Station 5: Students Instructions:

Context
You are a medical student in GP.

Background
You have been asked to see Ann Conor (1/1/1999) who has attended the surgery for
the first time with a rash.

Task
Please take a RELEVANT history and then DISCRIBE the rash seen and DISCUSS a
management plan and follow up if necessary.

1
 Station Acne
Instructions for Patient

You are a 19 - year old woman with acne on your face. Recently it has got worse. You want
treatment to sort this out. You have not been to this GP before but have seen other GPs in a
different part of the country.

You are very bothered by the appearance of your skin and feel your acne should have
improved by now- most of your friends have very good skin. You notice blackheads, pus-
filled bumps and some very painful red nodules that seem to last for ages. You are worried
because you think you might get scars on your cheeks (like your aunt). You notice that your
acne is worse around your periods but it improves in the sun. Your chest and back are not
affected. Your mother says that your diet (fatty food, chocolate) and poor washing are
responsible for your spots.

You are well and not on any other treatments. Your menstrual cycle is regular.

You have had several “courses” of antibiotics (erythromycin, oxytetracycline) for your acne
(prescribed elsewhere) but have never taken these for more than about 1 month at a time (it
may take four months to achieve a maximal response to treatment with antibiotics) and they
did not help. You would be worried taking antibiotics continually for any longer than this. You
have dabbed some creams on the spots (bought from Boots) but do not know what these
were-and nothing made a lot of difference.

You have a longstanding boyfriend and do have sexual intercourse. You use condoms but
irregularly. You are not on the contraceptive pill. You would take the pill if it would help your
acne. You have heard of a drug called Roaccutane that can help acne but know it is a very
strong treatment and are not keen on this.

You work in Boots on the cosmetic counter and need to look good for your job.

No family history of any serious medical problems or bad acne

2
DERMATOLOGY Student name:
Examiner Instructions
Please mark the student using the checklist below. The student should manage their own
time. Please give some comments in the box at the bottom or annotate their marking sheet
as appropriate.

Student Instructions: You are a medical student in GP. You have been asked to see Ann
Conor (1/1/1999) who has attended the surgery for the first time with a rash.
Please take a RELEVANT history and then DISCRIBE the rash seen and DISCUSS a
management plan and follow up if necessary.

Task 0
Introduction
Washes hands
Introduces themselves to parent (Name + Position)
Identifies patient (Name/DoB/Age)
Consents patient
Begins with open question
History of presenting complaint
Identifies problem
Clarifies details (duration/onset/progression)
Clarifies pattern of rash
Ascertains history of any associated history
Psychological and lifestyle impact
Systemic enquiry
PMH
Other medical problems
Ask about sexual relationships /menstrual history/ contraception
Drug History
Treatments used/response
Social history
Occupation
Smoking/Alcohol
Family history
Any family history of Acne
ICE
Patient’s thoughts, concerns or worries
Describing the Rash
Comments on site of lesion and distribution
Describe ouline if lesions and colour base and lesions
Typical features of Acne – microcomedone, open and closed
comedone, papules, pustules, nodules and cysts
State where else would like to look – back and shoulders
State likely diagnosis – Acne Vulgaris

3
Explanation + planning
Student explores patient’s understanding
Addresses misconceptions (diet, dirt)
Suggests appropriate management & mentions potential side
effects:
Should include a topical therapy
Systemic antibiotics and hormonal treatment
Mention oral Roaccutane (isotretinoin)-not needed currently.
Should discuss contraception
General Points
Always supportive to patient
Thanks and closes whilst offering to answer questions

ASSESS grading - The standard expected for this OSCE is that of a competent FY1
working in general practice

Very Poor Excellent

Accuracy 1 2 3 4 5
Skilfulness 1 2 3 4 5
Supportiveness 1 2 3 4 5
Efficiency & 1 2 3 4 5
Structure
Safety 1 2 3 4 5

Examiner’s Comments - How do YOU feel the student has performed? You may
take into account fluency and confidence of answers given: