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Medicine , :YouhgFellow's Committee ; r' OSCEDAY,2009 ,

OSCE Station:CARDIOVASCULAREXAMINATION
Candidate ame:...... N

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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 patient Positions and adequatelyexposes Gener:slInspection
splinterhaemorrhages, Examines hands for peripheral stigmata of CVS disease (for clubbing,
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)

and character bruits) on Assesses carotid pulse lcomments volume,

es betweenarterial and venouspulsation)

Inspects precordium (for scars,visible apex beal

and Palpates precordium (for heaves thrills)

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
crepitations) Auscultates the lung bases lfor inspiratory

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

Presents summaryof findings

patients dignity Aware of patients'needsthroughout exarnlnation+ nnaintains Professionalism

Comments:

Global Score:

2009 K SritharanOSCEssetltidls

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

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OSCEStation:RESFIRATORYEXAMINATION
Candidate ame:..... N 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 patlent PositionsanC aCequatelyexposes
paraphernalia) General Inspection (including comfort, respiratory resp. rate,useof accessory muscles, Examines hands for peripheral stigmata of respiratory
I c v a n o s i sh v o e r c a D n i c l a p > 2 f o r . f

disease (for ctubbing, nicotine staining,

Examines eyes (for anaemia, Horner's syndrome1

Examines for central cyanosis

Offers to examine cervical lymph nodes (esp. scalene LN)

lnspectschest (for scars,deformity, asymmetry, use of accessory Checkscentral position of trachea Checksposition of apex beat Palpates chestexpansion for chest (correct technique+ areas) Percusses Assesses vocal + tactile fremitus for 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 SoCiety Medicine of Young Fellow's Committee OSCE DAY 2OOg
OSCE Station: ABDOMINAL EXAMII{ATIO|{
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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 patient Positionsand adequately exposes Genera!Inspect!on
teuconychia, Examines Hands for peripheral stigmata of abdominal disease (for ctubbing,
Examines Examines ar erythema. DuDuvtren'scontracture. snider naevi. DurDura,Iiver flap - >2 for Eyes ifor jaundice, anaemia,xanthelasma,Kaiser-fleischer rings) oral cavity (for ulcers,angular stomatitis,telangiectasia,candidiasis, Peutz-Jehger'sspots, dentition,

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

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
Candidate Name:... 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)

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

breastto be examinedbehind their head palpates both breastsstarting with 'normal breast' first (4 quadrants,axillary Systematically Examinesboth axillae (normal side first) Palpates supraclavicular fossalymphadenopathy for Examinesfor hepatomegally Percusses axial spine for tenderness Offers to percussand auscultate chest of Closure: thanks patient, addressesany questionsor concerns and is sensitive patient's Washeshands or usesalcohol gel Presents summary of findlngs of Awareness patients needsthroughout examination Professionaiism

Comments:

Global Score:

K SritharanOSCEssentials 2009

The Royal Societyof Medicine YoungFellow'sCommittee OSCE DAY 2OO9

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OSCE Station:Upper Limb Neurological Examination

Candidate Name:..... Instruction: Mr Robertsis a 70year old retiredaccountantwho reportsweakness his right arm. in 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)

for Assesses pyramidal/pronator drift tone in both arms (for rigidity and spasticity) Assesses power in both arms: Assesses Shoulderabduction EIbow extension bow flexion Wrist flexion Wrist extension Finger extension Finger flexion Finger abduition Thumb abduction reflexesin both arms: Assesses Triceps reflex Biceps reflex and finger-to-nose test) Assesses co-ordination in the upper limbs (i.e. dysdiadochokinesis Assesses sensation both arms in Washes hands or usesalcohol gel Closure: Thanks patient and restores modesty

Presents findings
Awareness of patients needsthroughout examination Professionalism

Global Score:

K SritharanOSCEssentials 2009

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

OSCEStation:LowerLimb Neurological Examination
Candidate ame:..... N

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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 patient Positionsand adequatelyexposes
asymmetry) fasciculations, hypertrophy, General Inspection of legs 6or wasting,

Assesses tone in both legsincludingclonus power in both legs: Assesses Hip Flexion Hip Extension Knee flexion Knee extension Plantar flexion offeet reflexes in both legs: Assesses Knee reflex Ankle reflex plantar in both feet Assesses iest) in both legs Tests co-ordination (heel-shin sensationin both legs Assesses gait Assesses Performs Rhomberg's test Washes hands or usesalcoholgel Closure: Thanks patient and restoresmodesty Presentsfindings Awareness of patients needsthroughout examination Professionalism

Comments:

Global Score: 4
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The Royal Societyof Medicine Young Fellow's Committee OSCE DAY 2OO9

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OSCE Station: Thyroid Examination

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 patient (to clavicles) Positionsand adequately exposes
* General + Local Inspection (for scars, facialasymmetry) Inspection on sinuses, swellings, changes, skin

Tonsueprotrusion + Swallow test

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

+ protrusion from the Palpates neck lump from behind (andrepeats palpation and with swallowtests tongue

Palpatesfor centrally located trachea Percusses retrosternal extension for Auscultatesfor a thyroid bruit
proptosis, loss hair eyebrows 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 Presents findings and comments on further management Awarenessof patients needsthroughout examination Professionalism

Comments:

Global Score: 4 Clear Fass

J
a

2 Borderline

1 Fail

Pass

The Royal Society Nledicine of Young Fellow's Committee OSCE DAY 2OO9
OSCE Station: Cranial NervesExamination
Candidate Name:..... Instruction: Pleaseexaminethepatients' cranial nerves. Mark Scheme
Appropriate introduction including name and grade Obtains verbal consent 'Washes hands or usesalcoholgel Positions and adequatelyexposes patient
ptosis, General Inspection (for facialasymmetry, squint,exophthalmos)

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

Comments:

Global Score: 4
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K Sritharan OscEssentidls 2009

,The,Royal Societyof Medicine Young Fellow's Committee OSCEDAY 2OOg

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OSCE Station:Knee Examination

Candidate Name:..... Instruction: Mrs Bean is a long distancerunner who complains of left kneepain and crepitations. Please examine her knees. Mark Scheme
Appropriate introduction including name and grade Obtains verbal consent Washes hands or usesaleoholgel Positionsand adequatelyexposes patient
Inspection whilst standing (for scars, quadriceps sinuses, swelling, deformity, wasting)

Borderline

Assessment gait of Position the patient lying down and ensure the patient is comfortable
quadriceps wasting) Inspection whilst lying down lfor scars, sinuses, swelling, deformity,
Palpation of knee (for temperature, joint line tenderness, swelling in posterior fossa)

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

Comments:

Global Score:

K Sritharan OSCEssentials 2009

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

tation: Hip Examination
Candidate ame:..... N

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Instructiol: Mr Jones is a 48 year old labourer who complainsof a painful hip on weigltt bearing. Pleaseexamine Mr Jones' hips. 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 adequatelyexposes patient
Inspection of patient standing up (for scars, lumbarlordosis, sinuses, muscle wasting, increased scoliosis)

Borderline

Performaneeof Trendelenberg test Assessment Gait of Positionspatient lying down and ensurespatient is comfortable Palpationof greater trochanter for tenderness for Assessment lixed flexion deformitv (Thomas' test) Measurementof hip flexion Nleasurement hip extension of Measurementof hip external rotation Measurement of hip internal rotation Measurement hip adduction of 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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The,RoyalSocietyof Medicine Young Fellow'sCommittee OSCE DAY 2OO9

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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 adequatelyexposes patient both legs Asks if patient has any pain
General Inspection (for varicoseveins, spider veins, venouseczema, ankle swelling, scars, lipodermatosclerosis,

ulcers saitor) from front and behind

SpecilicInspectionof Long Saphenous Vein 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) for Offers to use hand-treldDoppler to assess 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 patient Posiiionsand adequately exposes
lnspection (for gangrene, ulcers, skin colour, hair toss,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 dorsalispedis pulses Palpation of both posterior tibial pulses Performance of Buerger's test (comments on Buerger's angle) to: Examine reriainder of peripheral vascular system Examine the abdomenfor a AAA MeasureABPIs examinationof the lower limb Perform a neurological Perform Washes hands or usesalcohol gel Closure: Thanks patient and restoresmodesty Presentation of fi ndings Awareness of patients needsthroughout examination Proiessionalism Offers -

Comments:

Global Score:

K Sritharan OSCEssenrials 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 (leftlateraldecubitus position drawnto chest) with knees piles) prolapsed Examines perianal region (for skintags, warts,fistulae, excoriation, posterior and lateralwalls) Technical performance of rectal examination (examines anterior,

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

Comments:

Global Score:
A -

3 Pass

2 Borderline

I Fail

Clear Pass

K Sritharan OSCEssentials

The Royal Societyof Medicine Young Fellow's Committee OSCE DAY 2OOg
OSCE Station:History Taking
Candidate ame:..... N

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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 symptoms Explores presentingcomplaint and associated and severity of symptoms Acknowledgesseriousness and respondsappropriately Acknowledgespatients' feelings/concerns past medicalhistory Determines Determinesdrug history Identifiesany allergies Explores socialand family history enquiry Performs appropriatesystems Appropriate use of open, closed and clarifying questions Listens effectively Addressespatient's ideas,concerns and expectations Appropriate useof body language Appropriately closesconsultation Summariseshistory optionsfor further management Offers differential diagnosisand suggests Professionalism

Comments:

Global Seore:

4 of Actor GlobalScore Consultation:

2009 K Sritharan OSCEssentials

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

OSCE Station:Communication:Explaining a Procedure
Candidate

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Instluction: You are an FYI in General Practice. Mr Bird has been referred for a colonoscopy/bronchoscopy/OGD/ERcP you have been askedto explain the proced,ure him. The and to examiner will adviseyou which procedure patientwill be undergoing. the Mark Scheme
Appropriate introduction including name and grade Establishes and maintains a rapport with the patient Explains the purpose of the consultation Checkspatient's prior understanding of the procedure/operaiion Elicits patient'sconcerns patients' feelings/concerns Acknowledges and 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 Summarises key points of the consultation the questionsand concerns Encouragesand addresses Discusses and negotiatesa subsequentmanagement plan 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 OSCEssentials 2009

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

rl'ROYAt-

OSCE Station: Communication- Drug Addict

Candidate Name:..... Instruction: You are a FYI doctor in GeneralPractice and have beenaskedto seeMr Jones.He appears to be quite agitated and is.demanding speak to a doctor urgently.You have 7 minutesto take a history to provide appropriate and management. Mark Scheme
Appropriate introduction including name and grade Esiabiistres and maintains rappoii ivith patient Acknowledgesand respondsto patients' feelingsappropriately patient's agenda Establishes Establishesown agenda Negotiatescompromise Elicits details of past history Elicits details of drug use Elicits details of past treatment questions Appropriate use of open/clarifying/closed Fluency/avoidsjargon and repetition Professionalism

Comments:

Global Score of Negotiating Plan:

PatientGlobal Scoreof CommunicationSkills:

Clear -Uass

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The,RoyalSoiiety of Medicine Yqung Fellow'sCommittee OSCE DAY 2OO9

OSCE Station: Communication- Colon Cancer
CandidateName:

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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 demonstrated an core'lesion in his sigtnoidcolon.Pleasediscusstheseresultswith thepatient and the necessary the follow up. Youhave 7 minutesto discuss resultsand furthermanagement. Mark Scheme
Appropriate introduction including name and grade Establishesand maintains rapport with patient Listens eifectiveiy Establishespatient's ideas,concernsand expectations Acknowledgespatients' feelings/concerns and respondsappropriately Showsappropriate skills in breaking bad news Appropriate use ofbody language ofcolonoscopyand bowelcancer Checkspatient's prior understanding ns reason for colo Describescolonoscopyclearly (preparation required, the procedure & complications and negotiates Discusses subsequentmanagement plan Summarises key points of consultation and checkspatient's understanding Offers information leafletsand arranges follow-up Addressesany questionsand concerns questions Appropriate use of open/clarifying/closed Fluency/avoidsjargon and repetition Prof'essionalism

Comments:

Global Scorein BreakingBad News: 43 GlobalScorein Negotiating Management Plan: 43 Actor GlobalScore Consultation: of

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

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OSCE Station:Communication- Autopsy

Candidate ame:...... N Instruction: Youare an FYI doctor in A&E and havebeeninvolvedin an unsuccessful resuscitation a on 7-yearold boy (David)wlto collapsedwhilstplayingfootball. Youare asked speakto Mr Steinberg, to the Youhave minutes discuss matter 7 to with thefather. this father, aboutthe autopsy.
Mark Scheme
Appropriate introduction including name and grade ai-rd ir-rainiains rapport v*ith patient Estatriisires and ensuresappropriate environment for consultation Offers condolences Acknowledgesand respondsto patients' feelings Establishespatient's agenda Establishes own agenda Negotiatescompromise reasons coroner PM/demonstratesknowledge for Discusses Explains in terms acceptableto relative what a post-mortemw Does not guaranteean autopsy will be done parent's concernsand suggests appropriate support Elicits and addresses questions Appropriate useof open/clarifying/closed jargcn and repetition Fluency/avoids Professionalism Borderline

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,of Medicine Young Fellow'sCommittee

oscE Dey 2009

OSCE Station: Communication- Ncohol Abuse
Candidate

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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, He and high MCV and a raisedgamma-GT. looks tired, unkempt smellsof alcohol. You have7 minutesto discussthe resultsandneeotiate manasement. Mark Scheme
Apprcpriate intrcduction including name and grade Establishesand maintains rapport with patient Listens effectively Acknowledgesand responds appropriately to patients' feelings (ICE) patient's ideas, concernsand expectations Establishes Elicits CAGE/Alcohol historv historv El!cits socia!/forensic Discusses lifestyle and potential stressors Offers information and negotiatesfurther management(i.e. counselling,rehabilitation and Summariseskey points in the consultation and checkspatient's understanding questions Appropriate use of open/clarifying/closed jargon and repetition Fluency/avoids Professionalism

Comments:

Global Score:

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

The Royal Societyof Medicine Young Fellow'sCommittee

dscE DAYzoos
OSCE Station: ECG Interpretation
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Instruction: Mr Smith is a 56year old gentleman whopresents A&E ruith chestpain. Yoa are asked to 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 Calculates Rate Commentson Rhythm DeterminesAxis Coinmentson: PRinterval ST segments QT interval T-waves Summarisesfindings Correct interpretation of ECG Commentsof further management

Comments

Global Score:
4 Clear Pass
7
1 r

Pass

Borderline

Fail
K Sritharan OSCEssentials2009

of The:RoyalSociety Medicine Young Fellow'sCommittee

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N l E D I C IN E

OSCE Station: PeakExpiratory FIow RateMeasurement

N Candidate ame:..... 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. 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 mouthpiece + zeroesmeter) Shows patient how to prepare PEFR meter (mentions disposable 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 readings(in lr'min) best of 3 PEFRP-eco:'ds Inierprets recorded PEFR againstpredicted value using chart Comments o" vatu. of pffn obtained and explains resultsto patient in context of asthma f*ptui^ need to keep PEFR diary and adviseswhen to take readings Washeshands or usesalcohol gel
o A d d r e s s e sa n y q u e s t i o n s r c o n c e r n s Arranges a follow-up appointment Offers information leaflets

Borderline

Closure:

throughoiit examination Awarenessoipatients needs Professionalism

Cornments:

Global Score:

2409 I( SiitharanOSCEssentiak

The Royal So0iety Medicine of Young Fellow'sCommittee OSCE DAY 2OO9

OSCE Station: Measurement Ankle Brachial Pressure of Index
Candidate Name:.....

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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
and constricting Fositions and adequately exposes patient (supine with shoes, socks proximally clothing

Ensuresthat legs have beenrestedfor >20 mins Selectsappropriate sized BP cuffand placesaround arm ultrasoundgel Palpates brachial artery and applies to UsesDoppler probe (at approx 45 degrees) locate brachial pulse deflates and recordspressureat which signal lnflates cufftill Doppler signal disappears, returns Cleansgel and offers to repeatprocessfor other arm would use higher of 2 brachialsystolicreadingsto ca States appropriate size cuff for patients calf and places abovethe malleoii Selects 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. Mark Scheme
Appropriate introduction includingname and grade Explains procedure and obtainsverbal consent Checks indication for urinary catheter lnsertion Washeshands or usesalcoholqel patient Positionsand adequately exposes 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 system Attachescatheter to-legbag/drainage patient with the is Ensures patient is comfortable (foreskin reptaced), area !s dry and assists CIears and disposesof clinical wasteappropriately Washeshands or usesalcohol gel Closure: Advises patient of further management Addresses any questionsor concerns
in type,amount waterinstitted balloon, of Documents procedure in notes (including date,time,catheter
of foreskin where approDriate

Borderline

Awarenessof patients needsthroughout examination Technical performance Professionalism

Comments:

Global Score:
7

fhe Royal SoCiety Medicine of 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 Discusses findings 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

2 Borderline

I Fail

Pass

The Royal Societyof Medicine Young Fellowos Committee 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 complete death certificate a with 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 patient to assess: Examines i.e.gentleshake/sternal of movements rub) + absence 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(requests pen torch) - Requestsopthalmoscopeto perform fundoscopyfor tracking/rail roading - Examinestrunk for other featuresof death i.e.muscle not tonefor rigor mortis(does 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 (disease causing death) Part lbic (diseaseunderlying this -ifnot in la) Part 2 (contributory diseases) Residence and consultant

Comments:

Global Score:

K Slitharan OSCEssentials2009

BIRTHS AND DEA

(Fomr prescribed Regi by

S REGISTRATION ACT 1953

ion ofBirths and Deaths Regulations 1987)

M EDICAL CERTIF
For use only by a Registered Medicalpractitionef W and to be dclivcredby hirn

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

Name of deceased D a t e o f d e a t h; r ss t a t e d o m e . . . . . . . . . . t 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 . . . . . . . . . . . . . . The certifiedcause ofdeath takesacconntofinfonnation obtainedfrom post-mortem. e day of.......... A g e a s s t a t e dt o m e

.:
_2

day of

,9

rt

2 Infomrationfrom post-mortetrmay be available later 3 Post rnortemnot beingheld.

A

rtng

I have reported this deathto the Coronerfor furtheraction. (Seeoverleafl

Tltese particulars not lo be

entered in death register Approximate interval between ollsetanddea(h

a)

o
I

(,

U
.9 o

ts o
ad

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

it nteanslhe disease, injury, or contplication whiclt cquseddeath. as Qualifications registered by Geueral MedicalCouncil..._...
Date