Simulated Patient Instructions
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Patient Instructions
Name of Patient:
Mrs Johstone age 48
Description of the patient & instructions to simulator:
Married, two teenage children, both were normal vaginal deliveries at birth, no forceps or tears. Lives with husband who had a vasectomy years ago
Last 2 years increased frequency and urgency occ accident – now has to wear pads Daytime up to 10 times a day, often small volumes Night time x 2 per night
Very rarely stress incontinence when lifting or coughing
LMP 3 weeks ago, no post coital bleeding, no intermenstrual bleeding, regular periods ‘ like clock work’ 7/27. No symptoms of prolapse (like something coming down)_
Last smear 2 years ago = normal
Avoids tea and coffee as that seems to make it worse No thirst, wt loss or fatigue, no family hx of diabetes
No pain on passing urine and no blood in urine
Just had a very embarrassing accident when she could not get to the loo in time at work (secretary in IT company) – mortified – hence appt – needs something to get things sorted as soon as possible
Previous medical history Nil except for hip pain due to trochanteric bursitis
Non smoker
Little alcohol x1 a week (half a bottle of wine)
Ideas – It's an aging thing Concerns – So embarrassing! Would like treatment today if possible Expectation – Something to get things better asap, might pelvic floor exercises help?
1 Doctor’s (GP ST) Instructions
Name & age of patient Mrs Johnstone 48
Summary Card PMH: Trochanteric bursitis 1998 DH: Nil Allergies:Nil BP/BMI/ ?smoking and alcohol hx: Not seen in last 3 years
Case Notes - Last few entries in records:
2010 – laryngitis, came as going on hols, hoping for an antbx – advice given
2 CSA EXAMINATION CARD
Patient Name:Mrs Johstone
Examination findings:
Urine dip test negative for blood, leucocytes nitrites and glucose
Abdominal examination normal
Vaginal examination normal, no evidence of prolapsed with good pelvic tone
BMI 31
3 CSA Case Marking Sheet Case Name: Mrs Johstone Case Title: Context of case
Overactive bladder which has caused a massively embarrassing incident at work
Assessment Domain: 1. Data-gathering, technical and assessment skills Positive descriptors: Negative descriptors: Details frequency, urgency, stress incontinence symptoms Inadequate exploration of symptoms Explores issues which might exacerbate the situation - coffee, tea, alcohol Failure to exclude potential sinister disease, underlying diseases or exacerbating Details Prior O&G hx, LMP, PCB, IMB, factors Discharge etc symptoms of prolapsed ICE and psychosocial impact not explored Explores symptoms of diabetes, UTI etc AND utilised in the consultation
Establishes ICE and psychosocial impact Inappropriate examination
Appropriate examination (abdo and No urine dip test offered vaginal)
Urine dip test (MSU if test abnormal)
Appropriate bloods e.g. Hba1c
Assessment Domain: 2. Clinical Management Skills Positive descriptors: Negative descriptors:
Offers chaperone No chaperone
Explain likely diagnosis OAB Little explanation or confusing explanation
3 day bladder dairy No bladder diary
Advice re wt loss Options don't make sense
Advice re may need bladder training rather Options don't seem relevant to her than tablets but they would also be an Inappropriate early referral option
Offer of a PIlealfet re incontinence and bladder training and continence aids
Review with diary results
Reassurance re tablet treatment will be an option as is referral to the local continence service
Assessment Domain: 3. Interpersonal skills Positive descriptors: Negative descriptors:
Empathic re incontinence Lacks empathy
ICE explored Incomprehensible explanations which break rapport Negotiated management plan
4 No shared decision making
Other aspects e.g. time keeping, consultation structure, comment on consultation skills etc Positive descriptors: Negative descriptors:
Grading: Clear pass = 3, Marginal Pass = 2, Marginal Fail = 1, Clear Fail = 0
Data Gathering Score = Clinical Management Score = Interpersonal Skills Score = Total for case = (max = 9)
5