-

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3rd Phase OSeE May 2001

Station

Candidate Name

&CandName

Candidate No, &Canc

Candidate instructions: This station tests your ability to suture a laceration. Please , speak to the examiner as if s/he were the patient.

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I Examiner: please rate the candidate on each at the following criteria. Please refold the suture pack between candidates. Note item 15.

1 Appropriate introduction to patient.

2 Tells patient what i5going to happen.

Mentions skin preparation.

Mentions local anaesthetic.

Unfolds suture pack correctly with sterile technique.

'I Puts on sterile gloves correctly ..

, Positions towel correctly.

Puts the needle in the needle holder correctly.

9 Uses forceps during the procedure with appropriate skill.

10 Ties knots correctly.

11 Closure of skin ~ 2 sutures minimum, correctly performed. ,

. 12 Demonstrates attention 10 sterile technique.

13 Describes procedure clearly to the patient (examiner).

14 Perfonns skill fluently.

EXAMINER PROMFT:

15 What anaesthetic must not be used on fingers? (adrenaline containing preparations).

Examiner Overall Rating: was the overall approach that expected of a professional?

ixaminer GlobaJ Rating: overall ability of candidate to suture.

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Station

Suturing

Station ~

Centre

&Centre

&Session

Circuit &Circuit

Session

Candidate Name

&CandName

Candidate No. aCanc

Examiner instructions: Please assess the candidate on each of the following criteria. Please refold the suture pack between candidates. Please note the examiner prompt (item 15).

1 Appropriate introduction to patient, gMng own name, greeting, role and patient's name and explains what slhe is going to do (all required to score)

Tells patient what is going to happen

Mentions skin preparation

,Mentions Jocal anaesthetic

Unfolds suture pack correctly with sterile technique

Puts on sterile gloves correctly

Positions towel correctly

Puts the needle in the needle holder correctly

Uses forceps during the procedure with appropriate skill (does not touch needle with fingers)

10 TIeS with appropriate knot

11 Closure of skin - 2 sutures minimum, correctly performed

12 Demonstrates attention to sterile technique

!-----,,----:-:-----:---:---:-----:---::--:-;----~-;:----- --- - -- --------------{

13 Describes procedure clearly to patient (examiner)

14 Performs skill fluently

15 EXAMINER PROMPT: What anaesthetic must not be used on fingers? (adrenaline containing preparations).

Examiner Global Rating: overall ability of candidate to suture

Good Pass Borderline Faill~:=1

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Station

Venepuncture

Station ~

Centre

&Centre

Circuit &Circuit

Session

&Session

Candidate Name

&CandName

Candidate No. &Canc

EXaminer instructions: Please assess the candidate on each of the following criteria. Please see ~he instructions on a separate sheet

Pass Border1iile

FaD

Selectsihe

container and equipment before taking blood

Attaches

under vacuum

Says would Jabel container

Canies out procedure in a proficient manner

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Practical skill- venepuncture

Station

Centre &Centre

&Circuit

Session &Session

Circuit

Candidate Name

&CandName

Candidate No. &CandNo

Candidate instructions: see sheet.

Examiner: Please rate the candidate on each of the following criteria.

1. Puts on gloves to carry out the procedure

· Selects the correct container and equipment before taking the blood

3. Attaches needle to Vacutainer correctly

· Applies tourniquet

· Cleans the area with a swab

· Enters the vein correctly

· Attaches container and withdraws blood under vacuum

· Removes tourniquet before removing needle

10. Applies pressure to venepuncture site

11. Mixes sample gently

12. Disposes of sharp correctly

13. Says would label container

14. Candidate's overall description to examiner of information to give to the patient

Examiner overall rating: Overall rating for candidate's competency in taking blood

Good Pass Borderline Pass Borderline Fail Fail

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ECG

Station

Centre

&Centre

Circuit &Circuit

Session &Session

Candidate Name

&C~mdName

Candidate No. &CandNo

Candidate instructions: see sheet.

Examiner: See prompt at question 19 and ask candidate to report the ECG.

1. Introduces self to patient.

11.0=10.0·=,

12. Confirms patient name and date of birth

13. Explains procedure to patient 1.0= 0.0=

14. Asks patient to remove clothing above the waist 1.0 = 0.0 =

15. Correctly positions patient on couch with legs straight and arms by side 1.0 = 0.0 = I

16. Suggests that skin is cleaned with alco swab and dried prior to lead and electrode placement 1.0 = 0.0 = I

7. States that chest may have to be shaved. 1.0= 0.0= I

Places dots in correct position IlImt;. If:l I

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Ia. V1 1.0= 0.0= I

9. V2 1.0= 0.0= I

10. V3 1.0= 0.0= I

11. V4

16. RLL

1.0= 0.0= I 1.0= 0.0= I., 1.0= 0.0= I 1.0= 0.0= I 1.0= 0.0= I 1.0= 0.0= I 1.0= 0.0= I 1.0= 0.0= I 1.0= 0.0= I

12. V5

13.V6

14. RUL

15. LUL

17.LLL

18. Asks patient to relax limbs during recording

19.Examiner prompt: Ask the candidate to identify the limb leads

Examiner prompt: Show the candidate the ECG trace and ask the candidate to report the ECG.

1~.gjEg}~~ I

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120. Name 1.0= 0.0= •

21. Rate 1.0= 0,0= •

122. Rhythm 1.0= 0.0= •

123. Axis 1.0= 0.0= •

124. p-r interval 1.0 = 0.0 = •

125. Conclusion - describes overall tracing pattern correctly 1.0 = 0.0 = •

126. Fluent report of the ECG trace 1.0 = 0.0 = •

Please continue on sheet 2 r~Et~~ • ')t?~~llm. • I~~~I~~ •

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ECG (continued)

Centre &Centre

Candidate Name

-- I

Station

Circuit &Circuit

Session &Session

&CandName

Candi date No. &CandNo

Examiner global rating: overall competency of candidate in preparing the patient for an ECG

Good Pass Borderline Pass Bordertine Fail Fail

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Practical skill .. urine testing

Station

Centre &Centre

Circuit

&Circuit

Session &Session

Candidate Name

&CandName

Candidate No. &CandNo

Candidate instructions: see sheet.

Examiner: Please rate the candidate on each of the following criteria. See prompts below.

Demonstrates urine dipstix tests

· Dipstix held against colour chart after time gap stated on container

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1. Checks expiry date of BM test 5L pot

2. Puts on gloves and apron - both to score

3. Dipstix immersed briefly into urine

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5. Correctly reports the BM stick reading - postitive for glucose

· Correctly disposes of dipstix. NOT THE URINE POT.

· Washes hands

8. Candidate performs the task in a fluent manner.

11. Tell patient to wash vulva with detailed instructions

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Instructions to collect a MSU

9. Check if patient knew how to perform a MSU

10, Instructions about equipment for tests, e.q. container of sterile water, gauze and sterile container (all to score)

12. Tell patient to start passing urine

13, Tell patient to then stop urinating/passing water, collect urine into container, or catch the middle of the tream and empty rest of bladder as usual.

14. Candidate gives a fluent explanation' of the task

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15. Does not use jargon or explains if used

What tests are done in the lab on a MSU sample?

16, Microscopy and culture and sensitivities

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If the test was positive for blood, what might this indicate?

17, T rau ma, infection, nephritis, ca rclnorna, stone, torsion TB • 2 to score

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(Please continue on sheet 2)

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PracticaJ skill - urine testing (ctd)

Centre &Centre

Circuit

Candidate Name

&CandName

Station

&Circuit

Session

&Session

Candidate No. &CandNo

Examiner overall rating: overall competence of the candidate to perform a urinalysis

Examiner overall rating: overall competence of the candidate to explain a MSU test

Good Pass Borderline Pass Borderline Fail Fail

Good Pass Borderline Pass Borderline Fail Fail

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Exercise capability prior to recent deterioration

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Asks about sputum production. quantity and quality

. Station

History - Haemoptysis

Station ~

Centre

&Centre

&Session

Circuit & Circu it

Session

Candidate Name

&CandName

Candidate No. &Canc

Examiner: Please assess the candidate on each of the following criteria.

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1 Appropriate introduction to patient gMog own name, greeting. role and patient's name and explains what slhe is going to do (all required to score).

Patient History

Principal complaint: Haemoptysis - in detail abaut onset

Frequency and volume/Quantity of haemoptysis

Presence of shortness of breath/dyspnoea.

Exercise capability now

Specifically asks about previous episodes ofhaemoptysis

Asks about chest pain/discomfort

10 Asks about symptoms of shortness of breath in bed. lying flat (orthopnoeaIPND - 1 to scOre)

11 Presence of ankle swelling

12 Aggravating and relieving factors· for shortness of breath

13 Details of current medication

14 Smoking history

15 Past medica1 history - particularty cardio/respiratory disease

16 Occupational history from school leaving

17 . Family history of respiratory disorders - asthmaITB/cancer

8 Social details: home situation/support agencies

9 Alcohol

o Provides accurate summary. Examiner to prompt jf not given.

1 Differential diagnosis: Ca lung; bronchiectesis; Tb - 2 to score. Examiner to prompt if not given.

see continuation sheet

_ Station

History - Haemoptysis (ctd)

Station

Centre

&Centre

Circuit &Circuit

Session

Candidate No. &Canc

&Session

Candidate Name

&CandName

Interview skills

Uses open question early and allows patient to

initial sentence

to score)

(verbal and non-verbal)

statements

competency at eliciting a medical history.

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History - Haemoptysis

Candidate instructions: This is Mr James White, a 65 year old retired man attending Outpatients. Please elicit a history relevant to this patienfs complaint and present a . summary and differential diagnosis to the examiner. You have 11 minutes for this station.

Summary: The candidate needs to ask you questions to discover the nature of your symptoms.

Background: You are Mr James White, a 65 year old retired journalist. Your GP has sent you to the hospital specialist because you have coughed up blood recently.

Dress: Smart casual

Medical history

With respectto the recent history of coughing up blood; the blood came up with the mucous; it looked bright red -streaks in the mucous but there was one episode of

significant loss, which soaked several paper tissues. . .

• the first episode was two weeks ago.

• you do not cough forcibly but always have a bout on waking. as below

If asked specifically - you have recentiy become short of breath + tired and lethargic. The breathlessness began 3 months ago with increasing limitation in activity. You have been limited in activity to walking short.dlstances. You have been deteriorating and any actions now make you tired and exhausted. Your breathing. is quiet without wheeze.

Associated with your breathlessness has been increasing production of sputum. You have always tended to cough up phlegm for several years, which is nonnalty a morning cough of white phlegm, which you associated with your smoking history. In the last two weeks it has become more significant in volume and recently with bouts of coughing, there has been blood in your sputum- looking like streaks of bright red.

(sputumJ phlegm interchangeable words)

Your breathing has been a problem over the last four or five years and caused you to retire

. prematurely. Climbing stairs had also become a problem and iii the last year you have only been able to climb a flight of stairs without stopping and even then you have had to wait for a few minutes before climbing the next flight of stairs.

You have had no swelling of your ankles, and you can sleep lying flat

There has been no pain in your chest although your chest feels tight recently with the increase in breathlessness. You have never before coughed up any blood and this recent episode has worried you because you know it could be associated with serious lung problems such as cancer (see concerns). You have seen your general practitioner for breathlessness and have been prescribed a puffer - a blue inhaler called Salbutamol [Ventolin]. which you use from time to time for tightness in the chest.

Y04r past medical history is otherwise unremarkable. You have had no heart problems. As a YO'Gng man you have never had any breathif"!g difocutties and no history of allergy.

You have never had any pets in your flal

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After leaving high school you started work in a local newspaper and have been in journalism ever since. You are married and have a grown up family of two children who are welt Your wife is Similarly healthy. Your breathing has been a problem over the last fOur or five years and caused you to retire prematurely There is no family history of respiratory diseases. Your parents lived to a good age although your father died at 65 from bronchial trouble. He had been a heavy smoker. (as discussed at the briefing. the patient is unclear that respiratory diseases and bronchial trouble may be the same)

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Your smoking history is that you began smoking in your teens and smoked 20-40 cigarettes a day until your early 60s. You have cut down now and limit yourself to 10 cigarettes a day. You drink alcohol in the fonn of wine and beer, about 1 pint of beer OR 2- 3 glasses of wine (2-3 units) a day. You live at home with your wrre in a third-floor flat in a block, whicli has no lift facilities. You are normalty independent and do not have support from any outside agencies. There has been no history of recent travel by car or air.

Concerns: you have had several friends who have suffered from lung diseases and you are worried that this may be your problem too. A close friend, who was also a heavy.·.: .. · smoker, developed lung cancer a few years ago and he had a very unpleasant end with _. breathlessness.

Also, you do not knowwhat investigations may be necessary and What" treatment may .be.

available for your condition and would like ltIe doctor to explain things to you. - ..

Simulated Patient Script

History· ~breviated Mental Test

Candidate Instructions: Mrls Warbeck, aged 73 (d.o.b. June 1st, 1930) was admitted

. ·yesterday following a fall at home. SIhe was bruised and shaken but otherwise unhurt The patient's spouse is rather worried about himlher as slhe seems to have lost interest in things in the last few months and is .becoming forgetful.

The consuttant has asked you to administer the Abbreviated Mental Test Score in order to assess the patient's memory and to report the score.

• Your name is MrisWarbeck and you are 73 years old. You live with your spouse in a terraced house close to the hospital. You are a retired postman. You are slightly deaf but wIll manage:to hear if the student speaks clearly and reasonably slowty ..

• You were admitted to hospital yesterday following a fall in which you tripped on the edge of a rug. Your only injuries were a badly bruised leg and side - nothing was broken. You were very shaken though. and you think this was why you were admitted. You will probably be going home tomorrow, from what you understand.

• You·r spouse has been quite worried about you in the last few months. You seem to have lost interest in things and do not go out of the house much. You used to be well dressed but recently you don't seem to have any interest in your appearance.

• This medical student wants to assess your mental state by asking the following questions:

• - the questions may be asked in a different order.

•

1. Age: Give your age correctly as 73.

2. Time.: (to nearest hour) Grl/e correct time.

3. Year: Give correct year (but a little hesitantly)

4. Addr~ for recall at end of test: You can repeat ·42 West Streef initially, but

have forgotten by the end when you are asked to recall it.

(Examiner - the candidate should ask the patient to repeat it, to ensure that it has been heard correctly: 42 West Street)

5. Name of institution In hospital but can't remember name of it

6. Recognition of two persons (e.g. examiner. student): Ide.ntify one person (examiner?) as a manager and second person (student?) as someone who

delivers things, that is, incorrecUy. -

7. Date of birth: Give incorrect year of birth (say. June 1st 1925).

8. Years of First World War: Correct 1914-1918. if asked for second - 1939-45

9. Name of present monarch or other well known person: Name of present monarch or other. correct.

10. Count backwards from 20 to 1: 00 this slowly and incorrectly (e.g. 20, ~9. 17, 16 and then a long hesitation, then say 'I'm sorry, I don't seem to be doing it very well today ... ').

• You don't mind having this test done. What would upset you is feeling patronised or laughed at You are also a bit distressed about not getting the answers correct for Questions about the numbers & the address .

. r ~ Dress: Please wear a bathrobe over your clothes as you are supposed to be in ... :. hospital.

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Patient globa·1 score= ability of candidate to perform test, giving clear instructions

No conferring!

"35

• Explores concerns: re results, repeat mammogram (both to score)

~----------------~~~~----------------~~

Explores concerns: re mastectomy. biopsy. details of tests - 1 to score

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Station

Gathering information from the anxious patient

Station ~

Centre

&Centre

&Session

Circuit &Circuit

Session

Candidate Name

&CandName

Candidate No. &Canc

Examiner instructions: Please assess the candidate on each of the following criteria.

1 Appropriate introduction to patient, giving own name, greeting, role and patient's name and explains what slhe is going to do (all required to score)

Asks if patilIDt minds talking to them

Asks open-ended question early in interview and allows patient to complete initial sentence

Identifies patient's concerns

Demonstrates active listening - verbal and non-verbal cues (eg 'I see, go on', and looks at patient. nods. etc)

Enquires about social circumstances

Enquires about emotional support

10 Appropriate silence

11 Makes empathic statements

12 Probes sensitively

13 Accurate summary including patient concems (examiner prompt if not given)

14 Confirms action plan - to tell consultant about her concerns; consultant to see her next

15 Does not give answers to management of care questions

16 Closes consultation with thanks and goodbye

Examiner Global Rating: coverall ability of candidate to gather information from an anxious patient

Good

Pass Borderline

Fail

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Station

Explaining colonoscopy and exploring concerns

Station ~

Centre

&Centre

Circuit

&Circuit

Session

&Session

Candidate Name

&CandName

Candidate No. &Canc

Examiner Instructions: Please assess the candidate on each of the following criteria.

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Appropriate to gMng own name, greeting. role

what slhe is going to do (all required to score)

after procedure need transport) or use machinery

of follow-up procedure: patient will be informed after procedure or at

follow-up

Examiner Global Rating: overall ability of the candidate to explain the procedure in a fluent manner

Borderline

Simulated Patient Global Rating: ability of the candidate to explain the procedure

I

Borderline

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Simulated Patient Script

Explaining Colonoscopy and exploring concerns

Candidate Instructions: You are in outpatients with your consultant. Ms/Mr Odumo is to have a colonoscopy in the Day Hospital next Tuesday. Explain the procedure and explore any concerns thaHhe patient may have about it. You are NOT required to discuss the risks of the procedure with fhe patient NOR to ask for consent on this occasion.

Summary for SP

The can~idate needs to explain the procedure of colonoscopy to you and explore any concerns that you may have about it.

Background

Mrl Ms Odumo, a VAT Inspector in a stressful post.. You are in Outpatients and have been talking to the consultant in the presence of the student Smart, articulate- briefly challenge any use of jargon. You have agreed to have a colonoscopy next week.

The col,1suHant has asked the student to explain the procedure to you and to explore your concems. The student does not have to explain the risks nor seek your consent - these matters will be addressed on the day of the procedure.

Medical history

For 6 months you have had bouts of diarrhoea with pain on the left-side.

You do not know anyone with anything similar and you have never had any tests in

hospital. "

You are well and not on any medication and a non- smoker

(The student should not spend time on the history - please give brief replies to any

questions about the past.) .

You do not know anything about this procedure but have been told to come to the Day Hospital at 8am next Tuesday.

If asked what you want to knowlwhat infonnation you would like, say that you need to understand, in detail:

• exactJy how to prepare for the test

• what will happen to you during the test

• and afterwards

• Social history: You are single, living alone. You usually drive to appointments but if the student says that you cannot drive yourself home after the procedure you would be willing to use a taxi.

Concerns: Do not disclose your concerns unless the student specifically asks about them and reveal one at a time.

1.Main concern is embarrassment about having the procedure

If the student asks what these concerns are please tell them that your worry is about passing wind or opening your bowels.

2. You are also worried about when you will be told the result

;3; .... and you want to get back to work as soon as possible

Grobal score, no conferring with examiner: ability of candidate to explain the procedure to'yoo:

4 qood 3 pass 2 borderline 1 fail

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3rd Phase OSeE May 2001

Station

r-.

Candidate No. &Canc

Candidate Name

&CandName

Candidate instructions: Mr(s) Jenner has been admitted for an upper GI tract endoscopy as a day case. As a medical student in the unit you are asked to explain the procedure and answer any concerns s/he may have about it. You are NOT required to discuss the risks of the procedure NOR to ask for consent on this occasion.

Examiner Instructions: Please assess the candidate on each of the following criteria.

-. me • IJII •

Explains purpose of nterview

• • • • • • • •

1 Appropriate introduction (own name, greeting. rote- 2 to score)

Explain. operation procedure

Checks patient's prior experience or knowtedge about procedure

" Explains medication will be given to ease the discomfort and relax - mentions sprayJinjection

oJ Explains endoscopy procedure: insertion of fibre optic tube

Explains basic principles of looking in stomach/biopsy etc

Explains details of the procedure - duration

9 Explainsdetails of the procedure· awake, sedated 10 G"iVeSCorrect details of the procedure

Explai.lls post-operative procedure

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Explains details of the procedure- position, on side

11 Explains about not going home on own

12 Explains that should not drive

13 Explains that can go back to work tomorrow

14 Explains need to return to OPD/GP for the result

Elicits patient's concerns

·\5 Elicits patient's concerns about sw~llowing a tube

16 Elicits patient'sconcems about cancer

17 Elicits patient's conems about getting the result

Communication skills

18 Establishes and maintains rapport with patient throughout

19 Appropriate use of listening skills

20 Acknowledgement of and positive response to patient's feelings

1 General fluency including non-use of jargon or explanation of jargon

2 Checks patient has understood explanation

3 Ends the interview appropriately

Examiner Overall Rating: was the approach that expected of a professional?

Examiner Global Rating: overall ability of the candidate to explore patient concerns

I

onchoscopy (ctd)

Station

tre

Circuit

&Circuit

Session &Session

&CandName

Candidate No. &CandNo

1 rating: was the approach that expected of a professional?

Good Pass Borderline Pass Borderline Fail Fail 1 rating: Overall ability of the candidate to explain the procedure of bronchoscopy

Good Pass Borderline Pass Borderline Fail Fail

It overall rating: ability of candidate to explain procedure

Good

Pass Borderline Pass Borderline Fail Fail

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X-ray (chest)

Station

Centre &Centre

Circuit &Circuit

Session &Session

Candidate Name

&CandName

Candidate No. &CandNo

Candidate instructions: see sheet.

Examiner: Please rate the candidate on each of the following criteria.

· Measures cardio-thoracic ratio

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1.Gives patient's name and age

· Gives date of film

· Describes film projection (PNAP)

· Assesses centralisation of film

5. Describes extent of film (degree to which whole thorax is demonstrated)

· Describes penetration quality

7. Comments on heart silhouette

· Describes heart size

10. Describes trachea and main bronchi position.

11. Describes main lung fields systematically

12. Comments on pulmonary vasculature

13. Comments on hilar region

14. Comments on the bony structure/thoracic shape

15. Demonstrates the abnormality

16. Gives a probable diagnosiS. EXAMINER PROMPT IF NO DIAGNOSIS IS SUGGESTED

17. Offers a differential diagnosis.

18. Performs reporting witha general degree of fluency.

Examiner overall rating: was the approach that expected of a professional?

Good

Pass Borderline Pass Borderline Fail Fail

Examiner Global Rating: overall ability of the candidate to report a radiograph

Good Pass Borderline Pass Borderline Fail Fail

•

Draft outline of marksheme for IPL

INFORMA nON TO NURSE, PHYSIOTHERAPIST and OCCUP A nONAL THERAPIST

Mr & Mrs C live in a 2nd floor flat with 2 bedrooms and living room! There is no lift in the building. Mrs C is 74 years old and has mild chronic obstructive airways disease. She has never had any social support Mr C is better from his chest infection. He can get out of bed on his own and spends most of the day sitting in a chair. He washes himself when prompted to do so by the nurses. He can feed himself. He walks to the toilet with a nurse as he feels unsteady on his feet. H e has not yet tried any stairs. There is some concern that Mr C has deteriorated and that Mrs C would benefit from a home help once a week to clean the flat as she is going to have to spend more time looking after her husband. Before he goes home, he will need to be assessed for stairs; if he cannot manage them he will need to be carried up to the flat by the ambulance men.

MARKING - 1 mark for each

1. Introduces himlherself

2. Asks other team members to introduce themselves

3. States purpose of meeting ie discharge planning for MrC

4. States that Mr C now medically stable and ready for discharge

5. Reiterates statement from wife that husband can come back home if "as good as before"

6. Asks for details about housinq- house or flat, need for stairs

7. Asks about state of health of wife

8. Asks wheteher Mr C can get out of bed on his own

9. Asks whether Mr C can wash and feed himself

10.Asks whether Mr C can get to and use the toilet himself 11.Asks whether Mr C can walk unaided

12.SpecificaUy asks about whther Mr C has had a stair assessment 13.Discusses implications if Mr C cannot manage stairs

14.Asks about sleep pattern/night behaviour

15.Asks whether she thinks Mrs C can manage on her own or whether she will not help

16. Asks team to set date for discharge

17. Uses open ended questions at start of the meeting 18.Displays knowledge of different memebers of team 19.5hows respect of opinions of different team members

20.Demonstrates he/she is making sure everyone has opportunity to contribute all that is necessary

21. Summarises discussion

22. Suggests discharge plan with appropriated "package" 23.Confirms other participants are happy with this

Station

History - pain in leg

Station c::J

Centre

& Centre

&Session

Circuit &Circuit

Session

Candidate Name

&CandName

Candidate No. &Canc

Examiner Instructions: Please assess the candidate on each of the - following criteria.

1 Appropriate introduction to patient giving own name, greeting. role and patienfs name and explains what slhe is 9?ing to do (all required to score).

History details

Age

Occupation

v

Asks about pain in leg

Site calf

Site: asks about both -thigh and buttock ..--

Duration of symptoms

When does it occur (on walking) ,/"

How far can the patient walk -._;

Asks if gets rest pain ___

10 Aggravating factors (by walking uphill and into the wind) -'

11 Alleviating factors (relieved by hanging leg out of bed) I..-

12 History of MI (7 years ago had clot dissolved by thrombolysis) ./

13 History of hypertension ,/

14 Angina (no)

15

Diabetes (no)

16

eVA (no)

History of back pain (no) t/

17

e Social history

18 How does problem affect life

19 Alcohol (glasses of red wine in evening. sometimes lunchtime. whis~efore bed)

Smoking (60 cig~ttes a day) ,./

Medication (aspirin and atenolol) J

Does the patient w[Sh to add anythiflQ

see continuation sheet

.' .~

'._ '---.' ..... - _"

·station

History - pain in leg (ctd)

Station c::J

Centre

& Centre

Circuit &Circuit

Session

&Session

Candidate Name

&CandName

Candidate No. &Canc

IiiI III IIfi

( I

Interview skills

not ask more than one question at a time)

Rating: candidate's competency at eliciting a medical history

Good Pass Borderline Fail

Simulated Patient Global Rating: overall ability of candidate to communicate

Good

P;;1SS Borderline Fall

I I

• • • • • • • • • •

-

-

..... " ...... ~ ... I ... U ..... " ......... .,'"

History - Pain in leg

Candidate rnstructions: You are a medical student in a vascular surgery clinic. Mr. Chadwick has been referred to the clinic with a pain in the left leg on walking. Please elici a focused history.

Summary

The candidate needs to ask you questions to discover the nature of your symptoms.

This is a 5 minute station and you will be asked to rate the students performance agaim the reference you have been given below for'hisJher ability to communicate with you.

Description of Patient

Me Ch~dwick., a 60 year old,barrister. You are a busy man and pay little attention to the

details of your medical history' .

Setting: Outpatient clinic Dress: Smart + tie

Backgr()und

Your GP has referred you because the pain in your left leg is troublesome

•

Pain in left leg

Site of pain - calf - if asked.specificaJly- not thigh or buttocks Began about 3 months ago; it is. the same -not getting any worse . Occurs on walking. not standing or at rest

It comes on at about 300 yards on the flat

In bed, the pain comes on shortly afler lying down and ;s relieved by hanging leg out of bed Aggravated by walking uphill -the pain comes on sooner than the 300yards on the fiat and into the wind

No pain walking up or down stairs

Medical history

7 yearS ago you had a slight heart attack and had a clot (in the chest) dissolved by thrombolysis - (as discussed at the briefing - you cannot recall more details)

, Prescnbed medicines - Aspirin and atenolol, since the heartattack

•

No angina; No diabetes; No strokes (eVA)

You have not had your blood pressure checked for several years and cannot recall whether you were told that it was raised

If asked about any other problems or quality of Ine:

You cannot play golf anymore -your only relief from a busy life

You are not impotent - if asked about this specifically; no back pain

Social History

You have been married twice and have two grown up children from your first marriage and two children aged 8 and 10 from your second marriage .

. You drink a few glasses of red wine, occasionally at lunchtime but usually in the evening and have a glass of whisky before going to bed.

V.Qu smoke 60 cigarettes a day .

. '

" ,

~

1. Is this problem going to get worse?

2. You are worried that it will never .be possible to play golf again

Patient's global rating of candidate~s ability to communicate

4 good

3 pass

2 borderline

1 fail

Please teU the Examiner your opinion -do not confer

.'

• -- I

History .. Pain in leg

Station

Centre

&Centre

Circuit &Circuit

Session &Session

Candidate Name

&CandName

Candidate No. &CandNo

Candidate instructions: see sheet

States purpose of interview

IE •
,
ti6 •
~ •
.
•
•
•
•
•
I
•
I
I
•
I Examiner: Please rate the candidate on each of the following criteria. See prompts below, history gathering skills section at end and Simulated patient sheet

Communication skills

1 Introduction - greeting, own name, full name of patient, role - all to score

History details

~Age

Asks about pain in leg

5 Site calf

Site: asks about both thigh and buttock

7 Duration of Symptoms

8 When does it occur (on walking)

9 How far can patient walk

10 Asks if gets rest pain

11 Aggravating factors (by walking uphill and into the wind)

12 Alleviating factors (relieved by stopping walking)

.. -I

13 History of MI (7 yrs ago had clot dissolved by thrombolysis)

14 History of hypertension

I

15 Angina (no)

I

16 Diabetes (no)

I

17 CVA (no)

•

18 History of back pain (no)

1 Smoking (60 cigarettes a day)

• • • • • • • • • • • •

Social History

19 How does problem affect life

o Alcohol (glasses of red wine in evening, sometimes lunchtime, whisky before bed)

2 Medication (Aspirin and atenolol)

3 Does the patient have any other symptoms

24 Asks specifically about impotence

25 Does the patient wish to add anything

History gathering:

26 Asks open-ended question early in interview

Please continue on sheet two

•

- - .

- .

History .. Pain in leg (ctd)

Station

Centre &Centre Circuit &Circuit

Session &Session

Candidate Name

&CandName

Candidate No. &CandNo

Candidate instructions - see sheet

borderline pass borderilne fail

IllS •
.. •
118 •
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
.:
•
•
•
•
•
•
•
•
•
•
•
•
• Examiner: Please rate the candidate on each of the following criteria. See prompts below, history gathering skills section at end and simulated atient sheet.

7 Avoids asking more than one question at a time

8 Demonstrates active listening

9 Open to closed-ended questioning

30 Makes transition statements or signposts

31 Does not use jargon/explains if used

32 Uses summaries + accurate

3 Appropriate closure - thanks and goodbye

Examiner Global rating: candidate's competency at gathering a history of reg pain.

good pass borderline pass borderline fail faU

Examiner: was the approach that expected of a professional

_-

· Station

History - Jaundice (Weight Loss)

Station D

Centre

&Centre

Circuit &Circuit·

Session

&Session

Candidate Name

&CandName

Candidate No. &Canc

Examiner"lnstructions: Please assess the candidate on each of the following criteria. Please note prompt for differential diagnosis (item15).

1 Appropriate introduction to patient giving own name, greeting, role and patient's name and explains whatslhe is going to do (all required to score).

Elicits details of presenting complaints

Jaundice - how long I..

Abdominal pain - site, nature, radiation, etc - 2 to score /'

Weight loss

Dark urine/pale stool .-'

Nausealvomiting

Change in appetite? J

Tiredness - how long?

f.:---=----:-:----'---------------------------------------1

r 1 Fever/rigors./

12 Itching v'

Enquires about other relevant history .

Avoids leading questions

Avoids jargon and, if used, explains meaning

see continuation sheet

/"

.....

. :~'

1.

_.

. Station

History - Jaundice (Weight loss) ctd

Centre

&Centre

Circuit &Circuit

Candidate Name

&CandName

Examiner Global Rating; candidate's competency at eliciting a medical history

Simulated Patient Global Rating: overall ability of candidate to communicate

•

station .. D

Session

Candidate No. &Canc

Borderline Fail

Good

Pass Borderline Fail

&Session

Simulated Patient Script

History of Jaundice

Candidate instructions: Mrls Roberts is a 55 year old successful engineer, happily married with 3 children. who has recently developed jaundice. The GP has referred the patient for further investigations - the patient has been a previously well non- smoker and never had any prescribed medication or operations. Please take a focussed

history relevant to the presenting complaint. The Examiner will ask you for your differential diagnosis.

Summary

The candidate needs to ask you questions to discover the nature of your symptoms. This is a 5 minute station and you will be asked to fate the studenfs perfonnance against the reference you have been given below for hislher ability to communicate with you.

e Description of Patient

Mrls Ro~erts , 55 year old successful engineer, happily married with 3 children - Not thin; you are overweight for your height and may have lost some. weight recently -fewer pub lunches

Setting: Outpatient clinic Dress: Smart casual . Mood - relaxed -nil particular

Background

Your partner noticed that you were looking slightly yellow and so you went to see you r GP who referred you to the clinic today

'-"'.

Please only give details to specific questions

If asked, this observation of looking yellow was one week ago. Over the past week the yellowness has become more noticeable. You have never had this before.

Further recent medical history

You have been feeling 'under the weather' for several months - if asked, explain that

you mean more tired! weary. .

You have noticed pain on the right upper side of your abdomen. This has been on and off over 6m, not every week - short attacks, lasting up to 24 hours.

The pain is sharp. H does not go anywhere else. Nothing seems to help it go -e.g. paracetamol, hot water bottle- so_you've just tried to ignore it

You have noticed that mayonnaise andother foods like pie and chips at the pub' seem to bring on the pain -you've been avoiding these.

If asked, this past week your urine has seemed darker than usual; your stools are like toothpaste (if asked, explain that you mean like toothpaste in colour and consistency!). Also the stools are difficult to flush away and rather smelly.

No itching; no fevers or shakes Ntfflausea. vomiting

Nd··~hange in bowel habit in terms of how often- you still go at least once a day and no blood seen but. ..• (as discussed at briefing - give a lead here that something ts

diiferentj

You are overweight for your height and may have lost some weight recently -fewer put lunches. Appetite normal between attacks

Other information

Never travelled outside Europe

You worK for a factory and do not go on site visits - no recent exposure to river water No previous operations; no blood transfusion

No knowledge of contact with others who have jaundice No drugs -recreational or prescribed

No hepatitis, no gallstones but your mother did have these

Non-smoker

Occasional glass of wine at the weekends

Patient's global rating of candidate's ability to communicate

4 good·

..

3 pass

2 borderline

1 fail

• Please tell the Examiner your opinion -do not confer

station

History - Retention of Urine (AUR)

Station ~

Cenue

&Centre

Circuit &Circuit

Session

&Session

Candidate Name

&CandName

Candidate No. &Canc

Examiner Instructions: Please assess the candidate on each of the following criteria. Please note prompt (item 19).

Appropriate introduction to giving own name. greeting.

what slhe is going to do (aU required to spore).

patienfs name

Borderline

/

/

Drug history /'

History of

. 7 _ Effect of urinary symtoms on normal activities h''''l-nnl taking

diagnosis: (benign prostatic hyperplasia, Ca prostate).

jner to prompt if not

given.

Summary

'atient Global Rating: overall ability of candidate to communicate

Simulated Patient Script

Retention of Urine

Candidate Instruction: A 74 year old man presents to t!1e Accident and Emergency Department complaining of an inability to pass urine. Please take a focussed history

Summary .

An elderly man who is lying on a trolley in Accident and Emergency waiting to be examined. His wife is with him and he is trying to maintain a brave front but is distressed and in pain.

Background

Mr Ashboume has been adr:nitted to the Accident and Emergency Department because he has not passed any urine for the past 6 hours.

Medical History

He has not been able to pass urine for the last 6 hours and feels that he wants to. He ha a feeling of fullness and discomfort in the lower part of his abdomen.

For the past 5 years he has noticed that the stream of urine has slowed down .and he has difficulty starting. He hasn't noticed any leaking of urine between going to ~·toilet but occasionally when he has finished and left the toilet he has noticed some dribbles of urinE in his pants. There is no urgency when he wants to pass urine. In the daytime he has to pass urine more frequentJy and also likes to know that if he goes out there are toilets available. This has meant that he has turned down some social invitations. ~t nighttime he has found that he has to get up to pass urine 5 or 6 times. It's not painful to pass urine at any time. He has had no previous pain.

He takes Coedine phosphate for a pain in his knee. He cannot take non-steroidal antiinflammatory drugs (NSAIDs)

Personality .

Mr Ashboume is 74 and retired. He was an insurance clerk.with the same company all his working life. He is married and lives at home with his wife who is in her late sixties. He has two children who are married with children and live nearby, He is enjoying his retirement, spending time with his grandchildren as weil as working on his allotment. He is a 'private' man who does not like to make a fuss and has had no illnesses that have required admission to hospital.

He thinks he has 'prostate trouble' - 'the old man's disease'. He is worried about having a catheter and the need for an operation.

He is slightly embarrassed and frightened but is trying not to show it.

Brief for Actor

. H.e is wearing a patient's gown and is covered by a blanket. His shoes have been 1:e,moved. (Keep·your clothes on under the gown ready for the next station)

-... :.