Dixie or Darrell Osborne Proofing Pro-Forma



Martha Skinner

Recruitment Guide

Age: 68

Allowable Range for SP: 60-75

Medical Conditions to Avoid:

Physical Characteristics:

Gender: Female

Race: Caucasian

Props: None

Patient Health History Questionnaire Data:

Patient Chart Note Data: (Items to be withheld so that student might ask about them are not listed)

Name:

DOB (SP’s in the year that comes to this age): 68

Date: (Use that of the day of the student encounter or leave blank)

Age: 68

Vital Signs at time of encounter:

Temp: 97.9

BP: 110/70

Pulse: 90

Respiration: 14

Weight: (what is SP’s own?): ___________

Height: (what is SP’s own?): ____________

CC: Weight Loss

Allergies:

Any Lab Reports, Images, Test Results or Findings Cards:

None

Martha Skinner

University of Kansas School of Medicine

Standardized Patient Program, Office of Medical Education

Standardized Patient Facts

Write your real name here___________________________________________

Make plans now to…

• Keep this document secure. Do not show it to anyone outside of this program.

• Keep the information on it confidential. Do not discuss the facts with anyone. If asked about it, reveal only general information about what you are doing, not any of the facts at all. The reason for these precautions is that this case constitutes an official medical school examination which represents thousands of dollars of development value. If it were revealed even to someone unconnected to the medical school the information could eventually make it back to a student and so couldn’t be used any more.

• Bring the document to all training sessions and performances. Before each session read through it once, say at home before you leave. When you find yourself unsure of a fact during training or performance, look it up as soon as possible. After each session read through it once again. You will want to leave the document with your things when you get ready for an encounter in an examination room.

Development of the Standardized Patient (sp) Role

When you see the doctor “as yourself,” you answer questions with facts about yourself; no problem. You don’t need to learn these patient facts because they are about your experience and history. They are facts in which you are the expert.

When you see a student or resident doctor “as the sp,” you do the same thing—answer with facts, only then the facts are about the sp. Since you aren’t really the sp, his or her facts must be learned. Then, it is simple to answer questions as if they were being asked of yourself.

In order to prepare to answer as the sp, please study the facts and a few directions for your case below. Once you can pass a quiz over these facts you will be ready for the next step. That step will be to practice answering questions as if you are the standardized patient. If someone helps you learn the facts, stick to answering just with facts and don’t skip ahead yet to answering in role. That will be made easier when you have first concentrated on and mastered the facts.

Martha Skinner, 68

Set Up: Martha Skinner is coming to this clinic for the first time, her previous primary care provider having recently retired. She is a 68 year old divorcee who lives alone.

Chief Complaint: (Say this exactly) “I’m concerned about my losing weight.”

Story Line: Martha Skinner is coming to the doctor’s office today because she is concerned about weight loss. She has lost 25 pounds unintentionally over the last year and in general doesn’t feel good. She worries that she might have cancer like her sister did when she started losing weight, but she doesn’t disclose this to the student unless he/she asks what she is worried about. She has very little interest in food and her appetite has been poor. However, she does not feel that her overall food intake has changed significantly

Patient Profile: Ms. Skinner has lived in the KC area since she was 10. She was divorced when she was 42 and has never remarried. She has lived in the same house for the last 35 years. She retired two years ago, having been employed for some 30 years as a secretary at an elementary school, and her sole means of support is a monthly social security check of $875. Martha leads a quiet, simple life. Her lifelong hobbies are gardening and quilting. She never learned to drive, and thus she doesn’t go out much. When she leaves the house, she goes to the store or to the doctor’s office (she is on a bus route), or one of her sons picks her up for a family outing. Her two sons live in the area and she talks to both of them about once a week. While her sons are both married, she has no grandchildren.

When she is asked what she does to keep busy, she says that she is not sure.

Because she has difficulty getting to sleep and is often up until 2 am watching TV, she gets up late in the morning. And she has never been one to eat breakfast. She spends the day watching some TV or reading the newspaper.

History of Present Illness:

Location: Unintended weight loss

Severity: 25 lbs in the past year

Timing: Gradual over the past 12 months; one year ago weight had been stable at _____ (SP’s weight plus 25 lbs.) for a number of years.

Aggravating or relieving factors: None

Associated symptoms (what else is (or is not) going on):

• No fevers, chills, night sweats

• Energy level is low; she tires easily if she plans too much activity in one day.

• No difficulty swallowing. She has her own teeth and they are in good shape. (if you as an SP have dentures, they fit well and do not impede eating)

• No chest pain or palpitations

• Some productive cough in the morning (“smokers cough”) but it does not continue during the day and is not a problem at night. No shortness of breath

• No heartburn symptoms. No pain in abdomen. No blood in stools. No nausea or vomiting. She struggles with constipation chronically and has to resort to enemas about two times a month for severe constipation. No diarrhea

• No swelling in legs

• No hair loss or cold intolerance

• Some mild arthritis in knees

• She has insomnia; often unable to sleep until 2 am. She sleeps late in the mornings, and does not usually nap during the day.

Past Medical History and Current Status

Childhood illnesses: None (other than lots of sore throats)

Adult illnesses: Seasonal allergies (nasal)

Accidents & injuries: None

Operations: Tonsillectomy as a child

Hospitalizations: Vaginal births of two children in the 1960s

Pneumonia when she was 58

Current Medications: Claritin when her allergies act up

Benadryl when she can’t sleep

Fleet enema as needed for constipation

Allergies: Seasonal

Tobacco: ½ pack a day for the past 45 years (started about the time she started working)

Diet:

• Sleeps through breakfast and has never been much of a breakfast eater anyway

• Drinks two cups of coffee in the morning

• Takes the city bus to the grocery store about once every two weeks.

• Intake of fresh vegetables and fruits is poor

• Does very little “real cooking” these days and typically eats canned soup or frozen meals

• Sometimes makes peanut butter and jelly sandwiches

• Drinks water with lunch and dinner and sometimes at other times during the day and evening.

• Doesn’t like milk or yogurt

• A typical snack is potato chips

• Eats out about once a month when one of her sons takes her to a restaurant

• Has very little interest in food and her appetite has been poor; however, she does not feel that her overall food intake has changed significantly

Screening tests: Normal mammogram and pap smear within the past year. She had screening colonoscopy 3 years ago and was told that it was totally normal and she didn't need to repeat it for 10 years.

Alcohol, drugs, related substances: Never

Immunizations: None

Environmental hazards: None

Use of safety measures: Doesn’t drive and wouldn’t think of having a gun in her house.

Family Medical History:

Father:

Mother:

Siblings: Older sister died of colon cancer 18 months ago.

Sons: Good Health

Bio-Psycho-Social History:

Record of Family Members:

Parents: Mother died at age 92 of pneumonia, and father died in his 60s of a heart attack.

Siblings: Brother, age 70, lives in Minnesota and she rarely hears from him; no known medical problems; Older sister passed away 18 months ago from colon cancer.

Children: Two sons, Matthew and Stephen, ages 42 and 40. Both married; no children. They are both in good health.

Occupation: Retired after 30 years as a school secretary in the principal’s office

Socioeconomic Status: Lower middle class

Marital/Partner status: Divorced 24 years ago. No sexual activity since then.

Sleep Pattern: She has insomnia; often unable to sleep until 2 am. She sleeps late in the mornings, and does not usually nap during the day.

Leisure activities: Gardening and quilting, both of which she really doesn’t do anymore

Support Systems: Her two sons

Important Life Experiences: Raising two boys and working 30 years as a secretary at the local elementary school

Religious Beliefs: None

Review of Systems

General: Unintended weight loss; tires easily

Respiratory: Morning cough

Musculoskeletal: Mild arthritis in knees

Gastrointestinal: Struggles with constipation chronically and has to resort to enemas about two times a month for severe constipation.

Psychiatric: Mood is ok, doesn’t feel depressed. Performs fewer activities because she is tired, but does not feel sad.

What to Expect in Physical Exam: None

Body Language, eye contact, mannerisms, etc.

• Looking a little anxious (do not smile when student enters the room)

• Poor eye contact

• Fidgeting somewhat with her hands

• Feeling somewhat scared (i.e., because her weight loss might mean she is dying of cancer like her sister did 18 months ago)

Communication: Poor eye contact

Does the SP have a hidden agenda? No.

Student Instructions:

This is your first time seeing Martha Skinner. She presents to your office with complaint of unintentional weight loss over the last year.

Interview this patient about her problems. You are not expected to perform a physical exam. You have 20 minutes to complete this interview. After the encounter you will receive feedback from the patient. After the patient feedback, you will be asked to formulate a list of reason(s) you think Ms. Skinner is losing weight in order of decreasing likelihood.

Student Post-Encounter Checklist:

Top of Form

[pic][pic][pic][pic]History (Hx)

|1. Asked about my normal diet |[pic]Yes [1] |[pic]No [0] |

|2. Asked how I get my groceries |[pic]Yes [1] |[pic]No [0] |

|3. Asked about my appetite |[pic]Yes [1] |[pic]No [0] |

|4. Asked about my ability to afford food |[pic]Yes [1] |[pic]No [0] |

|5. Asked about my living situation |[pic]Yes [1] |[pic]No [0] |

|6. Asked about my bowel movements |[pic]Yes [1] |[pic]No [0] |

|7. Asked about my ability to chew and/or swallow |[pic]Yes [1] |[pic]No [0] |

|8. Asked about my mood or if I felt depressed |[pic]Yes [1] |[pic]No [0] |

|9. Asked about my support system |[pic]Yes [1] |[pic]No [0] |

|10. Asked about abdominal pain or heartburn |[pic]Yes [1] |[pic]No [0] |

Interpersonal Communication (IpC)

|11. Greeted me warmly, confidently introduced self and called me by name |[pic]Yes [1] |[pic]No [0] |

|12. Used words I could understand (no medical jargon) |[pic]Yes [1] |[pic]No [0] |

|13. Maintained eye contact much of the time (but not excessively) |[pic]Yes [1] |[pic]No [0] |

|14. Used appropriate body language/posture, on patient’s level (e.g. |[pic]Yes [1] |[pic]No [0] |

|Nodding, leaning forward, facial expression) | | |

|15. Listened with interest and did not interrupt while I was talking; not |[pic]Yes [1] |[pic]No [0] |

|bored | | |

|16. Was respectful, friendly, never crabby, rude, arrogant or scolding |[pic]Yes [1] |[pic]No [0] |

|17. Asked about my feelings, concerns about my situation and how it may |[pic]Yes [1] |[pic]No [0] |

|affect me | | |

|18. Was professionally dressed, clean in appearance |[pic]Yes [1] |[pic]No [0] |

Satisfaction with Encounter (Sat/Enc)

|19. I was satisfied with the encounter. If marked "No," explain in the |[pic]Yes [1] |[pic]No [0] |

|comment section below | | |

Post-Encounter Discussion (SP's Notes)

|20. List issues you can use |[pic] |

|to lead the post-encounter | |

|discussion | |

Satisfaction with Feedback (Sat/Feedback)

|21. Student was positive and receptive to feedback; not defensive. If marked|[pic]Yes [1] |[pic]No [0] |

|"No," explain in the comment section below | | |

Optional Comment (Opt)

|22. Please provide |[pic] |

|additional comments about | |

|this encounter or the | |

|feedback here. | |

|Please be specific with | |

|comments and provide | |

|examples. | |

Bottom of Form

Encounter-Day Preparation:

A. Dress

• Clothed and sitting on a chair in the exam room

• Hygiene and grooming are fair

• No visible abnormalities

• Appearance is somewhat dowdy (not stylish; drab; old-fashioned)

B. Props (All items to have in the room): A purse with a package of cigarettes

Any Lab Reports, Images, Test Results or Findings Cards: None

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