CHECKLIST FOR STANDARDIZED PATIENTS TO COMPLETE FOLLOWING
PHYSICAL EXAMINATION
1.
Checklist item
Wash hands
2.
Determine BP
3.
4.
5.
Examine eyes.
6.
7.
8.
9.
10.
11. Examine ears.
12.
Technique standard to be observed
The student washed his/her hands
before the exam.
The collapsed blood pressure cuff was
placed snugly and smoothly around my
bare arm, so that the lower edge of
the cuff was at least 1 inch above
my antecubital fossa.
After inflating the blood pressure cuff,
the student let the cuff deflate slowly
while listening with his/her stethoscope
over the artery in my antecubital fossa.
The student informed me of my BP.
I was asked to read the letters on a
card (or newsprint) held 14 inches
away, first with one eye covered, then
with the other eye covered. I was
tested with and without my glasses.
I was asked to follow the student’s
finger to the extreme of upper outer
gaze and lower outer gaze for both
eyes.
I was asked to stare at the student’s
finger as he/she moved it from a
distance toward my nose.
I was instructed to stare at a distant
object while the student examined my
eyes with the ophthalmoscope.
The student held the ophthalmoscope
2.5-3 inches away from my eye in order
to examine my retina.
With the ophthalmoscope, the student
used his/her right eye to examine my
right eye and his/her left eye to
examine my left eye.
The student pulled my ear gently up
and backwards as he/she placed the
otoscope in my ear.
The insertion of the otoscope in my
ears was not painful.
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Yes
No
13. Examine mouth. The student looked at the sides and
under my tongue.
14.
The student asked me to say “ah”.
15. Examine neck
for lymph
nodes.
16. Examine carotid
arteries.
17.
18. Examine thyroid
gland.
19.
20. Examine chest
21.
22.
23. Examine heart.
24.
The student palpated the back and
sides of my neck as well as the
supraclavicular fossae (soft, depressed
area above each collarbone).
The student palpated each carotid
artery using his/her index and middle
fingers; only one side was examined at
a time.
The student listened over each
carotid artery with his/her
stethoscope.
The student used a gentle touch and
placed his/her index/middle fingers
under the strap muscle on each side of
my neck to feel my thyroid gland.
The student asked me to swallow
while inspecting and/or palpating my
thyroid.
The student percussed my chest by
applying one finger firmly against my
chest and tapping against it with a
quick and sudden blow from the middle
finger of his/her other hand.
The student percussed on the back of
my chest, alternating from one side to
another as he/she moved down (or up)
my chest.
The student asked me to take short
deep breaths through my mouth and
then listened to me breathe by placing
the stethoscope firmly against my
chest. The student listened to me take
a complete breath on each side of my
back, each side of my chest and each
side of the front of my chest.
The student felt the apex of my heart
using his/her fingertips.
The student listened to my heart in at
least four places with the diaphragm
of his/her stethoscope.
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25. Examine
abdomen.
26.
27.
28.
29. Palpation of
spleen
The student listened to my abdomen
with his/her stethoscope before
palpating it.
The student initially palpated my
stomach lightly and then more deeply,
in all 4 quadrants.
The student’s palpation of my
abdomen was not painful.
The student stood on my right side
while examining my abdomen.
The student placed his/her left hand
around the lower edge of my left rib
cage and lifted it gently upwards and
then placed his/her right hand under
my left rib cage. He/she asked me to
take a slow deep breath one or more
times while palpating for my spleen
with the right hand. (Some students
may ask you to roll slightly to the right.)
The student appeared comfortable
and/or confident conducting the
physical examination.
The student conducted the examination
in a smooth, well-sequenced manner that
did not require much repositioning on my
part.
The student used a gentle manner when
handling my body, including palpating my
stomach.
The student respected my modesty
through the use of proper draping or
gowning.
The student’s instructions to me were
clear and easy to understand.
The student did an excellent job in
examining me (OVERALL RATING).
Agree
strongly
Agree
Do not agree or
disagree
Disagree
Disagree
strongly
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