Simulated Patient Instructions



Patient Instructions

Name of Patient:

Mrs Joan Smith

Description of the patient & instructions to simulator:

Mrs S is a 72 year old lady who has a history of osteoarthritis and hypertension, for which she takes Paracetamol and Ramipril.

You have noticed a painless lump in your left breast and are worried that you have cancer. You will not divulge this information or your concerns until you feel comfortable with the doctor or are directly asked specifically about any concerns/worries you may have. You have put this off for a long time for fear of what the diagnosis might be.

The lump is hard and has been present for the last few months, it seems to be getting bigger, now over an inch in size. You have also notified that your nipple has turned inwards. No skin changes and no lumps in neck or armpits

You have booked an appointment and have decided to see if the doctor is 'nice' using an 'entry ticket' of a niggly pain in your left side of your chest following a minor fall over the dog in the sitting room yesterday. You do not have a cough, no haemoptysis, no sob.

You will look and act worried.

You live alone and are usually independent. Your husband died of cancer 2 years ago and you were his main carer. No children. Non-smoker. Drinks very little alcohol.

You don’t smoke or drink alcohol

Your sister was previously diagnosed with breast cancer and had a mastectomy and radiotherapy.

Opening line ‘It’s my chest doctor, I think I banged it and would like it checking out’.

Ideas = it’s breast cancer

Concerns – it’s breast cancer

Expectations – mastectomy and radiotherapy

Doctor’s (GP ST) Instructions

Name & age of patient

Mrs Smith Aged 72

Summary Card

PMH: Hypertension, osteoarthritis

DH: Ramipril 10mg a day, paracetamol 500mg qds prn for pain

Allergies: NKDA

Case Notes - Last few entries in records:

Ear wax

Itchy eyes & Ear wax

URTI

Annual HT Rev – bloods in date, BP at target, meds re-authorised

CSA EXAMINATION CARD

Patient Name:

Mrs S

Examination findings:

Chest examination normal

Chest wall examination normal

Breast examination – left side hard 4cm mass in left breast, inverted nipple, palpable firm axillary nodes, chest clear with no local chest wall tenderness

No postural drop

CSA Case Marking Sheet

|Case Name: Mrs S |Case Title: Left sided chest pain |

|Context of case |Breast tumour |

|Elderly woman |Presents with an entry ticket of ‘muscular pain’ after a fall |

|Lives alone |Breaking bad news |

|Frequent attender | |

|Assessment Domain: | |

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

|Positive descriptors: |Negative descriptors: |

|Picks up on cues and explores breast symptoms |Fails to pick up on cues |

|Identifies ICE re breast cancer |Goes down the musculoskeletal/fall route |

|Identifies family history |Fails to ask about social and FH |

|Identifies social situation and bereavement |Fails to do breast exam or does so without offering chaperone or in |

|Examines breasts in a sensitive manner (offers a chaperone) |insensitive manner |

|Makes the correct diagnosis | |

|Assessment Domain: | |

|2. Clinical Management Skills | |

|Positive descriptors: |Negative descriptors: |

|Explains findings and potential diagnosis at a pace she can absorb the |Manages M-S ‘chest pain’ |

|information |Fails to recognise urgency and doesn’t refer appropriately (2ww) |

|Explains fast track referral regards time frame and what will happen in|No follow up and/or safety-netting |

|clinic | |

|Deals with her ICE | |

|Checks understanding | |

|Offers specific follow up | |

|Assessment Domain: | |

|3. Interpersonal skills | |

|Positive descriptors: |Negative descriptors: |

|Establishes rapport |Doctor centred |

|Makes patient feel at ease |Lacks empathy |

|Offers chaperone |No chaperone offered |

|Shows empathy | |

|Identifies and deals with ICE | |

|Breaks bad news sensitively using warning shot, use of silence, empathy| |

|etc | |

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