Nutritional Assessment (MUST): OSCE Station Checklist

The MUST station is the OSCE’s most numerical talking station: a structured score with arithmetic inside it, wrapped in a conversation about why someone isn’t eating. The tool gives you the script.

The five steps:

The three MUST sub-scores and the risk band they sum to:

MUST step	Measure	Score
1. BMI	Above 20 / 18.5–20 / below 18.5	0 / 1 / 2
2. Unplanned weight loss (3–6 months)	Under 5% / 5–10% / over 10%	0 / 1 / 2
3. Acute disease effect	Acutely ill and no intake likely for 5+ days	2
Total	0 low risk / 1 medium / 2 or more high	—

1. BMI score. Calculate BMI (weight ÷ height²; the same arithmetic drilled in the CBT numeracy bank), then convert: above 20 scores 0, 18.5 to 20 scores 1, below 18.5 scores 2.
2. Weight-loss score. Unplanned loss over the last 3 to 6 months, as a percentage of the original weight: under 5% scores 0, 5 to 10% scores 1, over 10% scores 2. Do the division; the exam builds the numbers to be doable.
3. Acute disease effect. Score 2 if the patient is acutely ill and has had, or is expected to have, no nutritional intake for more than 5 days. Otherwise 0.
4. Sum. 0 low risk, 1 medium, 2 or more high.
5. Care plan matched to the risk, per local policy: high risk means dietitian referral, food-record charts, treating the barriers, and scheduled reassessment.

Say the scores as you go (“BMI 17.9, that’s 2 points; loss of 12.5%, another 2; total 4, high risk”). The examiner can’t mark silent arithmetic.

Screening is not the assessment

MUST finds risk; it doesn’t explain it, and the richer marks sit in the explanation. Ask what’s behind the empty trays: appetite, nausea, mouth pain, dentures, swallowing difficulty, needing help that doesn’t arrive, low mood, cultural or dietary needs the menu ignores. Each cause maps to an action a nurse can actually take (dental referral, antiemetics reviewed, red-tray or assisted meals, speech and language referral for swallowing). A care plan built from causes reads as clinical thinking; a care plan that says “encourage oral intake” reads as a poster.

Swallowing deserves its own beat: coughing on fluids or a wet voice after drinking raises aspiration risk, connects to the oral care station, and warrants referral before the next meal, not after the score.

Documentation: the three sub-scores, the total, the risk band, the plan with dates, and the reassessment interval. Numbers first, plan attached; that’s the whole tool in one line of the notes.

Five questions below, then bowel assessment, where the Bristol chart provides the shared language.