Step-by-Step OSCE Guide

GETTING STARTED

1. Perform hand hygiene and don PPE if required.
2. Introduce yourself: “Hi, I’m Jamie, one of the advanced clinical practitioners.”
3. Confirm the patient’s full name and date of birth.
4. Briefly explain the exam: “I’d like to examine your testicles today – this involves looking and gently feeling the area.”
5. Explain the need for a chaperone and gain verbal consent.
6. Ask the patient to remove their underwear and lie on the couch, covering themselves with a sheet.
7. Provide privacy to undress and check it is okay to re-enter.
8. Ask if the patient has any current pain or discomfort.

INSPECTION

9. Inspect the penis, groin and abdomen for abnormalities – scars, swellings, skin changes.
10. Ask the patient to lift the penis to allow visual inspection of the scrotum and perineum.

PALPATION

11. Examine the penis for signs of lesions, discharge or phimosis.
12. Palpate each testicle individually – assess size, consistency and tenderness.
13. Palpate the epididymis – feel for thickening, tenderness or cysts.
14. Palpate the spermatic cord from the testicle to the superficial inguinal ring.
15. Perform Prehn’s Test – if the testicular pain improves on elevation, this suggests epididymitis rather than torsion.
16. Assess the cremasteric reflex by lightly stroking the medial thigh and observing for testicular elevation (You may want to warn the patient in advance that you will be stroking their thigh!)

STANDING ASSESSMENT

17. Ask the patient to stand and re-inspect the scrotum.
18. Palpate the posterior scrotum – assess for varicocele (bag of worms texture) and inguinoscrotal hernia (non-palpable above the mass).

TO COMPLETE THE EXAM

19. Let the patient know the exam is complete and thank them.
20. Offer tissue or assistance with redressing.
21. Dispose of PPE and perform hand hygiene.
22. Summarise your findings clearly.
23. Suggest further investigations if required:
    – Full abdominal examination
    – Testicular ultrasound
    – Urinalysis or STI screen if appropriate

A testicular exam is intimate, so it’s crucial to maintain dignity while being thorough. Remember: torsion is a surgical emergency — Don’t miss it!