates cuff till Doppler signal disappears, deflates and records pressure at which signal returns Cleans gel and offers to repeat process for other arm States would use higher of 2 brachial systolic readings to calculate ABF1 Selects appropriate size cuff for patients calf and places above the malleoli Locates Dorsalis Pedis (DP) pulse by palpation or applies ultrasound gel and uses Doppler Continues as for brachial pulse and records DP pressure Repeats for Posterior Tibial (PT) pulse and records PT pulse pressure Uses the higher of the two readings when calculating ABPIs for the ankle Offers to repeat for other leg Cleans ultrasound gel from skin and restores patients' modesty Washes hands or uses alcohol gel Calculates and documents ABPIs in patient's notes Closure: - Advises patient of their results in the context of their symptoms. - Addresses any questions or concerns - Thanks the patient Presentation of findings with interpretation of results Awareness of patients needs throughout examination Professionalism

Comments:

Global Score:

K. SHtharan OSCEswntiala 2OOP

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'"" ROYAL Socj ETY -j MEDICINE

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 appears to be quite agitated and is demanding to speak to a doctor urgently. You have 7 minutes to take a history and provide appropriate management. Mark Scheme
Appropriate introduction including name and grade Establishes and maintains rapport with patient Acknowledges and responds to patients' feelings appropriately Establishes patient's agenda Establishes own agenda Negotiates compromise Elicits details of past history Elicits details of drug use Elicits details of past treatment Appropriate use of open/clarifying/closed questions Fluency/avoids jargon and repetition Professionalism Pass Borderline Fail

Comments:

Global Score of Negotiating Plan:

4 3 2

Patient Global Score of Communication Skills:

4 3 2

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SOCIJETYj?/-

QSCE Station: ABDOMINAL EXAMINATION

Candidate Name:

MEDICINE

Instruction: Mr Smith is 54 year gentleman who has a history of weight loss and change in bowel habits. Please examine his abdomen. Mark Scheme
Appropriate introduction including name and grade Obtains verbal consent Washes hands or uses alcohol gel Positions and adequately exposes patient General Inspection
Examines 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)

Pass Borderline

Fail

i I

General Palpation (light and deep) Liver Examination (palpation + percussion) Spleen Examination Right and Left Kidney Examination Examination for AAA (pulsatility + expansion abdominal aorta) Examination for bladder Examines for ascites (shifting dullness or/and fluid thrill) Auscultation for bowel sounds and bruits Offers to perform digital rectal examination Offers to examine hernial orifices and external genitalia Washes hands or uses alcohol gel Presents Summary of findings Awareness of patients needs throughout examination + treats patient with respect Professionalism

Comments:

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 Scheme
Appropriate introduction including name and grade Obtains verbal consent to perform examination Washes hands or uses alcohol gel Positions and adequately exposes patient
General Inspection of upper limb (for wasting, fasciculations, asymmetry, abnormal movements)

Pass

Borderline

Fail

Assesses for pyramidal/pronator drift Assesses tone in both arms (for rigidity and spasticity) Assesses power in both arms: Shoulder abduction Elbow extension Elbow flexion Wrist flexion Wrist extension Finger extension Finger flexion Finger abduction Thumb abduction Assesses reflexes in both arms: Triceps reflex Biceps reflex Supinator reflex Assesses co-ordination in the upper limbs (i.e. dysdiadochokinesis and finger-to-nose test) Assesses sensation in both arms Washes hands or uses alcohol gel Closure: Thanks patient and restores modesty Presents findings Awareness of patients needs throughout examination Professionalism

Comments:

Global Score:

OSCE Station: CARDIOVASCULAR EXAMINATION

Candidate Name:

ROYAL SOCIETY-/ MEDICINE

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 Scheme
Appropriate introduction including name and grade Obtains verbal consent Washes hands or uses alcohol gel Positions and adequately exposes patient Genera! Inspection
Examines hands for peripheral stigmata of CVS disease (for clubbing, splinter haemorrhages, peripheral cyanosis, Janeway lesions, capillary refill time, nicotine staining,tendon xanthoma) ->2 Examines radial pulse (comments on rate, rhythm and volume, collapsing pulse, radio-femoral delay)

Pass

Borderline

Fail

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 beat Palpates precordium (for heaves and thrills) Localises apex beat Auscultates in correct 4 areas Auscultates with the bell at the apex and with patient turned on left side for MS Auscultates with the diaphragm and with patient leaning forward for AR Auscultates the lung bases (for inspiratory crepitations) Examines for dependent oedema i.e. sacral and ankle Offers to assess peripheral pulses Closure: Thanks patient, offers to dipstick urine etc Washes hands or uses alcohol gel Presents summary of findings Aware of patients' needs throughout examination + maintains patients dignity Professionalism

Comments:

Global Score:

K. Sritharan OSCEssentials 2009

:'-;v''.
OSCE Station: Hip Examination
Candidate Name:

"' ROYAL SOCIETY?/ MEDICINE

Instruction; Mr Jones is a 48 year old labourer who complains of a painful hip on weight bearing. Please examine Mr Jones' hips. Mark Scheme
Appropriate introduction including name and grade Obtains verbal consent Asks patient about site of pain, degree of pain and effect on mobility Washes hands or uses alcohol gel Positions (standing initially) and adequately exposes patient
Inspection of patient standing up (for scars, sinuses, muscle wasting, increased lumbar lordosis, scoliosis)

Pass

Borderline

Fail

Performance of Trendelenberg test Assessment of Gait Positions patient lying down and ensures patient is comfortable Palpation of greater trochanter for tenderness Measurement of real and apparent leg length Assessment for fixed flexion deformity (Thomas' test) Measurement of hip flexion Measurement of hip extension Measurement of hip external rotation Measurement of hip internal rotation Measurement of hip adduction Measurement of hip abduction Offers to examine joint above and joint below Offers to examine the neurological and vascular supply of the lower limb Washes hands or uses alcohol gel Closure: Thanks patient and restores modesty Presentation of findings Awareness of patients needs throughout examination Professionalism

Comments:

Global Score:

Sritharar: OSCEssentials 2009

ROYAL MEDICINE

OSCE 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 Scheme
Appropriate introduction including name and grade Obtains verbal consent Washes hands or uses alcohol gel Positions and adequately exposes patient
General Inspection of legs (for wasting, fasciculations, hypertrophy, asymmetry)

Pass

Borderline

Fail

Assesses tone in both legs including clonus Assesses power in both legs: Hip Flexion Hip Extension Knee flexion Knee extension
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Plantar flexion of feet Assesses reflexes in both legs: Knee reflex Ankle reflex Assesses plantar response in both feet Tests co-ordination (heel-shin test) in both legs Assesses sensation in both legs Assesses gait Performs Rhomberg's test Washes hands or uses alcohol gel Closure: Thanks patient and restores modesty Presents findings Awareness of patients needs throughout examination Professionalism

Comments:

Global Score:

K. Sntharan OUCHssentmls 2009

.
. ROYAL SOCIETY?/' 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 Scheme
Appropriate introduction including name and grade Obtains verbal consent and outlines nature of the consultation Checks patients' understanding of PEFR and asthma Explains reason for measuring PEFR and how to measure PEFR Washes hands or uses alcohol gel Shows patient how to prepare PEFR meter (mentions disposable mouthpiece + zeroes meter) Positions patient i.e. standing Explains that patient should take a deep breath and form a tight seal with their lips around the mouthpiece Demonstrates technique of blowing Imo ihe metei as haid and fast as possible7 whilst holding meter horizontal and takingj:are not to obstruct scale with fingers Explains how to read meter and the need to zero dial prior to next attempt Checks patient understanding of technique Asks patient to perform PEFR and checks technique Records best of 3 PEFR readings (in 1/min) Interprets recorded PEFR against predicted value using chart Comments on value of PEFR obtained and explains results to patient in context of asthma Explains need to keep PEFR diary and advises when to take readings Washes hands or uses alcohol gel Closure:
Addresses any questions or concerns Arranges a follow-up appointment Offers information leaflets Thanks patient

Pass

Borderline

Fail
! 1

Awareness of patients needs throughout examination Professionalism

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 Scheme
Appropriate introduction including name and grade Obtains verbal consent Washes hands or uses alcohol gel Positions and adequately exposes patient
Inspection whilst Standing (for scars, sinuses, swelling, deformity, quadriceps wasting)

Pass

Borderline Fail

Assessment of gait Position the patient lying down and ensure the patient is comfortable
Inspection 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 n n gffyHnr P^teHar f ?p o- hnFg p T?<t Measurement for quadriceps wasting Measurement of knee flexion + assessment of crepitus Measurement of knee extension Assessment of extensor lag on straight leg raising Assessment for posterior sag Performance of anterior draw or Lachman's test and posterior draw test Performance of valgus and varus stress test Performance of McMurray's test Offer to examine the hip and ankle joints and assess the neurovascular status of the legs Washes hands or uses alcohol gel Closure: Thanks patient and restores modesty Presentation of findings Awareness of patients needs throughout examination Professionalism

Comments:

Global Score:

'..','. ,. '

1 w I
-i ROY \t SOCIETY r MEDICINE
Pass Borderline Fail
I

OSCE Station: Cranial Verves Examination

Instruction: Please examine the patients' cranial nerves. Mark Scheme
Appropriate introduction including name and grade Obtains verbal consent Washes hands or uses alcohol gel Positions and adequately exposes patient
General Inspection (for facial asymmetry, ptosis, squint, exophthalmos)

Asks about sense of smell Offers to test visual acuity Test of visual fields (including assessment for a central scotoma) Test of pupillary light reflex Test of accommodation reflex Offers to perform fundoscopy Assessment of eye movements (looks for nystagmus + asks about diplopia) Tpt nf snsatioj] to light touch in all three divisions of the trigeminal nerve Offers to test corneal reflex Assessment of jaw reflex Assessment of muscles of mastication (pterygoids, masseter and temporalis) Assessment of muscles of facial expression Offers to assess taste over the anterior 2/3 rds of the tongue Offers to perform otoscopy, assess hearing and perform Weber's + Rinne's tests Assessment of movement of soft palate Offers to test the gag reflex Inspection of the tongue for wasting, fasciculations Examination of tongue movements Assessment of sternocleidomastoid and trapezius muscles Washes hands or uses alcohol gel Closure: Thanks patient Presentation of findings Awareness of patients needs throughout examination Professionalism

Comments:

Global Score:

::

\:

".. ROYAL Soci 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 Scheme
Appropriate introduction including name and grade Explains examination and obtains verbal consent Washes hands or uses alcohol gel Positions and adequately exposes patient (to clavicles)
General + Local Inspection (for scars, sinuses, swellings, skin changes, facial asymmetry) + Inspection on Tongue protrusion + Swallow test Inspects 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 the front to confirm findings if necessary)

Pass

Borderline

Fail

Palpates for centrally located trachea

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Percusses for retrosternal extension Auscultates for a thyroid bruit

Examines for thyroid eye disease (for lid lag, lid retraction, chemosis, proptosis, hair loss eyebrows and ophthalmoplegia)

Offers to examine for: Pretibilal myxoedema Proximal myopathy Reflexes Washes hands or uses alcohol gel Closure: Thanks patient and restores patients' modesty Presents findings and comments on further management Awareness of patients needs throughout examination Professionalism

Comments:

Global Score:

3
Clear Pass Pass

2
Borderline

1
Fail
K Sritharan OSCEssentials 2009

ROYAL
SOCl 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.
Pass Borderline tail

Mark Scheme
Appropriate introduction including name and grade Obtains verbal consent Washes hands or uses alcohol gel Positions and adequately exposes patient
Inspection (for gangrene, ulcers, skin colour, hair loss, amputation, scars)

Palpation for skin temperature transition comparing both sides Assess capillary refill time Palpation of both femoral pulses Auscultation for femoral bruits Palpation of both popliteal pulses Palpation of both dorsalis pedis pulses Palpation of both posterior tibial pulses Performance of Buerger's test (comments on Buerger's angle) Offers to: Examine remainder of peripheral vascular system Examine the abdomen for a AAA Measure ABPIs Perform a neurological examination of the lower limb Perform a urinalysis Washes hands or uses alcohol gel Closure: Thanks patient and restores modesty Presentation of findings Awareness of patients needs throughout examination Professionalism

Comments:

Global Score:
4

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IfliJI
ROYAL
SOCIETY^ 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 Scheme
Confirms the following before proceeding: Patient's name and DOB Date and time investigation performed Patient'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/sec Calculates Rate Comments on Rhythm Determines Axis Cuiiunciits. ou morphology of the ORS complex Comments on: PR interval ST segments QT interval T-waves Summarises findings Correct interpretation of ECG Comments of further management Pass
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Borderline

HI
1

Fail

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Comments

Global Score:

3
Clear Pass Pass

2
Borderline

1
Fail

'

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OSCE Station: VARICOSE VEINS EXAMINATION

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SOCJJETYjf

MEDICINE

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 Scheme
Appropriate introduction including name and grade Obtains verbal consent Washes hands or uses alcohol gel Positions (standing) and adequately exposes patient both legs Asks if patient has any pain
General Inspection (for varicose veins, spider veins, venous eczema, lipodermatosclerosis, ankle swelling, scars, ulcers - gaitor) from front and behind

Pass

Borderline

Fail

Specific Inspection of Long Saphenous Vein Specific Inspection of Short Saphenous Vein Palpates for temperature, oedema, and along course of long and short saphenous veins Examination for saphenovarix at SFJ and feels for cough impulse at SFJ and SPJ Performs Tap Test Performs Tourniquet Test Auscultates any obvious varicosities for bruits (AV malformation) Offers to use hand-held Doppler to assess for SFJ and SPJ incompetence Offers to perform Perthes Test Offers to examine lower limb pulses and ABPIs. Offers to perform an abdominal, digital rectal and PV examination Closure: Thanks the patient and restores their modesty Washes hands or uses alcohol gel Presents summary of findings Awareness of patients needs throughout examination + treats patient with dignity Professionalism -- -

Comments:

Global Score:

K Sritbaran OSCEssattiah 2009

ROYAL
SOCIJTYj/

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. Mark Scheme
Appropriate introduction including name and grade Obtains verbal consent Washes hands or uses alcohol gel Positions and adequately exposes patient (requests chaperone)
Inspects breasts With patient sitting relaxed (for scars, asymmetry, skin changes, discharge)

Pass

Borderline

Fail

Inspects breasts with patients' hands behind their head Inspects breasts with patients' hands pushing into their hips Asks the patient about any pain or lumps in either breast prior to commencing palpation
rnmmnnf.es palpation with pfttipnt in thp rnrrecf position (i.e. Iving on COUCh with hand of

i 1

breast to be examined behind their head) Systematically palpates both breasts starting with 'normal breast' first (4 quadrants, axillary tail and nipple) Examines both axillae (normal side first) Palpates for supraclavicular fossa lymphadenopathy Examines for hepatomegally Percusses axial spine for tenderness Offers to percuss and auscultate chest Closure: thanks patient, addresses any questions or concerns and is sensitive of patient's modesty Washes hands or uses alcohol gel Presents summary of findings Awareness of patients needs throughout examination Professionalism

Comments:

Global Score:

, ROYAL

MEDICINE OSCE 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
Appropriate introduction to nursing staff including name and grade
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Pass

Borderline

Fail

Elicits appropriate details: time of death; persons present; when last seen alive; duration of death Requests hospital notes and drug chart Confirms patient's identity band Examines 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 appear until 3 hours after death), post-mortem staining (due to hypostasis) and decreased temperature

Documents above in notes (includes above details, time, date and signature) Legible writing/avoids abbreviations Correct patient details/Date/time and signature Part 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

MEDICINE

QSCE Station: Communication: Explaining a Procedure

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

Mark Scheme
Appropriate introduction including name and grade Establishes and maintains a rapport with the patient
Explains the purpose of the consultation Checks patient's prior understanding of the procedure/operation Elicits patient's concerns Acknowledges patients' feelings/concerns and responds appropriately Explains indication for the procedure/operation Explains preparation required before procedure/operation Explains procedure/operation Explains risks and benefits of the procedure Explains likely outcome after the procedure i.e. discharge date, follow-up, when results will be available and restrictions on lifestyle (i.e. driving, exercise, work) Checks patient's understanding of the procedure/operation Summarises the key points of the consultation Encourages and addresses questions and concerns Discusses and negotiates a subsequent management plan Offers information leaflets Listens effectively Appropriate use of non-verbal and verbal cues Fluency of consultation + avoids jargon and repetition Professionalism

Pass

Borderline

Fail

Comments:

Global Score:
4 3

Actor Global Score of Consultation:

4 3

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OSCE Station: Communication - Colon Cancer
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SOC1 ETY !

1 IT

i" ROY \t
MEDICINE

Instruction: As an FY1 in General Practice, you are asked to see Mr Mukhurji. Represented with fatigue and painless bright red rectal bleeding 2 weeks ago. An outpatient barium enema was performed and demonstrated an 'apple core ' lesion in his sigmoid colon. Please discuss these results with the patient and the necessary follow up. You have 7 minutes to discuss the results and further management. Mark Scheme
Appropriate introduction including name and grade Establishes and maintains rapport with patient Listens effectively Establishes patient's ideas, concerns and expectations Acknowledges patients' feelings/concerns and responds appropriately Shows appropriate skills in breaking bad news Appropriate use of body language Checks patient's prior understanding of colonoscopy and bowel cancer Explains reason for colonoscopy Describes colonoscopy clearly (preparation required, the procedure & complications) Discusses and negotiates subsequent management plan Summarises key points of consultation and checks patient's understanding Offers information leaflets and arranges follow-up Addresses any questions and concerns Appropriate use of open/clarifying/closed questions Fluency/avoids jargon and repetition ! Professionalism Pass Borderline Fail
1 <

Comments:

Global Score in Breaking Bad News:

Global Score in Negotiating Management Plan:

4 3

Actor Global Score of Consultation:

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 came into the practice a week ago with vague abdominal discomfort and was seen by the senior partner. Blood taken at that time snows a mild anaemia, nign ML.V ana a raised gamma-Lrl . tie icIOKS tir ea, unKempi ana smells of alcohol. You have 7 minutes to discuss the results and negotiate management. Mark Scheme Appropriate introduction including name and grade Establishes and maintains rapport with patient Listens effectively Acknowledges and responds appropriately to patients' feelings Establishes patient's ideas, concerns and expectations (ICE) Elicits CAGE/Alcohol history
A sirs brief mprlir-il inr\ pvyrhiatrir history

Pass

Borderline

Fail

Elicits social/forensic history Discusses lifestyle and potential stressors Offers information and negotiates further management (i.e. counselling, rehabilitation and follow-up) Summarises key points in the consultation and checks patient's understanding Appropriate use of open/clarifying/closed questions Fluency/avoids jargon and repetition Professionalism Comments:

Global Score:

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

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SOClJTYf

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 Scheme
Appropriate introduction including name and grade Explains procedure and obtains verbal consent Checks indication for urinary catheter insertion Washes hands or uses alcohol gel Positions and adequately exposes patient Ensures privacy and patients dignity is preserved (requests chaperone if female patient) Prepares procedure trolley/equipment maintaining asepsis Washes hands or uses alcohol gel and puts on sterile gloves Performs catheter insertion maintaining asepsis Warns patient prior to introduction of LA into urethra .. States that ideally would allow Smins for LA to take effect prior to catheter insertion Advances catheter to hub/till urine flows Inflates catheter balloon with water in accordance with manufacturer's guidelines Attaches catheter to leg bag/drainage system Ensures patient is comfortable (foreskin is replaced), the area is dry and assists patient with clothing Clears and disposes of clinical waste appropriately Washes hands or uses alcohol gel Closure: Advises patient of further management Addresses any questions or concerns Thanks 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)

Pass

Borderline

Fail

Awareness of patients needs throughout examination Technical performance Professionalism

Comments:

Global Score:

K Sritharan OSCEssentials 2009

The Royal Society of Medicine Young Fellow's Committee OSCE DAY 2009
OSCE Station: Communication - Autopsy
Candidate Name:

ROYAL MEDICINE

Instruction: You are an FY1 doctor in A&E and have been involved in an unsuccessful resuscitation on a 7-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. Pass Borderline Fail

Mark Scheme Appropriate introduction including name and grade Establishes and maintains rapport with patient Offers condolences and ensures appropriate environment for consultation Acknowledges and responds to patients' feelings Establishes patient's agenda Establishes own agenda Negotiates compromise Discusses reasons for coroner PM/demonstrates knowledge Explains in terms acceptable to relative what a post-mortem will involve Does not guarantee an autopsy will be done Elicits and addresses parent's concerns and suggests appropriate support | Appropriate use of open/clarifying/closed questions Fluency/avoids jargon and repetition Professionalism Comments:

Global Score for Negotiating Plan:

Patient's Global Score of Communication Skills/Consultation:

4
Clear Pass

3
Pass

2
Borderline

1
Fail

K Sritharan OSCEssentials 2009

The Royal Society of Medicine Young Fellow's Committee OSCE DAY 2009
OSCE Station: Digital Rectal Examination
Candidate Name:

ROYAL
SOCl ETY ?/

MEDICINE

Instruction: You are an FYl doctor. You have been asked to perform a digital rectal examination on a 40 year old female/male with per rectal bleeding.

Mark Scheme
Appropriate introduction including name and grade Explains need to perform procedure, what it entails and obtains verbal consent Requests chaperone (if appropriate) Washes hands or uses alcohol gel Prepares equipment gloves + lubricating jelly + tissue
Positions 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)

Pass

Borderline

Fail

if clinical waste riateh Assists patient with clothing and ensures they are comfortable following the procedure
Washes uaims wasnes hands

Discusses the findings + further management with the patient; Addresses patients ICE Sninmarv of consultation Summary nf rrmsiiltnf inn Offers to documents findings Awareness of patients needs throughout consultation and maintains their dignity Professionalism

Comments:

Global Score:
3

Clear Pass

Pass

Borderline

Fail

K Sritharan OSCEssendais 2009

The Royal Society of Medicine Young Fellow's Committee

OSCE DAY 2009
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. Present your history to the examiner when you have finished. Mark Scheme
Appropriate introduction including name and grade Explains the purpose of the consultation Establishes and maintains a rapport with the patient Identifies presenting complaint Explores presenting complaint and associated symptoms Acknowledges seriousness and severity of symptoms Acknowledges patients' feelings/concerns and responds appropriately Determines past medical history Determines drug history Identifies any allergies Explores social and family history Performs appropriate systems enquiry Appropriate use of open, closed and clarifying questions Listens effectively Addresses patient's ideas, concerns and expectations Appropriate use of body language Appropriately closes consultation Summarises history Offers differential diagnosis and suggests options for further management Professionalism Pass Borderline Fail
ROYAL MEDICINE

Comments:

Global Score:

Actor Global Score of Consultation:

4 3

K Sritharan OSCEssentials 2009

The Royal Society of Medicine Young Fellow's Committee OSCE DAY 2009

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n* R.OYA L SOCIETY"/

MEDICINE

OSCE Station: RESPIRATORY EXAMINATION

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Instruction: Mr Patel is 38 year gentleman who has a history offerers, weight loss and a persistent cough. Please examine his respiratory system. Mark Scheme
Appropriate introduction including name and grade Obtains verbal consent Washes hands or uses alcohol gel Positions and adequately exposes patient
General 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)

Pass

Borderline

Fail

Examines for central cyanosis Offers to examine cervical lymph nodes (esp. scalene LN) Inspects chest (for scars, deformity, asymmetry, use ot accessory muscles) Checks central position of trachea Checks position of apex beat Palpates for chest expansion Percusses chest (correct technique + areas) Assesses for vocal + tactile fremitus Auscultes chest (correct technique + areas) Adequate Closure: may offer to check sputum pot, check PEFR, thanks patient. Washes hands or uses alcohol gel Presentation of summary of findings Aware of patients needs throughout examination + treats patient with respect Professionalism

Comments:

Global Score:
4 3 2 1

K. Sritharan OSCEssennals 2009