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Royal College of Surgeons in Ireland

Intermediate Cycle 3 Clinical OSCE


STATION: Abdominal Examination – STOMA MARK SHEET
Examiners Name……………………...................... Candidate Number………………

Examiner to greet student and say: “Please examine this patient’s abdomen from a GI point of view.. After 5
minutes I will ask you some questions”
Patient’s findings: This patient has ______________
Please tick the appropriate box for each criterion. The standard expected is that of third year medical student.
Not Done Done Done
Done Poorly Adequately Well
Initial approach to the patient: performs hand hygiene,
introduces him/herself, explains what he/she will be doing,
obtains consent, asks about pain, positions and exposes
patient correctly
General Inspection: performs general observation of patient
and environment, mentions presence/absence of
environmental aids/devices, BMI/cachexia, drains
Closer Inspection - abdomen: mentions scars, stomas,
herniae, masses, pulsations, distension, caput medusa,
gynaecomastia
Palpation: kneels down, names all 9 areas, soft and deep
palpation, watches face for pain, liver edge, spleen, ballot
kidneys
Percussion: percuss out the liver/spleen, shifting dullness
Auscultation: bowel sounds, renal bruit
 STOMA – mentions location, colour of mucosa
(healthy pink/red colour?), spouted/unspouted ( The
presence of a spout identifies an ileostomy while a stoma
flush with the skin is usually a colostomy), number of
lumens, surrounding skin (INSPECT the surrounding
skin for erythema, rash, ulceration and mucocutaneous
junction seperation, contents of stoma bag, parastomal
herniae, verbalizes what to expect on digital examination
(If unable to determine the number of lumens from
visual exam this might help)
 PALPATE the surrounding area for tenderness and
masses such as parastomal hernias
 EXTRA: stomas cause a range of complications such
as skin changes that include erythema and fissuring.
Other complications include bleeding, separation
between the mucocutaneous edge and skin, prolapse,
parastomal hernias, narrowing and subsequently
obstruction.
Examiner: “What are your findings on examination”?
Presents a systematic description of findings (clear and
precise, with relevant negatives and positives)
Examiner: “What is your differential diagnosis”?
Use Insert cells / paste cells function to insert a question, 0 1-2 3-5 >6
answer and marking scheme from the file “Surgical
Questions for insertion into OSCE Mark Sheet 2015”
Overall approach to task including approach to patient and
clinical acumen

Overall Grade* (Please circle as appropriate)
<30% 40% 50% 60% 70% >80%
Very Poor
Excellent
Please
Poor Adequate Good Very Good Please indicate
indicate
precise %
precise %

Comments: (essential if candidate does not pass)

Examiner’s signature _________________________________________ Date


______________________
%
DESCRIPTOR PERFORMANCE
GRADE
>80% Excellent All criteria done well Outstanding performance for a
3rd year medical student -
Excellent examination
technique, excellent summary of
patient problems, excellent
related knowledge, and excellent
approach to patient
70% Very Good All criteria done adequately Excellent in most respects
and at least 3/4 done well

60% Good All criteria done adequately Good sound overall performance
and at least 1/2 criteria done
well.
50% Adequate – Bare All basic examination criteria Just reaching acceptable pass
Pass done adequately or well, but standard in physical
limited/incorrect responses to examination
some of the questions
concerning findings,
differential diagnosis and
additional knowledge
40% Poor - Fail 3-4 criteria poorly done or Poor performance – the
not done including at least 1 candidate may display some
basic examination criteria adequate attributes but does not
done poorly or not done reach an acceptable pass
standard overall

<30% Very Poor – Clear > 5 criteria poorly done or The candidate’s performance is
Fail not done so poor in most/all areas that the
standard required is not even
remotely approached.

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