Role Play- Scenarios



Role Play- Scenarios

We have provided some examples of sexual histories that you may want to role play with your fellow students- everyone should practice to be a doctor and a patient at least once

Cases 1-3 focus on HIV testing

Cases 4-7 focus on sexual history taking

Case Scenario 1 – Patient

You are 42 years old.

You were born in Zambia but have lived in the UK for over 5 years. Your partner died in Zambia before you moved to the UK. They had been unwell for some time but you were never sure exactly what they died from.

You have had no partners since then.

You have 3 teenage children who are well.

You have had a rash with blisters on your back for 2 days.

If asked by the doctor you also had some oral thrush last year.

You have never had an HIV test before and don’t understand why you need one now.

Case Scenario 1 – Doctor

You are a GP.

This patient has a clinical diagnosis of shingles.

You don’t need to take a full sexual history but ask about HIV risk and consent the patient for an HIV test.

Observer

Things to consider

• Did the healthcare worker explain the benefits of testing?

• Did they establish any risk for HIV infection or presence of indicator diseases?

• Did they get consent for the test?

• Is the window period important here?

• Did they arrange for the patient to receive the result?

When giving feedback, start by mentioning all the things that were done well before mentioning some areas that could maybe be improved on

Case Scenario 2 – Patient

You are a 28 year old heterosexual male and moved to the UK from Russia 2 years ago. You are married with 2 young children.

You are very surprised when the doctor says you need an HIV test.

You have injected drugs in the past but none since coming out of prison 8yrs ago

You have never had an HIV test before.

You had a short admission to hospital for pneumonia 2 years ago but otherwise were well until this illness.

Case Scenario 2 - Doctor

You are the FY2 on the medical assessment unit.

A patient has presented with a history of fevers, weight loss and productive cough. He has some palpable lymph nodes. His CXR shows some apical shadowing and cavitations.

Your consultant makes a presumptive diagnosis of TB and asks you to talk to the patient about HIV testing.

Observer

Things to consider

• Did the healthcare worker explain the benefits of testing?

• Did they establish any risk for HIV infection?

• Did they get consent for the test?

• Did they explain the presence of indicator disease

• Did they arrange for the patient to receive the result?

When giving feedback, start by mentioning all the things that were done well before mentioning some areas that could maybe be improved on

Case Scenario 3 – Patient

You are a 45 year old man and have recently moved from another part of London and want to register with a local GP.

You are very surprised when you are offered an HIV test. You don’t understand why you need a test. You are not unwell. You have never had a test but you used to be a blood donor, last giving blood about 15 years ago.

You have a regular male partner with whom you have been for 10 years and have unprotected oral and anal sex. You have had no other partners. You don’t know if your partner has ever had an HIV test.

You have never had sex with anyone from a high prevalence country. You have never injected drugs.

On further questioning you remember a recent flu like illness and a faint rash which settled by itself.

You want to know what the point of testing is as you feel so well.

You want to know how to get you results.

Case Scenario 3 – Nurse

You are a practice nurse in a central London GP practice. You are seeing a patient for a new patient registration visit.

It is routine in your surgery to offer a test to all new patients

Observer

Things to consider

• Did the healthcare worker explain the benefits of testing?

• Did they establish any risk for HIV infection or presence of indicator disease?

• Did they consider seroconversion illness?

• Did they get consent for the test?

• Did they explain the window period?

• Did they arrange for the patient to receive the result?

When giving feedback, start by mentioning all the things that were done well before mentioning some areas that could maybe be improved on

Learning points - Scenario 1-3

• Natural history of disease

• Benefits of knowing status

• Possibility of seroconversion illness considered

• Other indicators of HIV infection

Case Scenario 4 – Patient

You are a 25 year old female.You don’t have any symptoms

You have never had an STI screen or an HIV test in the past

You have a regular male partner with whom you have been having sex without condoms for 2 years. You use the COCP for contraception

You had unprotected sex with 2 different casual partners while on a 3 week holiday from which you returned 2 weeks ago. You had been travelling with 2 of your friends who are single, and had been drinking a lot of alcohol.

You are worried you may have caught something and that you may be putting your regular partner at risk. You have not had sex with your regular partner since coming back from holiday as you don’t want to pass anything on.

Case Scenario 4 – Doctor

A 25 year old female comes to see you in the GUM clinic.

Take a history, including a sexual history.

Observer

Things to consider

• Did the doctor introduce him/herself?

• Was there good rapport between patient and doctor?

• Did the doctor appear comfortable taking the history?

• Did the doctor make the patient feel comfortable?

• Did the doctor warn the patient about the personal nature of the questions that would be asked?

• Was the language used easy to understand or was jargon used at all?

• Was the doctor judgemental?

• Was the patient reassured about confidentiality?

• Did the doctor manage to get all the main points from the history?

When giving feedback, start by mentioning all the things that were done well before mentioning some areas that could maybe be improved on

Case Scenario 5 – Patient ( can be male or female)

You are 22 years old and very anxious and distressed.

You have never been to a GUM clinic before.

You have noticed multiple small lumps around your genitals which have been there for several weeks. They are not itchy or painful. You have not had anything like this before and are very worried.

You do not have any other symptoms.

You have a regular partner of 1 year with whom you usually use condoms.

You last had vaginal sex 1 week ago, using a condom.

You have not had any other partners in the last year and are worried that you partner is cheating on you and has given you this infection.

You are otherwise fit and well, on no medication and with no allergies.

Case Scenario 5 - Doctor

A 22 year old person comes to see you in the GUM clinic.

They are very anxious and distressed.

Take a history including a sexual history.

Observer

Things to consider

• Did the doctor introduce him/herself?

• Was there good rapport between patient and doctor?

• Did the doctor appear comfortable taking the history?

• Did the doctor make the patient feel comfortable?

• Did the doctor warn the patient about the personal nature of the questions that would be asked?

• Was the language used easy to understand or was jargon used at all?

• Was the doctor judgemental?

• Was the patient reassured about confidentiality?

• Did the doctor manage to get all the main points from the history?

When giving feedback, start by mentioning all the things that were done well before mentioning some areas that could maybe be improved on

Case Scenario 6 – Patient

You are 18 year old female

You became unwell about 4 days ago with flu-like symptoms. You then developed painful blisters and ulcers around your genital area. It is painful to pass urine. You haven’t had any discharge. You’ve never had anything like this before and are very worried.

You have a regular partner of 6 months. You used condoms initially but haven’t used them for the last few months. You use the COCP as contraception. You last had vaginal and oral sex with your regular partner 6 days ago.

You are feeling very guilty as you received oral sex from a casual partner (a work colleague) at a party 10 days ago. You are worried you may have caught something from them. You had consumed quite a lot of alcohol.

You have never had cold sores and don’t think your regular partner has. You don’t know about your work colleague.

You are otherwise fit and well and don’t take any medication. You are allergic to penicillin.

Case Scenario 6 – Doctor

You are a General Practitioner.

An 18 year old comes to see you in your surgery.

Take a full history.

Observer

Things to consider

• Did the doctor introduce him/herself?

• Was there good rapport between patient and doctor?

• Did the doctor appear comfortable taking the history?

• Did the doctor make the patient feel comfortable?

• Did the doctor warn the patient about the personal nature of the questions that would be asked?

• Was the language used easy to understand or was jargon used at all?

• Was the doctor judgemental?

• Was the patient reassured about confidentiality?

• Did the doctor manage to get all the main points from the history?

When giving feedback, start by mentioning all the things that were done well before mentioning some areas that could maybe be improved on

Case scenario 7 – Patient

You are a 26 year old homosexual man

You have had some pain passing urine and some clear urethral discharge for the last 2 days. You have had some bowel symptoms with painful defaecation and slurry stools in the last few weeks..

You don’t have a regular partner but have had sexual contact with 4 or 5 men in the last 3 months. You usually use condoms for anal intercourse but you had unprotected receptive anal intercourse at a party 1 week ago. You also received oral sex from the same partner.

You have never had an STI screen or an HIV test before. Within the last 3 months apart from the episode mentioned you have had no other unprotected anal intercourse.

You have not been vaccinated against hepatitis A or B.

You don’t drink alcohol but do occasionally smoke cannabis.

Case Scenario 7 – Doctor

A 26 yr old man comes to see you in the GUM clinic

Take a history including a sexual history

Observer

Things to consider

• Did the doctor introduce him/herself?

• Was there good rapport between patient and doctor?

• Did the doctor appear comfortable taking the history?

• Did the doctor make the patient feel comfortable?

• Did the doctor warn the patient about the personal nature of the questions that would be asked?

• Was the language used easy to understand or was jargon used at all?

• Was the doctor judgemental?

• Was the patient reassured about confidentiality?

• Did the doctor manage to get all the main points from the history considering the possibility of other sexually related infections

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