Talk to the Hand! OSCE by Katrina Romualdez

You have 3 minutes reading time. This OSCE will run for a maximum of 7 minutes.


A medical student on her first day in ED has picked up a case of M.E a 36/M who presents with the injury as shown below. She has sought guidance re: her assessment of this patient.

View attached:  Attachment 1

Instructions for the candidate

Discuss the key points in the history of this patient and demonstrate an approach to a thorough hand examination. Use the medical student's hands to demonstrate your exam technique.

Domains being examined

  • Medical Expertise
  • Communication
  • Scholarship and Teaching
  • Professionalism
The candidate has 3 minutes reading time. This OSCE is expected to run for a maximum of 7 minutes.

For the actor

It's your first day, you're a medical student, you're pretty clueless. You will however be able to remember and repeat back or demonstrate whatever the candidate has taught you. If the candidate has missed key features for history and exam, can prompt with "Is there anything else I should ask/do?"

For the examiner

Domains Assessment Objectives

Medical Expertise
Anatomy of hand
Correct approach to examination of tendon/nerve/vascular injury

Clear advice, engaged and approachable manner

Scholarship and Teaching
Providing opportunity to show knowledge, demonstrate techniques learned


Other Assessment Notes

Key elements in the history
- occupation
- handedness
- mechanism including need for work cover, any delay in seeking treatment
- allergies/medications/significant medical conditions
- last meal
- tetanus

Thorough and efficient approach to hand exam
- Discussing role of analgesia and regional anaesthesia techniques
- Comparing with normal hand
- Examination of sensation prior to anaesthesia
- Wound exploration in correct hand position (asking patient to assume position at injury)
- Examination of relevant tendon function

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