Simulated Patient Instructions



Patient Instructions

Name of Patient:

Gemma Watkins-Glenn age 21

Description of the patient & instructions to simulator:

You are 11 weeks pregnant and have has increasing morning sickness over the last month.

Had a booking appointment with your midwife 1 week ago – everything ok

Due to stop folic acid next week

Dating scan confirmed a singleton fetus

Nausea worse in morning, vomits after meals, still drinking fluids. Your mum advised toast before you got up but this has not helped

Married, non smoker and no alcohol

One prior pregnancy, no complications, daughter now age 2 – only minor nausea in that pregnancy

No urinary symptoms

No abdo pain

No fever

Last passed urine 4 hours ago, not dark

Otherwise well in your self

No dizziness on standing or feeling weak

Struggling to work - works as a cook in Mc Maggots restaurant, supervisor (man) not supportive in any way. Morning shifts are a nightmare fir you with the nausea

Ideas – morning sickness

Concerns – vomiting at work

Expectations – sympathy and advice and possibly medication

YOU ARE RINGING FROM WORK – UNABLE TO COME TO SURGERY AS ON SHIFT FOR ANOTHER 8 HOURS AND GO ON HOLIDAY TOMORROW (SCOTLAND)

Doctor’s (GP ST) Instructions

Name & age of patient Gemma Watkins-Glenn age 21

Summary Card

PMH: NVD baby daughter 2 years ago

DH:Nil

Allergies: Nil

BP/BMI/ ?smoking and alcohol hx: Non smoker

Case Notes - Last few entries in records:

Midwife – Second pregnancy (1st NVD no complications), booking bloods done, low risk pregnancy, booking pack provided

CSA EXAMINATION CARD

Patient Name: Gemma Watkins-Glenn age 21

Examination findings: N/A as tele consult

CSA Case Marking Sheet

|Case Name: Tele consult |Case Title: Hyperemesis |

|Context of case | |

|Advice consultation | |

|Assessment Domain: | |

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

|Positive descriptors: |Negative descriptors: |

|Previous obstetric hx |No red flags (indicators for admission) |

|Enquired re dating scan |SPICE not explored |

|Severity and hydration assessed |No exploration of prior hx or measures tried |

|Red flags explored | |

|Things tried so far | |

|Social & work impact | |

|ICE explored | |

|Assessment Domain: | |

|2. Clinical Management Skills | |

|Positive descriptors: |Negative descriptors: |

|Explanation of symptoms and usual duration |No explanation |

|Basic tips; grazing (small amounts and often), cool food, non spicy |Limited basic advice |

|food, cool water, ginger, accupuncture etc |No offer of medication |

|Pros and cons of tablet Rx e.g. promethazine |No offer of support around work |

|Offer of script (? deferred), offer of fit note (afternoon shifts only)|Inadequate safety netting |

|or sicknote | |

|Robust safety netting | |

|Assessment Domain: | |

|3. Interpersonal skills | |

|Positive descriptors: |Negative descriptors: |

|Establishes and maintains rapport |Fails to show empathy or maintain rapport |

|Shows empathy |No shared decision making |

|Shared management planning | |

|Acknowledges and uses SPICE implications | |

| | | | |

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