Rsm Osce Sheets 2009

The Ro5'alSociety.of.Medicine , :YouhgFellow's Committee ; r' OSCEDAY,2009 , OSCE Station:CARDIOVASCULAREXAMINATION

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C a n d i d a t eN a m e : . . . . . . Iugtruction: Mr Brown is a 56 year old gentleman with a history of angina on exertion and palpitations. He is a known hypertensiveand heavy smoker. Pleaseexamine his cardiovuscuiarsysiem. Mark Scheme Appropriate introduction including name and grade Obtains verbal consent Washes hands or usesalcohol gel Positions and adequatelyexposespatient Gener:slInspection Examines hands for peripheral stigmata of CVS disease (for clubbing,splinterhaemorrhages, caoillary relill time. nicotine Examines

radial

pulse (commentson rate, rhythm and volume, collapsingpulse, radio-femoral delay)

Offers to measureBP Examines

eyes (for anaemia,xanthalassma,corneal arcus)

on volume,characterandbruits) Assesses carotid pulse lcomments es betweenarterial and venouspulsation)

Inspects precordium (for scars,visible apex beal and thrills) Palpates precordium (for heaves

Localises apex beat Auscultates in correct 4 areas Auscultates with thetell 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 lfor inspiratorycrepitations)

Examines for dependentoedemai.e. sacral and ankle Offers to assessperipheral pulses Closure: Thanks patient, offers to dipstick urine etc Washes hands or usesaleoho!gel

Presentssummaryof findings Aware of patients'needsthroughout exarnlnation+ nnaintainspatients dignity Professionalism

Comments:

Global Score:

2009 K SritharanOSCEssetltidls

The Royal Societyof Nledicine Young Fellow'sCommittee ' OSCE DAY 2OO9

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OSCEStation:RESFIRATORYEXAMINATION C a n d i d a t eN a m e : . . . . . Instructionz Mr Patel is 38year gentlemanwho has a historyof fevers, weight lossand a persistent cough. Please examine his respiratory system. Mark Scheme Appropriate introduction including name and grade Obtains verbal consent Washeshands or usesalcohol gel PositionsanC aCequatelyexposespatlent General Inspection (includingcomfort,respiratoryrate,useof accessory resp.paraphernalia) muscles, Examines hands for peripheral stigmata of respiratory

disease (for ctubbing,nicotinestaining,

I c v a n o s i sh . v o e r c a D n i cf l a p > 2 f o r

Examines eyes (for anaemia, Horner'ssyndrome1

Examines for central cyanosis Offers to examine cervical lymph nodes (esp.scaleneLN)

lnspectschest (for scars,deformity, asymmetry, use of accessory Checkscentral position of trachea Checksposition of apex beat Palpatesfor chestexpansion Percusseschest (correct technique+ areas) Assessesfor vocal + tactile fremitus Ausculteschest (correct technique* areas) Adequate Closure: may offer to checksputum pot, check PEFR, thanks patient. Washeshands or usesalcoholgel Presentationof summary of findings Aware of patients needsthroughout examination * treats patient with respect Professionalism

Comments:

Global Score:

K Sritharan OSCEssentials2009

The Royal SoCietyof Medicine Young Fellow's Committee OSCE DAY 2OOg OSCE Station: ABDOMINAL EXAMII{ATIO|{ C a n d i d a tN e ame:.....

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Instruction: Mr Smith is 54yeur gentlemanwho has a kistory of weight lossand changein bowel habits. Plesse examine his abdomen. Mark Scheme Appropriate introduction including name and grade Obtains verbal consent Washeshands or usesalcohol gel Positionsand adequately exposespatient Genera!Inspect!on Examines Hands for peripheral stigmata of abdominal disease (for ctubbing,teuconychia, Examines

ar erythema. DuDuvtren'scontracture. snider naevi. DurDura,Iiver flap - >2 for Eyes ifor jaundice, anaemia,xanthelasma,Kaiser-fleischer rings)

Examines

oral

cavity

(for ulcers,angular stomatitis,telangiectasia,candidiasis,Peutz-Jehger'sspots, dentition,

LN) Offers to examine cervical lymph nodes (particularlyleft supraclavicular spidernaevi) Inspects chest lfor gynaecomastia, (for nspects abdomen scars,

General Palpation (light and deep) Liver Examination (palpation * percussion) SpleenExamination Right and Left Kidney Examination Examination for AAA (pulsatility * expansionabdominal aorta) Examination for bladder Examinesfor ascites(shifting dullnesso1land fluid thrill) Auscultation for bowel soundsand bruits Offers to perform digital rectal examination Offers to examine hernial orifices and external genitalia Washeshands or usesalcohol gel PresentsSummary of findings Awarenessof patienis needsthroughout examination * treats patient with respect Professionalism

Comments:

Global Score:

The Royal Societyof Medicine , Young Fellow's Committee . OSCE DAY 2OO9

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OSCEStation:BREAST E)L{MNATION CandidateName:... Instruction: Mrs Jones is a 40 year old lady wlto has recently noticeda lump in her breast.She is cleurly concerned.Perform an examination of her breasts. Mark Scheme Appropriate introduction including name and grade Obtains verbal consent WasheshanCsor usesalcohol gel Positionsand adequatelyexposespatient (requestschaperone) Inspects breasts with patient sitting relaxed (for scars,asymmetry,skin changes, discharge)

Inspectsbreastswith patients' handsbehindtheir head Inspectsbreastswith patients' hands pushing into their hips Asksthe patient about any pain or lumps in either breastprior to commencingpalpation with hand of

breastto be examinedbehind their head Systematicallypalpates both breastsstarting with 'normal breast' first (4 quadrants,axillary Examinesboth axillae (normal side first) Palpatesfor supraclavicular fossalymphadenopathy Examinesfor hepatomegally Percussesaxial spine for tenderness Offers to percussand auscultate chest Closure: thanks patient, addressesany questionsor concerns and is sensitiveof patient's Washeshands or usesalcohol gel Presentssummary of findlngs Awarenessof patients needsthroughout examination Professionaiism

Comments:

Global Score:

4

K SritharanOSCEssentials2009

The Royal Societyof Medicine YoungFellow'sCommittee OSCE DAY 2OO9

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OSCE Station:Upper Limb NeurologicalExamination CandidateName:..... Instruction: Mr Robertsis a 70year old retiredaccountantwho reportsweaknessin his right arm. Exumine this patient's upper limb neurological system. Mark Scheme Appropriate introduction including name and grade Obtains verbal consentto perform examination Washes hands or usesalccho! gel Positions and adequatelyexposespatient General Inspection of upper limb lror wasting,fasciculations, asymmetry,abnormalmovements)

Assessesfor pyramidal/pronator drift Assessestone in both arms (for rigidity and spasticity) Assessespower in both arms: Shoulderabduction EIbow extension bow flexion Wrist flexion Wrist extension Finger extension Finger flexion Finger abduition Thumb abduction Assessesreflexesin both arms: Triceps reflex Biceps reflex Assessesco-ordination in the upper limbs (i.e. dysdiadochokinesisand finger-to-nosetest) Assesses sensationin both arms Washes hands or usesalcohol gel Closure: Thanks patient and restores modesty

Presentsfindings Awareness of patients needsthroughout examination Professionalism

Global Score:

K SritharanOSCEssentials 2009

The,RoyalSocietyof Medicine Young Fellow'sCommittee OSCE DAY 2OO9

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OSCEStation:LowerLimb Neurological Examination C a n d i d a t eN a m e : . . . . . Instruction z Mrs Smith is a 67 year old artist who reports weaknessand numbnessin her right leg. Examine this patient's lower limb neurological system. Mark Scheme Appropriate introduction including name and grade Obtains verbal consent Washeshands or usesalcoholgel Positionsand adequatelyexposespatient asymmetry) hypertrophy, General Inspection of legs 6or wasting,fasciculations,

Assesses tone in both legsincludingclonus Assessespower in both legs: Hip Flexion Hip Extension Knee flexion Knee extension Plantar flexion offeet Assessesreflexes in both legs: Knee reflex Ankle reflex in both feet Assessesplantar Tests co-ordination (heel-shiniest) in both legs Assessessensationin both legs Assessesgait Performs Rhomberg's test Washes hands or usesalcoholgel Closure: Thanks patient and restoresmodesty Presentsfindings Awareness of patients needsthroughout examination Professionalism

Comments:

Global Score: 4 (-Iaqr-

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OSCE Station: Thyroid Examination CandidateName:... Instruction: Miss Jones is a 38 year old ludy who is complaining of weight loss,heat intolerunceand visualproblems. Please examine her thyroid gland. Mark Scheme Appropriate introduction including name and grade Explains examinatlon and obtains verbal consent Washeshands or usesalcohol gel Positionsand adequately exposespatient (to clavicles) * Inspection on General + Local Inspection (for scars,sinuses, facialasymmetry) swellings, skin changes,

Tonsueprotrusion + Swallow test [nspects Hands

(for sweating, palmar erythema,thyroid acropachy, onycholysis,vitiligo, tremor and HR)

Palpates neck lump from behind (andrepeats palpationwith swallowtests+ tongueprotrusionand from the

Palpatesfor centrally located trachea Percussesfor retrosternal extension Auscultatesfor a thyroid bruit proptosis, hair losseyebrows and Examines for thyroid eye disease (for tid tag,Iid retraction,chemosis,

Offers to examine foi'i Pretibilal mrxoedema Proximal myopathy Reflexes Washeshands or usesalcohol qel Closure: Thanks patient and restorespatients' modesty Presentsfindings and comments on further management Awarenessof patients needsthroughout examination Professionalism

Comments:

Global Score: 4 Clear Fass

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Pass

2 Borderline

1 Fail

The Royal Societyof Nledicine Young Fellow's Committee OSCE DAY 2OO9 OSCE Station: Cranial NervesExamination

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CandidateName:..... Instruction: Pleaseexaminethepatients' cranial nerves. Mark Scheme Appropriate introduction including name and grade Obtains verbal consent 'Washes hands or usesalcoholgel Positions and adequatelyexposespatient ptosis,squint,exophthalmos) General Inspection (for facialasymmetry,

Asks about senseof smell Offers to test visual acuitv Test of visual fields (including assessment for a central scotoma) Test of pupillary light reflex Test of accommodation reflex Offers to perform fundoscopy Assessmentof eye movements(looksfor nystagmus* asksabout diplopia) Offers to test corneal reflex Assessmentof jaw reflex Assessmentof musclesof mastication(pterygoids, masseterand temporalis) Assessmentof musclesof facial expression Offers to assesstast€-overthe anterior 2/3rds ofthe tongue Offers to perform otoscopy,assesshearing and perform Weber's * Rinne's tests Assessmentof movementof soft palate Offers to test the gag reflex Inspection of the tongue for wasting,fasciculations Examination of tonguemovements Assessrnentcf sternocleidomastoidand tr apeziusmuscles Washeshands or usesalcoholgel Closure: Thanks patient Presentationof fi ndings Awareness of paiients needsthroughout examination Professionalism

Comments:

Global Score: 4 Ll,;a,ir

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,The,RoyalSocietyof Medicine Young Fellow's Committee OSCEDAY 2OOg

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OSCE Station:Knee Examination CandidateName:..... Instruction: Mrs Bean is a long distancerunner who complains of left kneepain and crepitations. Please examine her knees. Mark Scheme

Borderline

Appropriate introduction including name and grade Obtains verbal consent Washes hands or usesaleoholgel Positionsand adequatelyexposespatient Inspection whilst standing (for scars,sinuses, swelling, deformity,quadricepswasting)

Assessmentof gait Position the patient lying down and ensure the patient is comfortable Inspection whilst lying down lfor scars,sinuses, swelling, deformity,quadricepswasting) Palpation

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

Measurernentfor quadricepswasting Measurement of knee flexion + assessmentof crepitus Measurement of knee extension Assessmentof extensorlag on straight leg raising Assessmentfor posterior sag Performance of anterior draw or Lachman's test and posterior draw test Performance ofvalgus and varus stresstest Performance of McMurrav's test Offer to examinethe hip and ankle joints and assessthe neurovascular statusofthe legs Washeshandsor usesalcoholgel Closure: Thanks patieni and i'estoresmodesty Presentationof fi ndings Awarenessof paiients needsthroughout examination Professionalism

Comments:

Global Score:

K Sritharan OSCEssentials2009

The Royal society ,ofMedicine Young FeIIow'sCommittee OSCE DAY 2OO9

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tation: Hip Examination Candidate Name:.....

Instructiol: Mr Jones is a 48 year old labourer who complainsof a painful hip on weigltt bearing. Pleaseexamine Mr Jones' hips. Borderline

Mark Scheme Appropriate introduction including name and grade Obtains verbal consent Asks patient about site of pain, degreeof pain and effect on mobility Washeshandsor usesalcoholgel Positions(standing initially) and adequatelyexposespatient Inspection of patient standing up (for scars,sinuses, lumbarlordosis,scoliosis) musclewasting,increased

Performaneeof Trendelenberg test Assessmentof Gait Positionspatient lying down and ensurespatient is comfortable Palpationof greater trochanter for tenderness Assessmentfor lixed flexion deformitv (Thomas' test) Measurementof hip flexion Nleasurementof hip extension Measurementof hip external rotation Measurement of hip internal rotation Measurementof hip adduction Measurementof hip abduction Offers to examine joint above and joint below Offers to examine the neurological and vascular supply of the lower limb Washeshands or usesalcohol gel Closure: Thanks patient and restoresmodesty Presentationof fi ndings Awarenessof patients needsthroughout examinaiion Professionalism

Comments:

Global Score:

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OSCEStation:VARICOSEVEII{S EXAMINATIOI{ CandidateName:..... Instructionz Mrs Forrester is a 33 year old teacherwho complains of prominentveins and swelling of her ankles natably qt the end of the day. Perform an examination of her varicoseveins. Mark Scheme Appropriate introduction including name and grade Obtains verbal consent Washes hands or usesalcoholgel Positicns (standing) and adequatelyexposespatient both legs Asks if patient has any pain General

Inspection

(for varicoseveins, spider veins, venouseczema,lipodermatosclerosis,ankle swelling, scars,

ulcers- saitor) from front and behind

SpecilicInspectionof Long SaphenousVein Specific Inspection ofShort SaphenousVein Palpatesfortemperature, oedema,and along courseoflong and short saphenousveins Examination for saphenovarixat SFJ and feels for coughimpulse at SFJ and SPJ Performs Tap Test Performs Tourniquet Test Auscultates any obviousvaricositiesfor bruits (AV malformation) Offers to use hand-treldDoppler to assessfor SFJ and SPJ incompetence Offers to perform PerthesTest Offers to examine lower limb pulsesand ABPIs. Offers to perform an abdominal, digital rectal and PV examination Closure: Thanks the patient and restores their modesty Washes hands or usesalcohol gel Presentssummary of findings Awarenessof patients needsthroughout examination + treats patient with dignity Professionalism

Comrnents:

Global Score:

K Sritharan OSCEssentiab 2009

The Royal Societyof Medicine Young Fellow's Committee OSCEDAY 2OO9

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OSCE Station: LOWER LIMB VASCULAR EXAMINATION CandidateName:..... Instructionz Mr Jones,a 65 year builder, complains of short distance intermittent calf claudication. He is a known diqbetic and hypertensive.Examine his lower limb vascular system. Mark Scheme Appropriate introduction including name and grade Obtains verbal consent Washes hands or usesalcohol gel Posiiionsand adequatelyexposespatient lnspection

(for gangrene,ulcers, skin colour, hair toss,amputation, scars)

Palpation for skin temperature transition comparing both sides Assesscapillary refill time Palpation of both femoral pulses Auscultation for femoral bruits Palpation of both dorsalispedis pulses Palpation of both posterior tibial pulses Performance of Buerger's test (comments on Buerger's angle) Offers -

to: Examine reriainder of peripheral vascular system Examine the abdomenfor a AAA MeasureABPIs Perform a neurologicalexaminationof the lower limb Perform Washes hands or usesalcohol gel Closure: Thanks patient and restoresmodesty Presentation of fi ndings Awareness of patients needsthroughout examination Proiessionalism

Comments:

Global Score:

K SritharanOSCEssenrials 2009

The ,RoyalSocietyof Medicine Young Fellow'sCommittee OSCE DAY 2OOg

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OSCE Station: Digital RectalExamination CandidateName:... Instruction: You are an FYI doctor. You have beenaskedto perform a digital rectal examination on q 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 Requestschaperone (if appropriafe) Washeshands or usesalcoholgel Prepares equipment - gloves+ lubricating jelly + tissue Positions patient appropriately (leftlateraldecubituspositionwith kneesdrawnto chest) piles) prolapsed Examines perianal region (for skintags,warts,fistulae,excoriation, Technical performance of rectal examination (examines anterior,posteriorand lateralwalls)

Assistspatient with clothing and ensuresthey are comfortablefollowing the procedure Washeshands Discussesthe findings + further management with the patient; Addressespatients ICE Summary of consultation Offers io documents lindings Awarenessof patients needsthroughout consultation and maintains their dignity Professionalism

Comments:

Global Score: -A Clear Pass

3 Pass

2 Borderline

I Fail

K Sritharan OSCEssentials

The Royal Societyof Medicine Young Fellow's Committee OSCE DAY 2OOg

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OSCE Station:History Taking C a n d i d a t eN a m e : . . . . . Iustruction: You are a FYL doctor. Mr(s) Joneshas come into A&E. Pleasetake a full history.Present your historyto the examinerwhen you havefinished. Mark Scheme Appropriate introductionincluding name and grade Explains the purpose of the consultation Establishesand maintains a rapport with the patient icieniifi es preseniingcorrrpiaint Explores presentingcomplaint and associatedsymptoms Acknowledgesseriousnessand severity of symptoms Acknowledgespatients' feelings/concernsand respondsappropriately Determinespast medicalhistory Determinesdrug history Identifiesany allergies Explores socialand family history Performs appropriatesystemsenquiry Appropriate use of open, closed and clarifying questions Listens effectively Addressespatient's ideas,concerns and expectations Appropriate useof body language Appropriately closesconsultation Summariseshistory Offers differential diagnosisand suggestsoptionsfor further management Professionalism

Comments:

Global Seore:

4 Actor GlobalScoreof Consultation:

K Sritharan OSCEssentials2009

The Royal Societyof Medicine YoungFellow's Committee OSCE DAY 2OA9

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OSCE Station:Communication:Explaining a Procedure

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Instluction: You are an FYI in General Practice. Mr Bird has been referred for a colonoscopy/bronchoscopy/OGD/ERcP and you have been askedto explain the proced,ureto him. The examinerwill adviseyou which procedurethe patientwill be undergoing. Mark Scheme Appropriate introduction including name and grade Establishesand maintains a rapport with the patient Explains the purpose of the consultation Checkspatient's prior understanding of the procedure/operaiion Elicits patient'sconcerns Acknowledgespatients' feelings/concernsand respondsappropriately Explains indication for the procedure/operation Explains preparation required before procedure/operation Explains procedure,/operation the Explains likely outcome after the procedure i.e. dischargedate, follow-up, when results will be availableand restrictions on lifestvle (i.e, drivins. exercise.work Checkspatient's understanding of the procedure/operation Summarisesthe key points of the consultation Encouragesand addressesquestionsand concerns Discussesand negotiatesa subsequentmanagementplan Offers information leaflets Listens effectivelv Appropriate use of non-verbal and verbal cues Fluency ofconsultation * avoids jargon and repetition Professionalism

Comments:

Global Score:

Actor Global Scoreof Consultation:

K Sritharan OSCEssentials2009

The Royal Societyof Medicine Young Fellow'sCommittee OSCE DAY 2OO9

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OSCE Station: Communication- Drug Addict CandidateName:..... Instruction: You are a FYI doctor in GeneralPractice and have beenaskedto seeMr Jones.He appears to be quite agitated and is.demandingto speak to a doctor urgently.You have 7 minutesto take a history andprovide appropriatemanagement. Mark Scheme Appropriate introduction including name and grade Esiabiistresand maintains rappoii ivith patient Acknowledgesand respondsto patients' feelingsappropriately Establishespatient's agenda Establishesown agenda Negotiatescompromise Elicits details of past history Elicits details of drug use Elicits details of past treatment Appropriate use of open/clarifying/closedquestions Fluency/avoidsjargon and repetition Professionalism

Comments:

Global Score of Negotiating Plan:

PatientGlobal Scoreof CommunicationSkills:

Clear -Uass

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CandidateName: Instruction: As an FYI in General Practice, you are askedto seeMr Mukhurji. He presented with fatigue and painless bright red rectal bleeding 2 weeksago. An outpatient barium enema was performed and 'apple demonstratedan core'lesion in his sigtnoidcolon.Pleasediscusstheseresultswith thepatient and the necessary follow up. Youhave 7 minutesto discussthe resultsand furthermanagement. Mark Scheme Appropriate introduction including name and grade Establishesand maintains rapport with patient Listens eifectiveiy Establishespatient's ideas,concernsand expectations Acknowledgespatients' feelings/concernsand respondsappropriately Showsappropriate skills in breaking bad news Appropriate use ofbody language Checkspatient's prior understandingofcolonoscopyand bowelcancer ns reason for colo Describescolonoscopyclearly (preparation required, the procedure & complications Discussesand negotiatessubsequentmanagement plan Summarises key points of consultation and checkspatient's understanding Offers information leafletsand arranges follow-up Addressesany questionsand concerns Appropriate use of open/clarifying/closedquestions Fluency/avoidsjargon and repetition Prof'essionalism

Comments:

Global Scorein BreakingBad News: 43 GlobalScorein NegotiatingManagementPlan: 43 Actor GlobalScoreof Consultation:

The Royal Societyof Medicine Young Fellow's Committee QSCEDAY 2OO9

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OSCE Station:Communication- Autopsy C a n d i d a t eN a m e : . . . . . . Instruction: Youare an FYI doctor in A&E and havebeeninvolvedin an unsuccessful resuscitationon a 7-yearold boy (David)wlto collapsedwhilstplayingfootball. Youare askedto speakto Mr Steinberg,the to discuss thismatterwith thefather. father, aboutthe autopsy.Youhave7 minutes Borderline

Mark Scheme Appropriate introduction including name and grade Estatriisiresai-rdir-rainiainsrapport v*ith patient Offers condolencesand ensuresappropriate environment for consultation Acknowledgesand respondsto patients' feelings Establishespatient's agenda Establishesown agenda Negotiatescompromise Discussesreasonsfor coroner PM/demonstratesknowledge Explains in terms acceptableto relative what a post-mortemw Does not guaranteean autopsy will be done Elicits and addressesparent's concernsand suggestsappropriate support Appropriate useof open/clarifying/closedquestions Fluency/avoidsjargcn and repetition Professionalism

Comments:

Global Scorefor NegotiatingPlan:

Patient's Global Score of Communication Skills/Consultation: 4 Clear Pass

3 Pass

) Borderline

1 Fail

K SritharanOSCEssentials 2009

The Royal Society,ofMedicine Young Fellow'sCommittee

oscE Dey 2009

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OSCE Station: Communication- Ncohol Abuse Candidate

Instruction: You are a FYl doctor in GeneralPractice. You are askedto seeMr Adam Smilh.He came into thepractice a week ago with vagueabdominaldiscomfortand was seenby the seniorpartner. Blood takenat that time showsa mild enaemia,high MCV and a raisedgamma-GT.He looks tired, unkemptand smellsof alcohol. You have7 minutesto discussthe resultsandneeotiatemanasement. Mark Scheme Apprcpriate intrcduction including name and grade Establishesand maintains rapport with patient Listens effectively Acknowledgesand responds appropriately to patients' feelings Establishespatient's ideas, concernsand expectations(ICE) Elicits CAGE/Alcohol historv El!cits socia!/forensichistorv Discusseslifestyle and potential stressors Offers information and negotiatesfurther management(i.e. counselling,rehabilitation and Summariseskey points in the consultation and checkspatient's understanding Appropriate use of open/clarifying/closedquestions Fluency/avoidsjargon and repetition Professionalism

Comments:

Global Score:

establish a rapport and offerexplanation): Actor Giobal Score for Communication Skills (abilityto empathise,

1

The Royal Societyof Medicine Young Fellow'sCommittee

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OSCEStation:ECG Interpretation C a n d i d a tN e ame:..... Instruction: Mr Smith is a 56year old gentleman whopresentsto A&E ruith chestpain. Yoa are asked to interpret his ECG. Discussyour lindings with the A&E Registrar. Mark Scheme Confirms the following before proceeding: Pafient'sname and DOB Date and time investigationperformed -

Patient's symptoms at time of investigation i.e. chest pain or painfree

Checkscalibration of the ECG i.e. strip recorded at a setting of 25mm/sec CalculatesRate Commentson Rhythm DeterminesAxis Coinmentson: PRinterval -

ST segments QT interval

T-waves Summarisesfindings Correct interpretation of ECG Commentsof further management

Comments

Global Score: 7

4 Clear Pass

Pass

Borderline

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Fail K Sritharan OSCEssentials2009

The:RoyalSocietyof Medicine Young Fellow'sCommittee r,r.RoY,q.l

F*o-ct:!::-g N l E D I C IN E

OSCE Station: PeakExpiratory FIow RateMeasurement C a n d i d a t eN a m e : . . . . . Instructionz Miss Pollen, a 26 year old PE teaclter,has recently developed a nocturnal couglr and wheezesuggestive of asthmu. Please measure her Peak Expirutorlt FIow Rate and discuss her further management. Borderline

Mark Scheme Appropriate introduction includingname and grade Obtains verbal consentand outlines nature ofthe consultation Checks patients' untierstandingof PEFR and asthma Explains reason for measuringPEFR and how to measurePEFR Washes hands or usesalcoholgel Shows patient how to prepare PEFR meter (mentions disposablemouthpiece + zeroesmeter) Positionspatient i.e.standing Expt"irr th"t p"tLntihould take a deep breath and form a tight sealwith their lips around the mouth eare not to obstruct scalewith fi hotdins meter horizontal and taki Explains how to read meter and the need to zero dial prior to next attempt Checks patient understandingof technique Asks patient to perform PEFR and checks technique best of 3 PEFR-readings(in lr'min) P-eco:'ds Inierprets recorded PEFR againstpredicted value using chart Comments o" vatu. of pffn obtained and explains resultsto patient in context of asthma need to keep PEFR diary and adviseswhen to take readings Washeshands or usesalcohol gel

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Closure: -

A d d r e s s e sa n y q u e s t i o n so r c o n c e r n s Arranges a follow-up appointment Offers information leaflets

Awarenessoipatients needsthroughoiit examination Professionalism

Cornments:

Global Score:

2

I( SiitharanOSCEssentiak2409

The Royal So0ietyof Medicine Young Fellow'sCommittee OSCE DAY 2OO9 OSCE Station: Measurementof Ankle Brachial PressureIndex

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CandidateName:..... Instruction'. Mr Jones is a 67year accountantwith a historyof right foot restpain. He is diabetic, Irypertensiveand has chronic renalfailure. Pleasemessureltis ankle pressare bracltiai indices. Mark Scheme Appropriate introduction includingname and grade E-p Washeshands or usesalcoholgel Fositions and adequately exposes patient (supinewith shoes, socksandproximallyconstrictingclothing

Ensuresthat legs have beenrestedfor >20 mins Selectsappropriate sized BP cuffand placesaround arm Palpatesbrachial artery and appliesultrasoundgel UsesDoppler probe (at approx 45 degrees)to locate brachial pulse lnflates cufftill Doppler signal disappears,deflates and recordspressureat which signal returns Cleansgel and offers to repeatprocessfor other arm Stateswould use higher of 2 brachialsystolicreadingsto ca Selectsappropriate size cuff for patients calf and places abovethe malleoii LocatesDorsalis Pedis @P) pulse by palpation or applies ultrasound gel and usesDoppler Continuesas for brachial pulseand recordsDP pressure Tibial (PT) pulse and records PT pulse pressure Repeatsfor Poste Usesthe higher of the fwo readingswhen calculating ABPIs for the ankle Offers to repeat for other leg Cleans ultrasound gel from skin and restorespatients' modesty Washeshands or usesalcohol gel Calculatesand documents ABPIs in patient's notes Closure: - Advisespatient of their resultsin the context of their symptoms. - Addressesany questionsor concerns - Thanks the patient Presentationof findings with interpretation of results Awarenessof patients needsthroughout examination Professionalism

Comments:

Global Score:

K SritharanOSCEssentials2009

The Royat Societyof Medicine Young Fellow'sCommittee OSCE DAY 2OOg

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OSCEStation:Urinary Catheterisation CandidateName: Instruction: Mr Smith is post-op day 1 incisional hernia repair and is clinically in acute urinary retention. Please insert a urethral urinaw catheter. Borderline

Mark Scheme Appropriate introduction includingname and grade Explains procedure and obtainsverbal consent Checks indication for urinary catheter lnsertion Washeshands or usesalcoholqel Positionsand adequately exposespatient Ensuresprivacy and patients dignity is preserved (requestschaperoneiffemale patient) Preparesprocedure trolley/equipmentmaintaining asepsis Washeshands or usesalcohol gel and puts on sterile gloves Performs catheter insertion maintaining asepsis Statesthat iCeally would allow 5mins for LA to take effect prior to catheter insertion Advances catheter to hub/till urine flows Inflates catheter balloon with water in accordancewith manufacturer's guidelines Attachescatheter to-legbag/drainagesystem the area !s dry and assistspatient with isreptaced), Ensures patient is comfortable (foreskin CIears and disposesof clinical wasteappropriately Washeshands or usesalcohol gel Closure: Advises patient of further management Addresses any questionsor concerns Documents procedure in notes (includingdate,time,cathetertype,amountof waterinstittedin balloon, of foreskin where approDriate

Awarenessof patients needsthroughout examination Technical performance Professionalism

Comments:

Global Score: 7

fhe Royal SoCietyof Medicine Young Fellow'sCommittee OSCE DAY 2OO9

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OSCE Station: Urinalysis CandidateName:... Instruction: You are a GP trainee, You are asked to dipstick the urine of a patient who describesa 2 day history offrequency and dysuria. Mark Scheme Appropriate introduction including name and grade Briefly describesand glvesreasonfor procedure and obtains consentto proceed Checks patients name and date of birth Washes hands or usesalcohol gel, puts on glovesand gown Takes urine sample and assesses appearance(colour, turbidity) and odour Immerses all pads of urine dipstick in urine specirnenbottle for l.-2 seconds Starts timing and keepsurine dipstick horizontal at all times Closesurine specimenbottle and puts aside Reads dipstick against colour chart on bottle at time indicated on chart After reaCing, discards urine dipstick and glovesappropriately in clinical waste Washeshands or usesalcoholgel Discussesfindings with patient and further management Documents the findings in the patients in the patients notes+/- offers to send urine for if annropriate Closesconsultation appropriately Summarises findings to the examiner Professionalism

Comments:

Global Score:

4 Clear Pass

J

Pass

2 Borderline

I Fail

The Royal Societyof Medicine Young FellowosCommittee OSCE DAY 2AO9 OSCE Station: Verification + Certification of Death

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Instruction: 1. You are the FYI doctor on-calland are bleepedto the ward to verify the deathof a patient. The date is today. 2. You are the patient's usual doctor and are askedto completea death certificatewith the information provided.You are basedat Hope Hospitaland the consultantis Dr Dye. Mark Scheme Appropriate introduction to nursing staff including name and grade Elicits appropriate details: time of death; personspresent; when last seenalivel duration of death Requestshospital notes and drug chart Confirms patient's identity band Examinespatient to assess: i.e.gentleshake/sternal movements rub) + absenceof spontaneous - Looks for absent respiratory effort (1 minute) - Palpatesmajor pulse (carotid/femoral) for 1 minute - Auscultatespraecordium for heart sounds(for 3 minutes) - Auscultateslungs for breath sounds(for 3 minutes) - Inspectseyesfor fiiEd, dilated pupils + absent corneal reflexes(requestspen torch) - Requestsopthalmoscopeto perform fundoscopyfor tracking/rail roading - Examinestrunk for other featuresof death i.e.muscletonefor rigor mortis(doesnot appear until 3 hours after death), post-mortem staining (due to hvpostasis)and decreased

Documentsabove in notes (includesabove details,time, date and signature) Legible writing/avoids abbreviations Correct patient detailslDate/time ancisignature Part 1a (diseasecausing death) Part lbic (diseaseunderlying this -ifnot in la) Part 2 (contributory diseases) Residence and consultant

Comments:

Global Score:

K Slitharan OSCEssentials2009

BIRTHSAND DEA (Fomr prescribedby Regi

M EDICAL CERTIF For use only by a RegisteredMedicalpractitionefW and to be dclivcredby hirn

S REGISTRATION ACT 1953 ion ofBirths and DeathsRegulations1987)

TE OF CAUSE:OF DEATI-I FIASBEEN IN ATTENDANCE during the deceased,s last illness, ith to thc Registralof Births and Deaths

.:

Name of deceased

_2

D a t e o f d e a t h; r ss t a t e dt o m e . . . . . . . . . .

e

day of..........

A g e a s s t a t e dt o m e

P l a c eo f d e a t h . . . . . . . . . . . . L a s t s e e na l i v e b y r r e . . . . . . . . . . . . . .

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day of

The certifiedcauseofdeath takesacconntofinfonnation obtainedfrom post-mortem.

2 Infomrationfrom post-mortetrmay be availablelater 3 Post rnortemnot beingheld. A

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I have reportedthis deathto the Coronerfor furtheraction. (Seeoverleafl Tltese particulars not lo be

entered in death register Approximate interval betweenollsetanddea(h

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f This does not tnean the mode of dying, such as heart .failure, asphyxia, asthenia, I hereby certify t.hatI was in rnedical attendance during t l t e a b o v e n a r n e c ld e c e a s e d ' sl a s t i l l n e s s ,a n d t h a t t h e particulals and cause of death above written are true to the best of rny knowledge and belief. For deaths in hospital:

l?leasegive the name ofthe consultant respousiblefor tlie

;

,9

it nteanslhe disease,injury, or contplication whiclt cquseddeath. Qualificationsas registered by GeueralMedicalCouncil..._... Date