Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

STATION NUMBER: 1 HISTORY TAKING, DATA INTERPRETATION, CLINICAL REASONING & PATIENT CONSULTATION CANDIDATE INSTRUCTIONS rd Youarea3 yearmedicalstudentshadowingingeneralpractice.Thispatient has been admitted with chest pain. • History Taking (14 marks): take a history of the presenting complaint from the patient. • Data Interpretation (3 marks): the examiner will present you with an ECG the patient has subsequently undergone and will ask you to interpret the results and present your findings. • Clinical Reasoning (5 marks): answer the examiner’s three questions. • Core Consultation (8 marks): marks awarded for appropriate and effective patient interactionSTATION NUMBER: 1 CARDIOLOGY HISTORY TAKING, DATA INTERPRETATION, CLINICAL REASONING & PATIENT CONSULTATION EXAMINER INSTRUCTIONS 1 Stationtimings: allstations arethirteen minutes in duration (ten minutes forundertaking the task, plus an additional three minutes to allow for feedback). You must not move candidates on to additional tasks during the station; they are responsible for managing their own time. A whistle will be sounded during the station as follows: - At the start: candidates have 60 seconds to read the candidate instructions outside the room - Atoneminute:candidatesmustentertheroomandcancommencetheirstationtasks - At eight minutes: candidates have two minutes remaining to complete their tasks. - At ten minutes: candidates must end their tasks immediately. You have 3 minutes to provide feedback on their performance and suggest areas of improvement if possible (help em’ out!) - At thirteen minutes: candidates must leave the room and move onto their next station. This is the same whistle as whistle 1, and candidates will have 60 seconds to read the candidate instructions outside the room If a candidate finishes the station early, they must remain in the station until the whistle is sounded at thirteen minutes. Feedback:duringthestationbeforethefeedback session,youmustnot providefeedback to candidates at any time. If a candidate clearly misunderstands the instructions, simply ask them to “please re-read the instructions”. If, using your better judgement, you feel the candidate is struggling considerably during the station, you may instead opt to use the time to teach the station how to undertake the task being assessed, and pass on any advice you may have. While examining candidates, only give a mark if the task is completed accurately by shading the appropriate circle. If the task is not attempted, incomplete or inadequately performed do not award the mark. Please fill in the mark sheet contemporaneously as the candidate is performing the task. Grade the candidate as fail, borderline, pass, or good pass.STATION NUMBER: 1 CARDIOLOGY HISTORY TAKING, DATA INTERPRETATION, CLINICAL REASONING & PATIENT CONSULTATION EXAMINER INSTRUCTIONS 2 Data Interpretation: Once thecandidate hascompleted the history, ask the following questions then hand them the ECG:  Can you name two differential diagnoses for chest pain and let me know which is your top differential?  Please interpret the ECG results and present your findings. Clinical Reasoning: After the candidate presents the ECG, you should ask them the following three questions: Q1. Name two treatments a patient with an established acute ST elevation MI should have immediately? Q2. Name two investigations that could be done to assess the extent of the myocardial damage. Q3. In a patient who has already received adequate lifestyle advice, what two drugs should be prescribed at discharge?STATION NUMBER: 1 CARDIOLOGY HISTORY TAKING, DATA INTERPRETATION, CLINICAL REASONING & PATIENT CONSULTATION ACTOR INSTRUCTIONS Name: Joan/John Ritchie Age: 72 years old Information you can give freely: Youthoughtyouhavehadbadindigestionfor thepast fewdays,butthepain has worsened today. Information that you may give on direct questioning: • You are a retired school teacher and since your retiral you have been generally healthy with no major health issues. • Twelve hours prior to your hospital attendance, you experienced a severe crushing pain in the front of your chest associated with sweating, nausea and one episode of vomiting. • Your daughter visited this afternoon, thought you looked terrible and called an ambulance. • The pain is in the centre of the chest but radiating towards your neck and jaw. • It was a severe, heavy sensation (clench your fist over your chest). • It came on during sleep and gradually increased in severity. • It lasted for over an hour. It eased eventually for no obvious reason although you still feel “not right” with some ongoing chest pain and maybe even a little breathlessness. • With hindsight you had experienced this before but not as severe or prolonged as this. Previously there were no associated features of breathlessness, palpitations, fainting or dizziness. • Nothing made the pain better or worse and hadn’t tried anything for the pain yet • Your only past history is high blood pressure diagnosed 15 years ago at a GP check-up. You have always felt well and don’t like to bother thedoctor.Youhavehadno previousheartor bloodvesselconditions. Youarenotsureifyouhavehighcholesterolorarediabetic –youdon’t think so • You were prescribed Ramipril 10mg once daily but admit to being careless with taking it. • Asfar asyouareawareyourownfather diedofaheartattackaged74. • You have smoked 10 cigarettes a day for 30 years although you want to stop. • The only exercise you do is playing bowls twice a week in the summer season. Otherwise you drive everywhere else. Answer questions directly. Answer all other questions in the negative. Do not volunteer additional information to non-direct questions. Patient Assessment: Patient Assessment Select a mark Please score how comfortable the consultation was and O 1 marks whether the student’s behaviour and manner were O 2 marks appropriate. Did the student address your concerns and make you feel confident in them as a doctor O 3 marksSTATION NUMBER: 1 CARDIOLOGY HISTORY TAKING, DATA INTERPRETATION, CLINICAL REASONING & PATIENT CONSULTATION Task Done/Correct Introduces self, identifies patient, explains purpose of interview, and O obtains consent History Taking (enquires about): Site O1 Onset O1 Character O1 Radiation O1 Associated symptoms (any two for 1 marks); arrythmias, SOB, ankle O1 swelling, N+V, sweaty, dizziness etc Timing O1 Exacerbating or relieving factors O1 Severity O1 Past medical history, enquiring specifically about prior cardiovascular O1 disease (1 mark) O1 Drug history and allergies O1 Family history and screening for cardiovascular risk factors O1 Social history (must ask about both smoking and alcohol for mark) O1 Ideas, concerns and expectations O1 Data Interpretation: Q1. Can you name two differential diagnoses for chest pain and let me know which is your top differential? (Any two from the following but must O1 include Myocardial Infarction selected as top differential for 1 mark): pulmonary embolism, pneumothorax, pericarditis, GORD, Q2. Interpretation of ECG. O1 Rate, rhythm and ST segment change for 1 mark O1 (Final diagnosis for 1 mark) Acute anterior STEMI Clinical Reasoning:Q1.NametwotreatmentsapatientwithanestablishedacuteSTelevation O1 O1 MI should have immediately? Any two from, one mark each: analgesia & anti-emetic, aspirin/clopidogrel or ticagrelor, heparin, oxygen Q2. Name two investigations that could be done to assess the extent of O1 O1 the myocardial damage. Any two from, one mark each: echocardiogram, repeat ECG (for development of Q waves), troponin (-I or -T) Q3. In a patient who has already received adequate lifestyle advice, what O1 two drugs should be prescribed at discharge? Angiotensin Converting Enzyme Inhibitor, aspirin, clopidogrel or ticagrelor, beta-blocker and statin Core Consultation Skills: Select a mark Generic 8 core consultation marks are awarded (out of 5 from the O 1 mark – well examiner and out of 3 from the simulated patient). These are based off: below the expected standard Non-verbal skills: eye contact/body posture/appropriate physical contact Balance of questions: open/closed/reflective O 2 marks – Structure: appropriate structure to interview Borderline Rapport/empathy/patient concern: appropriate responses to patient statements O 3 marks – Language: clear/understandable/no jargon Satisfactory Cues: recognised and responded appropriately to any verbal or non-verbal cues O 4 marks – Good O 5 marks – Excellent Overall Assessment of Performance: Fail O Borderline O Pass O Good Pass OSTATION1NUMBER: