Simulated Patient Instructions - Pennine GP Training
Patient Instructions
Name of Patient:
Sarah aged 48
Description of the patient & instructions to simulator:
You have come to see your GP today, as for the last 3 months you have been bleeding between periods.
You are concerned that you might be going through the menopause and want reassurance as to whether this is the case. If the Dr thinks you are peri-menopausal – you want advice about possible treatments.
Your periods remain regular, but in between you have been bleeding approx 2-3 times per cycle. The bleeding is light and not painful
You are up to date with your smears – all have been normal
No history of pain during, or bleeding after sex.
No discharge
No hot flushes
No vaginal dryness
You have 2 children, both teenagers, both normal vaginal deliveries.
You have no symptoms of anaemia (fatigue, soboe, pallor etc)
You have no symptoms of hypothyroidism (wt gain, fatigue etc)
Things are going well at home, you are normally fit and well
You have not been experiencing any mood swings
You are using condoms as contraception, and don’ t think there is any chance of pregnancy.
Doctor’s (GP ST) Instructions
Name & age of patient
Sarah, age 48
Summary Card
Infrequent attender
Normal smear May 2015.
Skin rash July 2012 – settled with emollients and loratadine.
Previous 2 x vaginal deliveries
No relevant FH
No alcohol, never smoked
PMH – nil of note.
CSA EXAMINATION CARD
Patient Name:
Sarah
Examination findings:
Abdominal examination – normal
PV exam – normal appearance of vulva, vagina and cervix, no discharge. Anteverted uterus, no masses. Normal examination.
CSA Case Marking Sheet
|Case Name: Intermenstrual bleeding. |Case Title: |
|Context of case | |
|Recognition of intermenstrual bleeding. | |
|Data gathering | |
|Positive descriptors: |Negative descriptors: |
|Distinguishes between irregular periods and intermenstrual bleeding |Fails to clarify details about pattern of bleeding |
|Takes a thorough gynae and sexual history |ICE not explored |
|Explains and Conducts bimanual PV exam with offer of chaperone |Does not ask about other PV symptoms |
|Pregnancy test |No sexual history |
|Triple swabs |No examination |
| |No pregnancy test or swabs |
|Assessment Domain: | |
|2. Clinical Management Skills | |
|Positive descriptors: |Negative descriptors: |
|Explains differential diagnosis |Falsely reassures re. Symptoms and attributes to menopause. |
|Recognises need to refer for DAPH |Explanation alarming or confusing |
|Explains why hysteroscopy is needed and what the concerns are |Fails to refer for hysteroscopy |
|FBC arranged | |
|Arranges review | |
|Assessment Domain: | |
|3. Interpersonal skills | |
|Positive descriptors: |Negative descriptors: |
|Uses ICE to facilitate the consultation |Poor rapport |
|Offer of chaperone |No empathy |
|Explains DAPH in sensitive manner |ICE ignored |
|Good rapport maintained throughout | |
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