Instructions to Candidate!

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A 28 year old female has presented with a self harm laceration to her right wrist. A completed
mental health assessment has been made. The ENP is concerned about the median nerve. She is
also not confident in suturing the wound. !
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Task!
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Assess the median nerve function at the level of the wrist. Then suture the wound, placing one
simple suture and one mattress suture. Finally, give advice to the patient about her wound care.!
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Examiner role!
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Observation and prompt at 6 minutes.!
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Examination Clinical skill Communication

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Instructions to Examiner!
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This is a clinical examination and clinical skill assessment station. The station is 7 minutes long.
The candidate is expected to examine and demonstrate both a motor and sensory assessment of
the median nerve at the level of the wrist, describing the muscles tested (normal clinical findings).
They then will be expected to suture a prepared wound (cleaned and LA in situ) with simple and a
mattress suture, using an appropriate suture material. Please use the comments section on the
score sheet to give feedback on suture technique e.g. instrument handling / suture
placement and wound handling.!
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Examiner prompt!
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Please examine this lady’s median nerve function at the level of the wrist, describing what you are
doing and your findings; then suture the prepared wound. At 6 minutes ask the candidate what
dressing they are to apply and give the patient wound care advice.!
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Role player 1 - patient!
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You are only needed to follow instruction. Your nerve function is normal and you have no motor
deficit (normal sensation thumb / index / middle / radial border ring fingers and normal motor power
thumb flexor pollicis brevis / abductor and opponens pollicis; each must be examined).!
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Successful expectations!
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A good candidate will:!
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Perform a rapid examination of the sensory distribution of the median nerve!
Understand that the motor supply to the thumb is variable and that the opponens is the most
reliable median motor branch!
Place a simple and mattress suture with 4-0 nylon using a good dextrous technique!
Give advice on all aspects of wound care and as to when the sutures need removal!
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Expected timeline!
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Start - introductions!
Complete examination and describe findings - 3 minutes!
Place two sutures as described - 6 minutes!
Prompt and response for wound care advice and timeline for suture removal - 7 minutes!
END!
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Equipment!
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Neurotip!
Suture kit!
Synthetic suture material!
Sutures!
Table!
x2 chairs!
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Scoring matrix next page!
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Scoring matrix!
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Circle the mark (x) when the candidate has obtained the score. If more than one score equate to
the task and mark accordingly if obtains part or all elements.!
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Task 1 2 3 4

Introduces self and x

confirms the need
to examine the
hand

Examines the x x
correct sensory
distribution of the
median nerve

Uses both coarse x x

touch and pin prick
testing

Uses the pen test x

to evaluate
sweating

Assesses all motor x x x

elements of the
median nerve (all 3
muscles)

Places a simple x x x x
suture and
mattress suture
using 4-0 nylon
only

Shows good x x
technique for tissue
handling

Shows dexterity for x x

equipment handling

Suggests a base x x
non adherent
dressing and
absorbent
protective dressing

Advises on wound x
care check by
practice nurse at 48
hours with dressing
change

Advises on signs of x x x
infection (pain /
redness/swelling)

Asks about sick x

note
Recommends x
suture removal at
10-14 days by
practice nurse
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