Station Infant with a rash

FOR THE MEDICAL STUDENT

Remember the standard expected for this OSCE is of a competent FY1. For this station you
are expected to take the role of a FY1 working in general practice.
Background Information

You are working as a FY1 in general practice. You see a parent with an irritable 10month-old boy with an itchy rash.
Task
You will be asked to take a focused and relevant dermatological history from the
parent.
When you are ready, ask the examiner for the clinical examination findings.
You will be asked to explain your findings to the parent and agree a

management plan with the parent

You do not need to remember these stages as the examiner will prompt you as you proceed
through the station

Station Infant with a rash

Notes to the patient
You arrive with your 10-month-old son who has developed a rash over the last six
weeks, mainly on his face and arms. Your son is constantly scratching his skin and in
some places it has caused bleeding. This is your first child and you are worried and
tired.
You also state your childs skin is very dry, rough and the rash on his face makes him
physically unattractive.
He is irritable, sleeping poorly (as are you).
You are worried that your child may be infective to other children and also worry that
other friends children may not want to play with your unattractive son. You have
not taken him to the weekly infant swimming class for over a month because you are
too embarrassed by his skin condition.
You wonder if a cream and/or dietary restrictions would help the rash (you would like
to know more about eczema). He has never had a rash, lip swelling or any other
problems that you can clearly link to foods. You are not sure how much you should
bath him.
Your child is otherwise well and has no asthma or hay fever.
You had eczema as a child but this cleared but you have dry skin mild and hay fever.
No-one else at home is itching

Station Infant with a rash

EXAMINER FORM (complete both pages)
STUDENT NUMBER:
Which Learning Outcomes are being assessed in this OSCE station?
Students MUST be able to
Take a dermatological history
Describe cutaneous physical signs
Explore a patients concerns and expectations
Students should be able to formulate a differential diagnosis, describe the investigation and
discuss the principles of care of patients with:
Itching and childhood atopic dermatitis
Background for Examiner
You will briefly introduce the parent of a child with a rash and ask the student to take a
focused dermatological history.
You will describe the physical signs. You will tell the student that he /she is confident the
child has atopic eczema and ask him to explain this diagnosis to the patient and discuss
management.
At the end of the whole exam session and not before, you will be feeding back to the student
about their performance. For most students, you may feel their performance was fine. Do not
tell them about pass/fail decisions. This feedback is about technique/approach.

Please start the exam off and indicate the next stages as appropriate as follows
Please tell the student: You are working in general practice. This parent is consulting you
for the first time about her child. Please take a focused and relevant dermatological history
from the parent.
After 5 minutes (if not already there) tell the student the clinical findings

The child has a rash as shown mainly on the face with a non-specific distribution
elsewhere but sparing the nappy area. The rash appears non-infected. The rash affects
the forearms and to a lesser extent his knees. The rest of the clinical examination is
normal, and you believe the diagnosis to be atopic eczema.
Then say: Please can you explain the diagnosis to the parent and discuss options for
management.

Station Infant with a rash

Assessment
COMPETENCE
Competence task

Completed

Comment
(only if reqd)

Student takes dermatological history including

symptoms, duration, treatments used/response,
exacerbating factors, factors that make it better Shows
awareness of need to ask about psychological and
lifestyle impact child unattractive.
Asks about family history.
Elicits parent's ideas, concerns, expectations

Student addresses patients anxieties-not contagious, can

improve appearance, prognosis - may go away.
Not a food allergy-no history of lip swelling or hives
Explores treatment and how much time parent has for
applying treatment
Discusses likely outcome of treatment - control not cure,
reduce itch, redness and scaling.
Explains and negotiates management - emollients
frequently, topical steroid x2/day
Continue baths
Good student should explain how to use treatment
emollients liberally, stop soap and use emollient as soap,
use topical steroids thinly
May discuss side effects skin thinning-but reassure that
mild steroids will not do this
Good student will offer patient information leaflet,
patient support group, website

Station Infant with a rash

Examiners should give a global assessment of each students performance at this station. The
standard expected for this OSCE is that of a competent PRHO working in general practice.
How do YOU feel the student has performed? You may take into account fluency and
confidence of answers given. Please underline the descriptor that best describes the
performance of this student:
CLEAR FAIL Student does not ask appropriate questions and has no knowledge of
treatment
BORDERLINE Student takes history, but omits one aspect e.g. psycho-social aspects or
symptoms, poor at counselling patient or negotiating treatment.
CLEAR PASS Student covers points in history listed, responds appropriately to
patients questions and works with the patient to decide on treatment.
ABOVE EXPECTED STANDARD Student covers all points listed, shows insight into
indications for different treatments and handles discussion confidently and accurately
Finally, check the correct student details are at the top of the form.
check the correct student details are at the top of the form.