Simulated Patient Instructions



Patient Instructions

Name of Patient:

Andrew Smith

Description of the patient & instructions to simulator:

You are a 42 year old male, who is usually fit and well. You have a wife and small child at home, you work full time in an office.

For the last 5 days you have been feeling unwell with a runny nose, sore throat and dry cough. If asked you have not had any chest pain, not had any fevers, not coughed blood up, not coughing any sputum up, no recent weight loss, no night sweats.

You had a similar problem about 4 years ago and was given antibiotics for a ‘chest infection’, you think that you have the same thing again and that this will make it get better quickly.

You are already annoyed and angry at the surgery due to a telephone assessment earlier in the week telling you that you had a cold and that nothing needs to be done. Having not been properly assessed you feel fobbed off and angry that no-one saw you, if this isn’t acknowledged by the doctor then your rapport with them will be limited.

You are particularly concerned about a wedding at the weekend, you are the best man and don’t want to look like an idiot coughing and spluttering everywhere. You feel that a course of antibiotic is the only treatment that could possibly work and unless explained to properly that you have a viral illness and that antibiotics will be ineffective you will be argumentative if they are denied

Doctor’s (GP ST) Instructions

Name & age of patient Andrew Smith

Summary Card

PMH: None

DH: None

Allergies: None

BP/BMI/ ?smoking and alcohol hx: 130/70, BMI 26, Non-smoker, 8 units ETOH a week

Case Notes - Last few entries in records:

Friday 26/8/16

Telephone assessment

- Sore throat, runny nose, dry cough, no fevers, no pain, not SOB, advised likely viral illness, self help advice, TRIN

April 2012

- Cough with green sputum, crackles on chest, LRTI, Plan - amoxicillin

CSA EXAMINATION CARD

Patient Name:

Andrew Smith

Examination findings:

HR 75, BP 132/68, RR 16, SpO2 98%, T 36.8

Chest – clear, normal percussion note, equal air entry

Heart sounds normal

Throat and ears – normal

No cervical lymphadenopathy

CSA Case Marking Sheet

|Case Name: Smith – Angry, antibiotics |Case Title: Angry viral illness |

|Context of case | |

|42 yr old, wanting abx for viral symptoms, gets angry if denied and | |

|doesn’t understand | |

|Assessment Domain: | |

|1. Data-gathering, technical and assessment skills | |

|Positive descriptors: |Negative descriptors: |

|ICE and Psycho-social impact explored |Doesn’t exclude red flags |

|Excludes red flags, appropriate focused questions |Doesn’t acknowledge consultation earlier in week |

|Acknowledges and discusses frustration of tele triage |Doesn’t examine |

|Examines appropriately | |

|Assessment Domain: | |

|2. Clinical Management Skills | |

|Positive descriptors: |Negative descriptors: |

|Doesn’t prescribe antbx |Give antibiotics |

|Clear explanation of illness and reasons for not prescribing antbx |Fails to explain viral illness |

|Suggests OTC remedies or prescription of cough suppressants |Fails to safety net/offer follow up |

|Clear safety net, offers early follow up | |

|Assessment Domain: | |

|3. Interpersonal skills | |

|Positive descriptors: |Negative descriptors: |

|Allows ventilation. |Doesn’t elicit ICE |

|Listens to concerns and shows empathy of situation |Doesn’t establish rapport |

|Explores social worries and looks to offer solutions |Doesn’t listen or show empathy or understanding |

|Builds and maintains rapport |Uses complex medical language |

| | |

|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 | |

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