Before – WIPE
- Wash hands
- Introduce self (including full name and grade)
- Patientās name, DOB and what they like to be called
- Explain examination (Ā± chaperone if intimate exam) ā also tell the patient you will be talking to the examiner throughout
During
- Tell them the exam should not be painful but, if thereās any discomfort, to let you know
- For general inspection, always stand back at the foot of the patientās bed with your arms behind your back and then present. Comment on the general appearance first, e.g. āOn general inspection, this patient looks well.ā Then go on to present other relevant patient details (e.g. āThere is no evidence of jaundice, cachexia or pallor.ā) and comment on the presence/absence of things around the bed.
- Ask if they have pain anywhere before touching them and use the patientās name and talk to the patient during the exam
- Examine from the patientās right-hand side ā a medical tradition
- Most medical schools like you to talk through your findings as you go. If this is the case, turn to the examiner in between each part of your examination (e.g. the hands), and confidently present your findings, for example: āOn examination of the hands, there was stage three clubbing, but no evidence of leukonychia, koilonychia or palmar erythema.ā Then do the same for the next section (e.g. eyes, then mouth etc.). DONāT SAY, āI am looking for koilonychia.ā Say instead, āThere is no evidence of koilonychia.ā
After
Thank the patient and restore clothing. Then take your stethoscope off and hold it in your hand. Stand straight with your arms behind your back, look the examiner in the eyes and say with confidence:
- āI would complete my examination by ā¦ā (state other examinations, NOT investigations)
- āIn summary, this is Mr X and I have examined his respiratory system.ā
- Major finding(s): āThe major finding wasā¦ā (state the most striking finding(s) first to capture their attention)
- Additional findings to back up your case: āIn additionā¦ā (state other important positive and relevant negative findings)
- Donāt list irrelevant negative findings
- Avoid presenting a long list of findings without thinking about their clinical significance
- If you know the diagnosis, think about the cause and consequences of the condition
- Diagnosis/differential: āThese findings would be consistent withā¦ā or āMy differential diagnosis would includeā¦ā
- āAfter taking a full history, further investigations might includeā¦ā ā make these relevant to the presenting complaint
OSCEstop Top tips
- OSCEs are aboutĀ acting. Even if you donāt feel confident or havenāt seen something before, act as if you have done it 100 times!
- How you say things matters as much as what you say. BeĀ confidentĀ but not arrogant.Ā
- Flaunt your knowledge! If you have good background knowledge, show it to the examiner whenever you can.
- Try to useĀ buzzwords, e.g. āThere is a symmetrical deforming polyarthropathy, with no active synovitis.ā
- Read the questionĀ carefully ā there will always be one station where you will lose marks for not reading the question correctly
- SomeĀ examiners act grumpyĀ and uninterested even though they may actually be very nice and generous. Go in expecting every examiner to act like this and you wonāt be thrown when they are.
- Pauses to think are absolutely fine. Donāt mumble, say āerrrrā, or speak before you know what you want to say.
- Never forget toĀ wash your hands. It should be the first thing you do when you go in.
- For orthopaedics, donāt forget to say you would like to examine joints above and below, and assess neurovascular status
- In all psychiatry stations, donāt forget about risk to self and others
- If you donāt know what to do, just go back to basics: inspection / palpation / percussion / auscultation for most exams; or look / feel / move / special tests / function for orthopaedics
- Lastly, and most importantly, try to enjoy yourself. Take satisfaction in demonstrating your knowledge and spotting rare signs. Examiners are all very generous in finals and the stations are usually basic: the medical school and examiners do not want you to see you fail.
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