OSCE Station: Clinical Breast Examination — Improved Checklist

Instructions for examiners: Use the three radio scores for each item: Not done (0), Done partially (1), Done properly (2). Observe and mark only what you directly see the student perform. Total maximum score: 40.

Station setup & communication

Introduces self, states role, greets patient and confirms patient identity.

Explains procedure to patient and obtains verbal consent.

Ensures patient privacy and warm comfortable room; requests disrobe to waist with adequate draping.

Offers/ensures chaperone (female chaperone present when appropriate).

Inspection (sitting upright)

Inspect the patient seated upright. Observe and comment on:

Inspects breasts with arms by side: notes size, shape, asymmetry, skin colour, visible lumps or ulceration.

Requests hands on hips/waist (presses hands on hips): observes for dimpling, tethering or contour change.

Requests arms raised above head: observes for skin retraction, nipple inversion, contour changes and infra-mammary crease abnormalities.

Examines nipples/areola for direction, discharge, erosion, excoriation or inversion; inspects for prominent veins or peau d’orange.

Palpation — general technique (supine)

Key technique notes: Ask patient to lie supine with a small pillow under the ipsilateral shoulder and the ipsilateral arm above the head. Use the pad of three fingers. Apply light, medium and deep pressure to examine skin/subcutis, breast parenchyma and chest wall respectively.

Positions patient supine with pillow under shoulder and ipsilateral arm raised.

Uses pad of three fingers and examines in overlapping systematic fashion (no gaps) with light, medium and deep pressure as appropriate.

States and uses a defined search pattern (student specifies and follows one): clock-face, vertical strips, concentric rings or quadrants.

Covers entire breast area with overlapping palpation (periphery to retroareolar).

Palpation — focused steps and duct assessment

Examines retroareolar area and major ducts by rolling tissue between thumb and finger to elicit masses or discharge.

If discharge present, attempts gentle expression and notes colour, single vs multiple duct origin, spontaneous vs expressed.

Assesses and documents tenderness over lump and surrounding tissue.

Lump identification and documentation

On finding a discrete lump the student should state and document the following for clear clinical records: clock-position, distance from nipple (cm), two orthogonal dimensions (measure with ruler/vernier calipers), consistency, tenderness, mobility, relation to skin and underlying muscle, and whether nearby skin or nipple is involved.

Axillary and regional lymph node examination

Explains and relaxes patient; inspects axilla for skin changes, erythema or palpable masses.

Performs systematic axillary node exam (pectoral/anterior, lateral, central, apical) using appropriate hand positions and counter-pressure when needed.

Checks supraclavicular and infraclavicular nodes using mirror-image method from behind and documents any enlargement.

Additional practical points

Assesses both breasts and compares sides throughout (notes asymmetry or contralateral findings).

Maintains patient comfort, explains each step, and uses a chaperone when required.

Communicates findings clearly to patient (verbal summary).

Final documentation (required)

Records all findings clearly in the case sheet using clock position, measurements and descriptive terms (consistency, tenderness, mobility); documents axillary findings.

Includes a pictorial representation on the case sheet: breast outline with lump marked by clock position and distance from nipple.