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Explanation and Advice Ellie Rowbotham - s2015028@ed.ac.ukMy resources Geeky medics OSCE Stop Passmed (clinical knowledge, and some cases) Speak to older years Zero to finals ANKI - can download decks Think practically about stations they could actually give you - which you could speak about for 8 minutes General OSCE advice - find a group early, weekly - practice with friends - closer to time - write mock osces for each other + timing! - ask each other for feedback On the day - outside station - 2 mins - plan your structure! - If you are unsure - don’t make something up! Each station - try and forget the last! Always check how much drink - so how many bottles is that in a week? Other advice ● conditions – in your head, colour code how you would feel about these ● Allowing you to focus on weaker areas Go over the formatives - what did I not know Think - if this came up do I reckon I could pass it? What makes someone fail? - not being safe - not being polite - hurting the patient - not picking up on something life-threateningCommon explanation and advice •Atrial fibrillation/ flutter •Alcohol (only raised GGT) •Diabetes Smoking cessation •Something like asthma or COPD • Use of asthma inhaler - maybe •Common because it’s common Type 2 Diabetes/ pre-diabetes •Key – what we can do, what you can doExample case 1Structure History Brief (around 2 minutes), don’t forget red flags - important to ask lifestyle also - think what they could modify - alcohol intake - they may try to hide this - couple of glasses - OK so how long to drink a bottle? E+A Give them a choice of what they would like to speak about - what we can do - what you can do - Future plans/ investigations/ monitoring?This case History Any palpitations - ask alcohol - ask smoking - ask exercise Red flags - chest pain - LOCExplanation and advice Tap out their heart beat - can show ecg, explain each heart beat Always correlate to the symptoms in the history!! What they can do - alcohol - smoking - BP control - What we will do - rate control versus rhythm control - doctor will help you decide what is best suited to youExample of potential feedback given What is the examiner looking for? Safe Communication - no jargon Structured How to impress Giving an outline of what you will discuss - ‘does that sound ok?’ Link to symptoms Safety nettingCase 2 Read FBC, 20 y/o called Ellie - discuss the results with her and likely further management Normal Range Serum Ferritin - 30 41 – 400 ug/L Serum Iron - 10 12 – 30 μmol/L Total Iron-Binding Capacity - 100 45 – 80 μmol/L Transferrin Saturation - 10 15 – 50% What do we want in our history?Iron deficiency anaemia add History - any red flags to ask for? - When would this be alarming? What two aspects should we think about? - https://geekymedics.com/iron-supplementation-counselling-osce-guide/Case 3 Routine bloods - patient doesn’t know why they have been called in 26 20 40 120 10 45 https://geekymedics.com/interpretation-of-l- useful tool to help with LFTsPassmed units advice The government now recommend the following: ● men and women should drink no more than 14 units of alcohol per week ● they advise 'if you do drink as much as 14 units per week, it is best to spread this evenly over 3 days or more' ● pregnant women should not drink. The wording of the official advice is 'If you are pregnant or planning a pregnancy, the safest approach is not to drink alcohol at all, to keep risks to your baby to a minimum. Drinking in pregnancy can lead to long-term harm to the baby, with the more you drink the greater the risk.' One unit of alcohol is equal to 10 mL of pure ethanol. The 'strength' of an alcoholic drink is determined by the 'alcohol by volume' (ABV). Examples of one unit of alcohol: ● 25ml single measure of spirits (ABV 40%) ● a third of a pint of beer (ABV 5 to 6%) ● half a 175ml 'standard' glass of red wine (ABV 12%) To calculate the number of units in a drink multiply the number of millilitres by the ABV and divide by 1,000. For example: ● half a 175ml 'standard' glass of red wine = 87.5 * 12 / 1000 = 1.05 units ● one bottle of wine = 750 * 12 / 1000 = 9 units ● one pint of 5% beer or lager = 568 * 5 / 1000 = 2.8 unitsHistory General health - think what could some complications of alcohol excess be? CAGE Cut Annoyed Guilt Eye-opener > 2 suggest excessive drinking and alcoholism Driving! Job - any responsibilities etc Self care + do they look after anyone else (screen for neglect)Explanation and advice The effects of alcohol - liver disease, fibrosis, cancer (but in understanding tone) - stopping drinking - prevent worsening How to do this - not cold turkey (unless taking denzodiazepine also) What he can do - has he spoken to anyone about this? - could ask what some positives could be - In mine - I suggested writing his reasons on a sticky note and adding it to the fridge What we can do - support services - potential medication options - Do they want to tell those close to them? -Questions?Feedback feedback form:minute now before you leave to fill in a quick https://forms.gle/Yk5pRb8hvJ1a9hGs9 (2021-22) AIM Facebook Page ▶ Give our Facebook page a like for updates and opportunities,just search @AIMEdinburgh Thank you for coming! ▶ If you have any more questions, feel free to email me at s2015028@ed.ac.uk, or email accessibilityinmedicine@gmail.comFeedback https://app.medall.org/feedback/feedback-flow?keyword=e64fb0dc61f9bee5ebea09b7&o rganisation=accessibility-in-medicineSign up to the mailing list ▶ Sign up to the AIM mailing list to be the first to hear about tutorials, discounts, and opportunities! ▶ https://forms.gle/qJ NyeoFzA9B5urND7Thank you to our sponsors: