Examination Skill assessment Checklist

Students Name: ____________________________ College ID___________

0 not performed, 1 performed unsatisfactorily, 2 performed satisfactorily

TASK: Perform examination of breast on the given mannequin

S.
no.
Step Details 0 1 2

1 Introduction Greet the patient and introduce yourself
Explain the procedure and gain the consent of
the patient.
Ensure privacy and always have a female
attendant.
Position the patient correctly (semi-recumbent
45%) with appropriate draping.
Wash your hands/warm them

2 Inspection Examine & compare both sides:
Symmetry & Contour
Skin condition: Dimpling / Puckering, peau d
orange, ulceration, discoloration, Engorged
veins
Nipple-areola complex:
Surface(cracks/fissures), discharge, retraction
Arms and thorax: (edema, distended veins)

3 Palpation With gentle rotatory mini-movement using the
fingers palpate the:
The four quadrants in a circular manner
Axillary tail of Spence
Nipple-areola complex
Inframammary fold
Repeat the same steps for other breast

4 Check the
lymph nodal
status
Palpate the following groups
Axillary (Use Right hand to examine left axilla
and vice versa)
Supraclavicular

5 Conclusion Finish up your exam with thanking the patient
and draping her
Wash your hands and summarize your
findings

TOTAL

Signature of Faculty