OSCE Clinical Skills VI Breast Examination

IDENTIFYING DATA

Authors Name

: Erwin M. & Freda S.H.

Institution

: Faculty of Medicine, Pelita Harapan University

Type and length of station : 8 minute station

Date Revised

: May 2013

------------------------------------------------------------------------------------------------------------------------------------------------System/ Block

: Clinical Skills VI

Area of competency

: Physical examination

Specific Competency

: Breast Examination

STATION CONSTRUCT

Patient's name

: Mrs. Stephanie

Patient's age

: 22 year-old

Setting

: Clinic

Actual Diagnosis

: Fibroadenoma in the right breast

Candidate's task and instructions

Task

: Breast Examination

Instructions

Mrs. Stephanie, 22 year-old, who came to the clinic today because she noticed a
lump in her right breast while taking a shower around 2 months ago.
In the next 8 minutes, perform:

Breast examination on both side to detect a lump and to evaluate

breast condition that may require medical attention.

Explain what you are doing and your expected positive and negative
findings as you proceed.

Props : 3 chairs, 1 table, 1 bed, 1 female manikin.

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SCRIPT FOR THE STANDARDIZED PATIENT

Patient Profile
1. Demographics
Age
Gender
Weight
Socioeconomic level
Educational background
Work

: 22 year-old
: Female
: 60 kg
: middle
: Bachelor
: Accountant

2.

Chief complaint in patient's words: I felt a lump in my right breast

3.

Patient behaviour, affect and mannerisms: cooperative

History of illness:
Mrs. Stephanie, 22 year-old female, the accountant, felt a lump in her right breast. Her problems
began about two months ago when she felt a small lump in her right breast while taking a shower. Initially the
lump was as small as seeds but then it grew bigger. The lump sometimes palpable but sometimes not. There
was no discharge from the nipple. The complaints are not affected by the menstrual cycle.
Summary of Symptoms to Be Simulated :
Simulated patient is a female manikin.

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ANSWER and EXAMINER CHECKLIST- Breast Examination

No.
1
2
3
4
5
6
7
8
9
10
11
12

13

14
15
16
17
18

Item
The student should ask permission from the patient that he/she is going to perform
breasts examination
Inspection
Asking the patient to lower the gown and the bra
Asking the patient to put the arms over side
Inspect from anterior side, both breasts
The student should comment on skin (color, ulceration, edema, peau dorange,
symmetri/asymetri)
The student should comment on contour (flattening, masses,dimpling) and
nipple areola complex (discharge,ulceration)
Asked the patient to put arms on her waist and press elbows towards( to see if there is
mass attached to the thoracic cage)
Asked the patient to lean forward with arms out in front (to seek any minor asymmetri
of the breasts )
Palpation of the lymph nodes
Examiner put the patient on sitting position for lymph node palpation
Palpated the lymph nodes in axillary region (both sides) with proper manner
(the examiner shake the right hand of the patient using his/her right hand, and his/her
left hand palpate the right axillary lymph nodes
Palpate both of the supra and infraclavicular nodes (bilaterally)
Palpation of the Breasts
Asked patient to put arm overhead then palpate (ie. the right arm was put over head
before palpating the right breast)
Performed complete breasts palpation in circular motion towards every direction until
the axillary tail is reached, starting from inner side(near nipple areola complex)
OR
Performed complete breasts palpation in upwards and downwards motion, starting
from medial axillary line, to midsternal line, from clavicle to inframammary fold (if using
this technique in proper manner, the axillary tail will always be examined)
Palpate the contralateral breast with the same way as above
Should mention if there is any lump was palpated, describe the lump : contour
(smooth/irregular), border (smooth/irregular), mobility ( mobile/immobile), and
tenderness.
The both of breast palpations is ended with palpating the nipple areola complex
Interpersonal/communication skills
The student was able to make the patient feel comfortable
Express gratitude and close the examination
Total

Score
1
1
1
1
1
1
1
1
1
2
2
2

2
2
2
1
1
25

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GLOBAL RATING SCALE

Overall Competency: Physical Examination

The following items require your global assessment of different aspects of the student's performance. A list of descriptors
is included below each aspect to guide your assessment. Use the scale:
1 = Does not meet requirements; 2 = Requires improvement;
3 = Meets requirements; 4 = Exceeds requirements.
1.
Communication [Appropriate in amount, organization, and clarity of language]
2.
Professional attitude [Pleasant, respectful, empathetic]
3.
Physical exam performance [Fulfils the necessary steps, correct (the "mechanics")]
4.
Quality of physical exam technique [Smooth, confident, logical, precise (the "art")]
Global Rating Rate the students overall performance. Use the scale:
1 = Does not meet requirements; 2 = Requires improvement;
3 = Meets requirements; 4 = Exceeds requirements.

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