Summary of Common Conditions Seen in OSCEs
Hints and Tips for the Exam
Patient Welfare and Dignity
This is arguably the most intimate clinical examination of all, and it requires a specific and deliberate emphasis on showing respect for the patient and her dignity. If you appear to make the patient uncomfortable or treat her without adequate respect, the examiners will almost certainly fail you, even if your technique is clinically sound. Remember the following points:
- Chaperone, chaperone, chaperone: You will definitively fail if you do not ask the examiner for a chaperone, even if the patient says that she does not mind you examining without one.
- Explain what you will be doing: Be clear in your wording, and ensure that the patient understands that you will be feeling her breasts for lumps or any other abnormalities.
- Don’t leave the patient naked while you present the findings: Although your patient will be a person dressed normally with a breast manikin, it is essential that you treat the patient as if she were undressed. So make sure that you cover the patient with a blanket (if one is available), and offer to help her get dressed – you will never be asked to do this, but it will show that you have a robust grounding in basic professional medical etiquette.
Techniques for Palpation
Students often find it difficult to decide which technique to use when palpating the breasts. Ultimately it does not matter how you do it, as long as you cover all four quadrants using a technique that minimises the chances of missing lumps. It is also vital that you complete the examination in the time frame given, so keep an eye on the watch. Use the pulp of the fingers and move them in a rotatory manner in each area being palpated. We have described a number of techniques below (see also Figure 10.1)– use whichever you feel most comfortable with.
Figure 10.1 Breast examination techniques
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