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xiv OSCE tips

• Be nice to the patient. Have I already said this? Introduce yourself, shake hands, smile, even

joke if it seems appropriate – it makes life easier for everyone, including yourself. Remember to

explain everything to the patient as you go along, to ask him about pain before you touch him,

and to thank him on the second bell. The patient holds the key to the station, and he may hand

it to you on a silver platter if you seem deserving enough. That having been said, if you reach

the end of the station and feel that something is amiss, there’s no harm in gently reminding

him, for example, “Is there anything else that you feel is important but that we haven’t had time

to talk about?” Nudge-nudge.

• Take a step back to jump further. Last minute cramming is not going to magically turn you

into a good doctor, so spend the day before the exam relaxing and sharpening your mind. Go

to the country, play some sports, stream a film. And make sure that you are tired enough to fall

asleep by a reasonable hour.

• Finally, remember to practise, practise, and practise. Look at the bright side of things: at

least you’re not going to be alone, and there are going to be plenty of opportunities for good

conversations, good laughs, and good meals. You might even make lifelong friends in the process. And then go off to that Greek island.

1General skills

Station 1

Hand washing

Hands must be washed before every episode of care that involves direct contact with a patient’s skin,

their food or medication, invasive devices, or dressings, and after any activity or contact that potentially

contaminates the hands.

The procedure

• Your arms should be bare below the elbows: roll up your sleeves, remove your watch, any jewellery, and fake nails or nail varnish (fingernails should be kept short, ideally not exceeding 1mm

from the edge of the nail bed).

• Turn on the hot and cold taps with your elbows and thoroughly wet your hands once the water

is warm.

• Apply liquid soap (used in most hospital situations) or disinfectant from the dispenser (used

in the operating theatre). Disinfectants include pink aqueous chlorhexidine (‘Hibiscrub’) and

brown povidone iodine (‘Betadine’). Alcohol hand rubs offer a quicker alternative to liquid

soaps and disinfectants, though they should be applied for at least 20–30 seconds. Mere soap

bars are to be avoided.

• Wash your hands using the Ayliffe hand washing technique (see Figure 1 overleaf):

➀ palm to palm

➁ right palm over left dorsum and left palm over right dorsum

➂ palm to palm with fingers interlaced

➃ back of fingers to opposing palms with fingers interlocked

➄ rotational rubbing of right thumb clasped in left palm and left thumb clasped in right palm

➅ rotational rubbing, backwards and forwards, with clasped fingers of right hand in left palm

and clasped fingers of left hand in right palm

• Rinse your hands thoroughly.

• Turn the taps off with your elbows.

• Dry your hands with a paper towel and discard it in the foot-operated bin, remembering to use

the pedal rather than your clean hands!

• Consider applying an emollient if you have dry skin.

[Note] Alcohol hand rubs are ineffective against spores and should be avoided if there is contamination with biological

remnants such as faeces, blood, or urine; if there is visible dirt; or if the patient is infected with Clostridium difficile.

Clinical Skills for OSCEs

2 Station 1 Hand washing

Figure 1. Ayliffe hand washing technique:

1 Palm to palm

2 Right palm over left dorsum and left palm over right dorsum

3 Palm to palm fingers interlaced

4 Backs of fingers to opposing palms with fingers interlocked

5 Rotational rubbing of right thumb clasped in left palm and vice versa

6 Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice

versa

5 6

3 4

1 2

3General skills

Station 2

Scrubbing up for theatre

The equipment

• Scrubs • Sterile gown pack

• Theatre clogs or plastic overshoes • Sterile gloves

• Theatre cap • Brush packet containing a nail brush and

• Surgical mask nail pick

Before handwashing

State that you would:

• Change into scrubs and ensure that your arms are bare below the elbows.

• Exchange your shoes for theatre clogs or use plastic overshoes.

• Don a theatre cap, tucking all your hair underneath it.

• Enter the scrubbing room and put on a surgical mask, ensuring that it covers both your nose

and mouth.

• Depending on the clinical situation, consider wearing eye protection (goggles/visor).

• Open out a sterile gown pack on a clean, flat surface without touching the gown.

• Open out a pair of sterile gloves (in your size) using a sterile technique, letting them drop into

the sterile field created by the gown pack.

Handwashing

• Open a brush packet containing a nail brush and nail pick.

• Turn on the hot and cold taps and wait until the water is warm.

From here on, keep your hands above your elbows at all times.

The social wash

• Wash your hands with liquid disinfectant, either pink chlorhexidine (‘Hibiscrub’) or brown

povidone iodine (‘Betadine’), lathering up your arms to 2 cm above your elbows.

The second wash

• Use the nail pick from the brush packet to clean under your fingernails.

• Dispense soap onto the sponge side of the brush and use the sponge to scrub from your

fingertips to 2 cm above your elbows (30 seconds per arm).

Dispense soap using your elbow or a foot pedal, not your hands.

• To rinse, start from your hands and move down to your elbows so that the rinse water drips

away/down from your hands without re-contaminating them.

The third wash

• Using the brush side of the brush, scrub your fingernails (30 seconds per arm).

Clinical Skills for OSCEs

4 Station 2 Scrubbing up for theatre

• Using the sponge side of the brush, scrub:

– each finger and interdigital space in turn (30 seconds per arm)

– the palm and back of your hands (30 seconds per arm)

– your forearms, moving up circumferentially to 2 cm above your elbows (30 seconds per arm)

Remember to keep the brush well-soaped at all times.

• To rinse, start from your hands and move down to your elbows.

• Turn the taps off with your elbows.

After handwashing

• Use the two towels in the gown pack to dry your arms from the fingertips down (one towel

per arm).

• Pick up the gown from the inside and shake it open, ensuring that it does not touch anything.

• Put your arms through the sleeves, but do not put your hands through the cuffs.

• Put on the gloves without touching the outside of the gloves. Practise this – it’s not easy!

• Ask an assistant to tie up the inside of the gown, and to hold on to one side of the card (attached

to the front of the gown) while you rotate to tie up the outside of the gown yourself.

After scrubbing up, keep your hands in front of your chest and do not touch any non-sterile

areas, including your mask and hat.

5General skills

Station 3

Venepuncture/phlebotomy

Specifications: The station consists of an anatomical arm and all the equipment that might be

required. Assume that the anatomical arm is a patient and take blood from it.

Before starting

• Introduce yourself to the patient.

• Confirm his name and date of birth.

• Explain the procedure and obtain his consent. For example, “I would like to take a blood sample

from you to check how your kidneys are working. This is a quick, simple, and routine procedure

which involves inserting a small needle into one of the veins on your arm. You will feel a sharp

scratch when the needle is inserted, and there may be a little bit of bleeding afterwards. Do you have

any questions?”.

• Ask him from which arm he prefers to have (or normally has) blood taken.

• Ask him to expose this arm.

• Gather the equipment in a clean tray.

The equipment

In a clean tray, gather:

• A pair of non-sterile gloves

• A tourniquet

• Alcohol wipes (sterets)

• A 23G (blue) needle/‘butterfly’ and Vacutainer holder