1. The difficulties in this station are primarily pretending to talk to a mannequin as if it were a patient and also putting your patient at ease with such an invasive procedure. As such, building a rapport with the patient is paramount and will also form a major part of the mark scheme.

2. Firstly, ensure you have all of the necessary equipment for the station. This is gloves, lubricant and tissues. You should also ensure that you have a chaperone with you.

3. Next discuss the procedure to the patient. Explain that they will feel pressure on their anus and that then you will insert your finger into their rectum. Tell them it should not last long and that although it may feel uncomfortable it should not be painful.

4. Positioning the patient in this procedure is very important. Ask them to lie on their left hand side with their knees drawn up towards their chest and their anus exposed.

5. Having put on your gloves, separate the buttocks and inspect the area around the anus. Look for any abnormalities including skin tags, haemorrhoids and fissures.

6. After inspecting, lubricate your right index finger.

7. Tell the patient you are about to start the procedure, place your finger on the anus so that it points anteriorly and apply pressure to the midline of the anus.

8. Maintain the pressure so that your finger enters the rectum. Initially you need to assess anal tone by asking the patient to squeeze your finger.

9. Next you need to systematically examine each part of the rectum. This is done by sweeping the finger both clockwise and anti-clockwise around the entire circumference. You should be feeling for any abnormalities such as impacted faeces, masses or ulcers.

10. One of the main reasons for performing rectal examination in males is to assess the prostate gland. This lies anteriorly and should always be felt. You should check the size, consistency and presence of the midline groove.

11. Remove your finger and examine the glove for the colour of any faeces as well as the presence of any mucus or blood.

12. Clean off any lubricant left around the anus and remove and dispose of your gloves. Allow the patient to put their clothes on and thank them.

© Matthew Green and Laura Henderson 2006.