Semester One 2015 OSCE Feedback
Physical examination station: Gastrointestinal Examination
Pass mark: 25/40
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In general, students performed well. Instructions to the patients were clear, and patients
were asked if they had pain in their abdomen prior to palpation. The examination was
performed systematically, and all facets of the examination were covered. Most students
finished the GI examination within the allotted time. There were a few common errors in
gastrointestinal examination, and some comments from examiners suggesting areas where
technique could be improved:
Inspection for spider naevi- many students only checked the anterior chest and neck, instead
of the “distribution of the superior vena cava” which includes the back as well.
Metabolic flap- many students did not have their patient hold the position for an adequate
time. The patient must hold for 15 seconds.
Exposure of the abdomen was commonly inadequate- the patients were wearing pants with
waistbands at or near the waist, and needed to be asked to pull them down to the hips to
expose the lower half of the abdomen. Most students asked the patient to remove their top,
but accepted the position of the pants, so inspection and palpation of the lower abdomen
was not possible
Inspection of the abdomen once the patient was supine was often cursory. Allowing a few
breaths to watch the rise and fall of the abdomen provides valuable information in the
clinical setting.
Superficial and deep palpation of the abdomen was performed systematically but the deep
palpation was often too superficial and /or brisk.
Watch the patient’s face for any reaction as you palpate for signs of tenderness
When feeling for liver and spleen, the hand palpating the anterior abdomen should not
move significantly once placed in each position- the organ moves to meet the hand, and the
hand is repositioned between breaths. (Similarly for the kidneys, the anterior hand palpates
deeply but holds a steady position and waits for the posterior hand to move the kidney
towards it.) If the “watching” hand is moving, there is too much sensation to the hand from
the movement to accurately feel the liver/ spleen/kidney if it also meets the hand.
Palpation of the liver was generally well performed, but measurement of liver span was
often performed in the wrong place. The span should be measured in the midclavicular line,
but it was frequently percussed too medially, so the liver span appeared to be unusually
small.
The palpation of the spleen was generally timed with inspiration but many students did not
have their hand parallel to the costal margin.
In palpation of the kidneys, it is important to have the anterior hand under the costal
margin, and place so you are feeling for the kidney with the fingers and not the heel of the
hand. Push the kidney anteriorly by flexing the metacarpophalangeal joints of the hand
placed posteriorly in the renal angle.
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Examiner question - When answering the question about the features of chronic liver
disease in a male patient many students were not systematic in their answer. A suggestion
would be to consider the signs as though you are examining this patient. e.g. Features of
general inspection then features in the hands, face, chest and abdomen. i.e jaundice, palmar
erythema, Dupuytren’s contracture and leuconychia, icteric sclera, spider naevi,
gynaecomastia and features in the abdomen e.g., distention due to ascites, caput medusae,
etc.
Interview station: Chest Pain Interview
Pass mark: 24 /40
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This station was done well, with students approaching the case in a systematic manner. Your
listening and questioning skills were generally of a high standard. Some possible areas for
improvement include the following:
If patient unable to describe the pain offer a ‘menu’ of adjectives
Always ask about the severity of pain and use the scale of 1 – 10
Always ask about chronology of the pain - including the duration of each episode of pain and
the pattern of the episodes over time
Remember to ask about the associated features of chest pain including shortness of breath,
nausea, sweating, and collapse
Ask about past history of heart disease
Listen carefully to the examiner question regarding the features of the pain rather than
listing risk factors for heart disease