Speculum and bimanual examination (model)
PLAB 2 & PRES 3 · practical skills / obs-gyn · medium · 8 minutes
Candidate brief
You are an FY2 doctor in a GP surgery. Mrs Hannah Wright, 29, presents with three weeks of abnormal vaginal discharge and discomfort during intercourse. A chaperone is present. A pelvic model is provided for the examinations. Please take a brief relevant history, then perform a speculum examination and a bimanual examination on the model, verbalising each step and your findings. Explain to the patient what you are doing throughout, and agree the next steps with her.
What examiners look for
In intimate examinations, consent is a continuous process, not a sentence at the start: consent for the speculum is not consent for the bimanual; the patient can withdraw either at any time; and the candidate narrates BEFORE each new action. Examiners for these stations are scoring trust-building as a clinical skill, because in real practice it is one. The chaperone is protective infrastructure for patient and clinician alike: present, introduced by name/role, and documented. "A chaperone was available" and "the chaperone was in the room throughout" are different statements, and candidates should know which one they did. Technique details that examiners reward: inspect before you insert; warm the speculum; blades open only when fully inserted; cervix actively visualised and described (ectropion in a young woman is a normal finding, not pathology); swabs taken while you are there — a second examination because swabs were forgotten is a service failure the patient pays for. The bimanual is a structured sweep, not a rummage: cervix (excitation tenderness points toward PID), uterus (position, size, shape, mobility), adnexae (mass, tenderness), then look at the glove — blood or discharge on the glove is a finding, not waste. Today's examination is reassuring but the consultation is not finished: a late period demands a pregnancy test in any woman with pelvic symptoms and discharge, because ectopic pregnancy and PID are the two diagnoses this presentation must not miss; and a suspected STI without a partner plan treats half an infection. And mind the sequence of dignity: let her dress before the results conversation. Findings delivered to an exposed patient on a couch are remembered very differently from the same findings delivered to a dressed patient in a chair.
Guideline references
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