Station Acne

FOR THE MEDICAL STUDENT

This station requires you to describe how you would take an appropriate dermatological
history and then to describe clinical photographs. You will be asked to discuss the treatment
of the case.

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 in general practice. A 19-year old female is consulting you for the first time.
She tells you that she would like treatment for her acne.

Task

 You will then be asked to describe how you would take a focused and relevant
dermatological history from a patient presenting with acne.

 You will then be shown some clinical photographs and asked to describe the features
present

 You will be asked to discuss appropriate therapy with the patient.

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

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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

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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 patient’s concerns and expectations

Students should be able to formulate a differential diagnosis, describe the investigation and
discuss the principles of care of patients with:
 A teenager with a rash on the face (acne)

Background for Examiner

You will briefly describe a patient with acne and ask the student to take a history.

You would expect the student to ask about psychological impact of the condition, drugs she is
taking/other medical problems and previous treatments including response to the treatments.
A good student will want to know about the length of any previous courses of antibiotics.

You will show the student the clinical photographs and ask him/her to describe the lesions
that are present

The student should discuss appropriate first-line therapy including side effects of treatment
with the patient.

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

Tell the student “You are working in general practice. A 19-year old female is consulting you
for the first time. She tells you that she would like treatment for her acne. She is well.
Please take a focused and relevant dermatological history”.

After 5 minutes (if not already there) show the student the clinical photographs and say
Please describe the clinical findings.

Then say “You decide this girl has fairly superficial acne with blackheads, pustules and
occasional nodules on her face but no deep scarring. Please can you discuss management
with the patient.”

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Assessment

COMPETENCE

Competence task Completed Comment (only if

reqd)
Student describes focused dermatological
history for this case including symptoms,
duration, treatments used/response. Shows
awareness of need to ask about psychological
and lifestyle impact. May ask about sexual
relationships /menstrual history/ contraception/
family history
Student identifies different lesions present in
the clinical photos
Student explores patient’s understanding,
addresses misconceptions (diet, dirt) and
suggests appropriate management;
mentions potential side effects: should include
topical therapy, systemic antibiotics and
hormonal treatment and may mention oral
Roaccutane (isotretinoin)-not needed at the
moment. Should discuss contraception

Examiners should give a global assessment of each student’s performance at this station. The
standard expected for this OSCE is that of a competent FY1 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, cannot describe lesions and
has no knowledge of treatment

BORDERLINE Student is not confident about the history, omits psycho-social aspects,
is unsure of signs/and/or treatment

CLEAR PASS Student covers points listed

ABOVE EXPECTED STANDARD Student covers all points listed, shows insight into
indications for different treatments and handles discussion with patient confidently and
accurately

Finally, check the correct student details are at the top of the form.