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STATION NUMBER: 4 Communication skills CANDIDATE INSTRUCTIONS You are the FY2 in General Practice. Your next patient has been invited to a colonoscopy after a positive qFIT test. ● Communication skills (21 marks): Take a focused history from the patient and explain what colonoscopy is. Answer any questions they might have as you go along. ● Core consultation skills (5 marks): marks awarded for appropriate and effective communicationSTATION NUMBER: 4 Communication skills EXAMINER INSTRUCTIONS 1 Stationtimings: all stations arethirteen minutes in duration (ten minutes for undertaking 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 - At one minute: candidates must enter the room and can commence their station tasks - 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: during the station before the feedback session, you must not provide feedback 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 performeddo 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: 4 Communication skills ACTOR INSTRUCTIONS Name: Joan/John Smith Age: 76 years old You have been invited to have a colonoscopy test after a positive home test kit “qFIT”. You are quite anxious about the procedure and think it might mean that you have cancer. History of the presenting complaint: - No change in bowel habits - No blood in the stool - No weight loss, night sweats or fatigue - No other symptoms PMH: nil Medication: none. No allergies FH: father had a stroke. No cancers that run in the family. SH: social drinker (3-4 glasses of wine at the weekend), non-smoker ICE: you have no idea what colonoscopy entails, and you hope it isn’t painful. You are very worried after you qFIT test result and think this might mean you have cancer- “is there anything you are not telling me doc?”. You just want more information about colonoscopy. Explaining the procedure - The candidate might ask you what you know about the procedure. You don’t know much other than it is a tube passed through the lower end. And you feel a bit embarrassed of having that done. - That candidate should explain what you need to do to prepare for the procedure. If they don’t, ask “so is there anything I can do before to prepare for this” - When is biopsy mentioned ask:” so does taking a biopsy hurt?” - The candidate will explain that you can go home the same day after the procedure if they don’t ask “so do I have to stay in hospital after this?”. You have a friend who is picking you up after the procedure. - The candidate will explain there are risks associated with the procedure. If they don’t ask “are there any risks to colonoscopy?” - The candidate will explain when the result be be available procedure. If they don’t, ask “so when do I get the result for this”Questions to the candidate: When asked if you have any questions. Ask if there is any chance you can be given something to make you asleep during the procedure. You don’t think you can handle it and prefer sleeping through it. Summary: When asked to summaries. Use the piece of information given by the candidate. An example of a summary is: So because the testing kit showed blood in my stool. I have to have a colonoscopy." - "This is where a camera is inserted through my bottom to look at my bowel. - "I am having this procedure to look at what is causing the blood, and you might take a sample of it.”STATION NUMBER: 4 Communication skills Task Done/Correct Introduces self O 1 Identifies patient name and DOB O 1 Explains procedure and obtains consent O 1 Communication skills: Asks what the patient knows and what happened so far O1 Asks about red flag symptoms O1 Elicits patient’s concerns (1) and expectations (1) O1 O1 Explains what the procedure is (a thin tube inserted at the anus to O1 look at the gut) Pre procedure Explain that the patient will need to take a laxative O1 During the procedure Explains that a sedative is given (1) and responds appropriately to O1 O1 patient’s concerns ie wanting GA (1) Explains that biopsies may be taken but these are painless O1 Post procedure Explains that they can go home the same day (1) should have someone pick them up (1) O1 O1 Explains side effects and potential complications – mark for each up to three marks (bloating, perforation, bleeding, infection, O1 O1 O1 drowsiness) Safety netting O1 Explains about the results O1 Closing remarks Asks the patient to summariesAsks if the patient has any questions O1 O1 Core consultation skills Shows empathy both verbally and non-verbally O1 Responds to patient’s worries in appropriate way O1 Delivers information in appropriately sized chunks O1 Checks patients understanding throughout O1 Avoids medical jargon O1 Overall Assessment of Performance: Fail O Borderline O Pass O Good Pass O