Membership of the Royal College of Surgeons (MRCS) Clinical and Communication Skills (OSCE Part B) Syllabus

Clinical and Communication Skills (OSCE Part B) syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Clinical and Communication Skills (OSCE Part B) in Membership of the Royal College of Surgeons (MRCS), not a summary of it.

1. 1

   History Taking and Communication

   3 topics

   • Structured surgical history
     • Presenting complaint and systems review
     • Past surgical and drug history
   • Communicating with patients and relatives
     • Breaking bad news
     • Explaining diagnoses and procedures
   • Consent and shared decision-making
     • Risk and benefit explanation
     • Managing the angry or anxious patient
2. 2

   Clinical and Procedural Examination

   4 topics

   • Examination of the abdomen and groin
     • Hernia and stoma examination
     • Acute abdomen signs
   • Vascular and limb examination
     • Peripheral pulses and ischaemia
     • Varicose veins and ulcers
   • Examination of lumps, breast and neck
     • Assessment of a lump
     • Thyroid and lymph node examination
   • Musculoskeletal and neurological examination
     • Joint and limb assessment
     • Peripheral nerve testing
3. 3

   Practical and Generic Surgical Skills

   3 topics

   • Aseptic technique and instrument handling
     • Scrubbing, gowning and gloving
     • Surgical instruments and sutures
   • Wound closure and knot tying
     • Suturing techniques
     • Local anaesthetic infiltration
   • Common bedside procedures
     • Chest drain and catheterisation
     • Abscess incision and drainage
4. 4

   Data and Information Interpretation

   3 topics

   • Interpreting investigations
     • Blood results and arterial blood gases
     • ECG interpretation
   • Imaging interpretation
     • Chest and abdominal radiographs
     • CT scans in emergency surgery
   • Clinical reasoning and management planning
     • Differential diagnosis
     • Prioritisation and escalation

Clinical and Communication Skills (OSCE Part B) flashcards for Membership of the Royal College of Surgeons (MRCS)

22 of 50 cards from the Clinical and Communication Skills (OSCE Part B) deck — real questions with worked answers.

1. In a structured surgical history, what does the mnemonic 'SOCRATES' stand for when characterising pain?

   Site, Onset, Character, Radiation, Associations, Time course, Exacerbating/relieving factors, Severity.

2. What are the key components in order of a complete surgical clerking history?

   Presenting complaint, history of presenting complaint, past medical/surgical history, drug history and allergies, family history, social history (including smoking, alcohol, occupation), and systems review.

3. Why is a thorough anaesthetic history (previous anaesthetics, problems, family reactions) important in a surgical pre-op history?

   It screens for difficult airway, previous adverse reactions, and inherited risks such as malignant hyperthermia or suxamethonium (pseudocholinesterase deficiency) apnoea.

4. In communication, what is the recommended structure for breaking bad news to a patient?

   The SPIKES protocol: Setting up, assessing Perception, obtaining Invitation, giving Knowledge, addressing Emotions with empathy, and Strategy/Summary.

5. What is a 'warning shot' in breaking bad news, and why is it used?

   A brief preparatory statement (e.g. 'I'm afraid I have some serious news') that signals difficult information is coming, allowing the patient to brace and absorb it.

6. For valid consent to be legally and ethically sound, which three criteria must be met?

   The patient must have capacity, the consent must be given voluntarily (free from coercion), and it must be informed (material risks, benefits, and alternatives disclosed).

7. What are the four components of mental capacity under the Mental Capacity Act 2005?

   The ability to understand the information, retain it, weigh it up (use and balance it) to make a decision, and communicate the decision.

8. What legal standard for disclosure of risk during consent was established by Montgomery v Lanarkshire (2015)?

   Disclosure of any 'material risk' — a risk a reasonable person in the patient's position would attach significance to, or that the doctor knows this particular patient would — replacing the old Bolam test for consent.

9. In shared decision-making, what does the 'BRAN' mnemonic help patients consider?

   Benefits, Risks, Alternatives, and what happens if they do Nothing.

10. What is the correct sequence for examining the abdomen?

    Inspection, palpation (light then deep), percussion, and auscultation.

11. During abdominal palpation, what is Murphy's sign and what does it indicate?

    Arrest of inspiration on deep palpation of the right upper quadrant during inspiration; a positive sign suggests acute cholecystitis.

12. What is Rovsing's sign and what condition does it suggest?

    Pain felt in the right iliac fossa when the left iliac fossa is palpated; it suggests appendicitis (peritoneal irritation).

13. How do you clinically distinguish an indirect from a direct inguinal hernia at the bedside?

    Reduce the hernia and occlude the deep ring (mid-point of inguinal ligament, above the femoral pulse); an indirect hernia is controlled and will not reappear on coughing, whereas a direct hernia bulges medially despite occlusion.

14. What anatomical landmark distinguishes an inguinal from a femoral hernia on examination?

    An inguinal hernia lies above and medial to the pubic tubercle; a femoral hernia lies below and lateral to the pubic tubercle.

15. What is the differential between a direct and indirect inguinal hernia in relation to the inferior epigastric vessels?

    Indirect hernias pass lateral to the inferior epigastric vessels (through the deep ring); direct hernias protrude medial to them (through Hesselbach's triangle).

16. When examining the peripheral arterial system of the limb, in what order should the lower limb pulses be palpated?

    Femoral, popliteal, posterior tibial (behind medial malleolus), and dorsalis pedis (lateral to extensor hallucis longus tendon).

17. What is Buerger's test and what angle indicates severe ischaemia?

    Elevate the leg until it goes pale (Buerger's angle); an angle below $20^{\circ}$ indicates severe ischaemia. On lowering, reactive hyperaemia (sunset foot) confirms it.

18. What are the '6 Ps' of acute limb ischaemia?

    Pain, Pallor, Pulselessness, Paraesthesia, Paralysis, and Perishing cold (Poikilothermia).

19. How is the Ankle-Brachial Pressure Index (ABPI) calculated and what range indicates peripheral arterial disease?

    $$\text{ABPI} = \frac{\text{Highest ankle systolic pressure}}{\text{Highest brachial systolic pressure}}$$ Normal is $0.9$ to $1.2$; $<0.9$ indicates PAD, and $<0.5$ indicates critical limb ischaemia.

20. What does an ABPI value above $1.2$ suggest and in whom is it common?

    Falsely elevated readings from non-compressible, calcified vessels, commonly seen in diabetics and patients with chronic kidney disease.

21. In examining a varicose vein patient, what does the Trendelenburg (tourniquet) test assess?

    It localises the site of venous incompetence; controlling filling with a high tourniquet suggests saphenofemoral junction incompetence, while filling despite it indicates incompetent perforators below the tourniquet.

22. What are the key descriptive features to assess when examining any lump?

    Site, Size, Shape, Surface, Edge, Consistency, Colour, Temperature, Tenderness, Transilluminance, Pulsatility, Compressibility, Fluctuance, Mobility/fixation, and relation to surrounding structures (skin/deep tissues).

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