<p> Patient Instructions</p><p>Name of Patient: </p><p>Mrs Johstone age 48</p><p>Description of the patient & instructions to simulator: </p><p>Married, two teenage children, both were normal vaginal deliveries at birth, no forceps or tears. Lives with husband who had a vasectomy years ago</p><p>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 </p><p>Very rarely stress incontinence when lifting or coughing</p><p>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)_</p><p>Last smear 2 years ago = normal</p><p>Avoids tea and coffee as that seems to make it worse No thirst, wt loss or fatigue, no family hx of diabetes </p><p>No pain on passing urine and no blood in urine</p><p>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</p><p>Previous medical history Nil except for hip pain due to trochanteric bursitis </p><p>Non smoker</p><p>Little alcohol x1 a week (half a bottle of wine)</p><p>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?</p><p>1 Doctor’s (GP ST) Instructions</p><p>Name & age of patient Mrs Johnstone 48</p><p>Summary Card PMH: Trochanteric bursitis 1998 DH: Nil Allergies:Nil BP/BMI/ ?smoking and alcohol hx: Not seen in last 3 years</p><p>Case Notes - Last few entries in records:</p><p>2010 – laryngitis, came as going on hols, hoping for an antbx – advice given</p><p>2 CSA EXAMINATION CARD</p><p>Patient Name:Mrs Johstone</p><p>Examination findings:</p><p>Urine dip test negative for blood, leucocytes nitrites and glucose</p><p>Abdominal examination normal </p><p>Vaginal examination normal, no evidence of prolapsed with good pelvic tone</p><p>BMI 31</p><p>3 CSA Case Marking Sheet Case Name: Mrs Johstone Case Title: Context of case </p><p> Overactive bladder which has caused a massively embarrassing incident at work</p><p>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</p><p> Establishes ICE and psychosocial impact  Inappropriate examination</p><p> Appropriate examination (abdo and  No urine dip test offered vaginal)</p><p> Urine dip test (MSU if test abnormal)</p><p> Appropriate bloods e.g. Hba1c</p><p>Assessment Domain: 2. Clinical Management Skills Positive descriptors: Negative descriptors:</p><p> Offers chaperone  No chaperone </p><p> Explain likely diagnosis OAB  Little explanation or confusing explanation</p><p> 3 day bladder dairy  No bladder diary</p><p> Advice re wt loss  Options don't make sense</p><p> 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</p><p> Offer of a PIlealfet re incontinence and bladder training and continence aids</p><p> Review with diary results</p><p> Reassurance re tablet treatment will be an option as is referral to the local continence service</p><p>Assessment Domain: 3. Interpersonal skills Positive descriptors: Negative descriptors:</p><p> Empathic re incontinence  Lacks empathy </p><p> ICE explored  Incomprehensible explanations which break rapport  Negotiated management plan</p><p>4  No shared decision making</p><p> </p><p>Other aspects e.g. time keeping, consultation structure, comment on consultation skills etc Positive descriptors: Negative descriptors: </p><p>  </p><p> </p><p>Grading: Clear pass = 3, Marginal Pass = 2, Marginal Fail = 1, Clear Fail = 0</p><p>Data Gathering Score = Clinical Management Score = Interpersonal Skills Score = Total for case = (max = 9)</p><p>5</p>