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* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
STATION 1. YOU ARE ON GP ATTACHMENT. YOU ARE ASKED TO TAKE A HISTORY FROM NANCY MC GRATH A 48 YEAR OLD WOMAN. STATION 1 PATIENT SCENARIO You are Nancy McGrath, a 48 yr old woman. You have been having episodes of severe pain in the upper part of your tummy for the past week. The pain is more on the right than the left. There is no radiation. It’s not a sharp or burning pain – more a very severe dull pain. You have had it 4 times over the past week. It started on a Sunday afternoon after your lunch. It built up slowly to the worst pain you’ve ever had, including labour pains. You couldn’t get comfortable with it, you felt sick and sweaty. You were going to call the out of hours GP but it started to settle down and you decided it was bad indigestion. The meal had been very fatty. In all the pain lasted 4 hours or so that time. Since then it has recurred 3 more times in the evenings after your dinner, the same pattern on each occasion. You have delayed coming to the doctor because you have become worried with the way it keeps coming back and are afraid it might be something serious. You feel guilty for not looking after your health better, you know you are overweight and eat an unhealthy high fat diet. You feel well in between episodes, appetite normal, no weight loss or other GI symptoms. You have no urinary symptoms. You are on the combined oral contraceptive pill and have been for years. You are a non smoker, non drinker. You are married with three teenage children, all well at home. You have no significant past medical history. Your parents are both still alive and in good health. You have no siblings. EXAMINER SHEET STATION 1 STUDENT NAME____________ Inadequate Adequate Good Introduces self – first and second names and role (medical student). Checks identity of patient Gains consent to take history Establishes reason for presentation Elicits patient’s ideas, concerns and expectations. Establishes duration and pattern of symptoms Asks about pain – location, type, radiation and severity Asks about relieving and exacerbating factors including effect of food Asks about associated symptoms Asks about fever/ malaise Asks about appetite, nausea, heartburn, dyspepsia, vomiting, haematemesis, diarrhoea, steatorrhoea, constipation, blood pr. Asks about urological symptoms, dysuria, frequency, haematuria Asks about respiratory symptoms Asks about medications Asks about past medical history Takes full social history Conducts full systems review. Checks history back to patient Addresses patient concerns Demonstrates empathy What is most likely to be causing this patient’s symptoms? BILIARY COLIC Please give a global rating of this student: FAIL BORDERLINE Comment on strengths: Comment on weaknesses: PASS STATION 2 YOU ARE IN A+E ON ATTACHMENT AND ARE ASKED TO EXAMINE THE ABDOMEN OF A 22 YEAR OLD MAN WITH ABDOMINAL PAIN FOR THE PAST 24HRS. STATION 2 PATIENT SCENARIO THE STUDENT WILL EXAMINE YOUR TUMMY. YOU ARE SORE ON THE LOWER RIGHT SIDE . IF THE STUDENT ASKS TELL THEM THAT IS WHERE IT HURTS AND WHEN THEY TOUCH YOU THERE SAY IT HURTS. THE DEEPER THEY PRESS THE MORE IT HURTS. EXAMINER SHEET STATION 3 STUDENT NAME____________ Inadequate Adequate Good Introduces self – first and second names and role (medical student). Checks identity of patient Uses hand gel Gains consent to examine patient General Inspection – comments hydration, distress, jaundice, anaemia. Inspects hands – comments on palmar creases, clubbing. Asks patient to indicate where pain is Inspects abdomen – scratch marks, scars, distension, visible peristalsis. Superficial palpation – starts as far from painful area as possible Palpates observing pts face for signs of distress Deep palpation – all 9 divisions of the abdomen Checks for rebound/ peritoneal irritation Palpates for hepatomegaly Palpates for splenomegaly Percusses for liver and spleen, starting in the RIF. Ballots the kidneys Auscultates for bowel sounds Offers to examine hernial orifices Suggests DRE necessary Summarises examination findings including comments on guarding, rebound etc. Ask the student to summarize their examination findings. Please give a global rating of this student: FAIL BORDERLINE Comment on strengths: Comment on weaknesses: PASS STATION 3 YOU ARE ASKED TO TAKE A HISTORY FROM MICHAEL MURPHY A 58 YEAR OLD MAN ADMITTED FOR THE INVESTIGATION OF JAUNDICE. STATION 3 PATIENT SCENARIO You are Michael Murphy, a 58 year old man. You presented to your GP 3 days ago because your wife noticed that you seemed to be changing colour and becoming jaundiced. Up to about a month ago you were feeling well, then you began to feel progressively more tired and lost your appetite a bit. You have lost about half a stone in weight over the same period. At the time you attributed that to work related stress, you are a salesman and are under a lot of pressure to keep your sales up , some of your colleagues have been let go and you don’t feel secure in your job. You have no nausea or abdominal pain but have now lost interest in food completely. You are a bit constipated as you are not eating much. You have not had any temperature. You have noticed since you came into hospital that your urine is darker than normal and your stools paler. You travelled to Egypt 6 weeks ago for a sales conference but had no illness there and stayed in a 5 star hotel in a resort. You had the vaccinations recommended before you went – you think there was one for hepatitis. You have never had a blood transfusion. You are a married man with three adult children. You will not appreciate being asked about your sexual history unless the reasoning is properly explained to you, likewise any questions about drug abuse. You have no other symptoms but are very concerned about the fact that you are missing work through this illness. You just want to get sorted and get out of hospital as soon as possible. EXAMINER SHEET STATION 3 STUDENT NAME____________ Inadequate Adequate Good Introduces self – first and second names and role (medical student). Checks identity of patient Gains consent to take history Establishes reason for presentation Elicits patient’s ideas, concerns and expectations. Establishes duration of symptoms Asks about symptoms preceding the jaundice Asks about abdominal pain Asks about appetite, nausea, weight loss, pruritis Asks about fever and malaise Asks about changes in stool and urine colour Asks about heartburn, dyspepsia, vomiting, haematemesis, diarrhoea, steatorrhoea, constipation, blood pr. Asks about foreign travel and vaccinations Asks about blood transfusions, tattoos and iv drug abuse. Asks about alcohol intake Asks about medications Asks about past medical history Takes full social history Raises the issue of sexual history without offending pt. Conducts full systems review. Checks history back to patient Addresses patient concerns Demonstrates empathy What is most likely to be causing this patient’s symptoms? CA. PANCREAS Please give a global rating of this student: FAIL BORDERLINE Comment on strengths: Comment on weaknesses: PASS STATION 4 MR SEAN O’CONNOR IS A 67 YEAR OLD MAN WITH UNEXPLAINED WEIGHT LOSS OF APPROX 1 STONE OVER THE PAST 2 MONTHS. HE IS IN HOSPITAL FOR INVESTIGATIONS AT PRESENT. YOU ARE ASKED TO EXAMINE HIM FOR A POSSIBLE GI CAUSE. EXAMINER SHEET STATION 4 STUDENT NAME____________ Inadequate Adequate Good Introduces self – first and second names and role (medical student). Checks identity of patient Uses hand gel Gains consent to examine patient General Inspection – comments on weight loss, hydration, distress, jaundice, anaemia. Inspects hands – comments on palmar creases, clubbing, checks for flap. Inspects arms for scratch marks, petechiae, spider naevi, rashes. Inspects face- anaemia, jaundice. Examines mouth – angular stomatits, glossitis, ulcers. Palpates cervical lymph nodes. Inspects abdomen – visible masses, scratch marks, scars, distension, visible peristalsis. Superficial palpation – all 9 divisions. Palpates observing pts face for signs of distress Deep palpation – all 9 divisions of the abdomen Palpates for hepatomegaly Palpates for splenomegaly Percusses for liver and spleen, starting in the RIF. Ballots the kidneys Auscultates for bowel sounds Offers to examine hernial orifices Suggests DRE necessary Summarises examination findings. Ask the student to summarize their examination findings. Please give a global rating of this student: FAIL BORDERLINE Comment on strengths: Comment on weaknesses: PASS STATION 5 YOU ARE ON GP ATTACHMENT AND ARE ASKED TO SEE MARY CARROLL A 55 YEAR OLD LADY IS BEING REFERRED FOR A GASTROSCOPY FOR DYSPEPSIA SYMPTOMS. YOU ARE TO TELL HER THAT SHE HAS BEEN REFERRED FOR THE TEST AND TO EXPLAIN THE PROCEDURE TO HER. STATION 5 PATIENT SCENARIO You are Mary O’Carroll, a 55yr old lady who has come to see the GP with indigestion going on for the past few months . After your meals you are getting burning discomfort in the upper part of your tummy. It settles a bit with Rennies or a glass of milk. You were hoping the GP would just give you some tablets but he wants to send you to hospital for another test and has sent you in to talk to the student about the test. You are getting worried that the GP thinks there’s something serious going on. You feel perfectly well and have no symptoms apart from the indigestion You are single and work in a post office. You have no past medical history. Both your parents are dead. They both lived into their 90s and died of old age. You have a brother and sister. You brother had a heart attack a few years ago but is fine now and your sister is also well. You are fit and active and eat a balanced diet. You don’t smoke and you drink a few glasses of wine at the weekend. In relation to the test you want to know why you are being sent for it, will you have to stay the night, will you be asleep for it, what are they looking for, could it be something serious and how will you feel afterwards? Will you get the results straightaway or will you have to wait? EXAMINER SHEET STATION 5 STUDENT NAME_____________ Inadequate Adequate Good Introduces self, first and second name and explains role. Checks patient identity Gains consent for consultation Ascertains patients understanding of need for further investigation. Explains reason for referral – need to identify cause of symptoms, discusses possible findings. Ascertains patient’s understanding of endoscopy Explains procedure – day case, sedation, camera, biopsy. Advises pt about drowsiness after test and need to arrange a lift home from hospital. Outlines to patient how results will be communicated to her . Does not frighten the patient Elicits patients concerns Addresses patient concerns Does not use medical jargon Demonstrates empathy Checks patient understanding - Asks patient to repeat back explanation Please give a global rating of this student: FAIL BORDERLINE Comment on strengths: Comment on weaknesses: . PASS STATION 6 EXAMINE THIS PATIENT PRESENTED TO A+E. WHO HAS HE IS COMPLAINING OF PROGRESSIVE SWELLING OF HIS ABDOMEN AND DRINKS 60 UNITS OF ALCOHOL PER WEEK. EXAMINER SHEET STATION 6 STUDENT NAME____________ Inadequate Adequate Good Introduces self – first and second names and role (medical student). Checks identity of patient Uses hand gel Gains consent to examine patient General Inspection – comments on alertness,weight, hydration, distress, jaundice, anaemia. Inspects hands – comments on palmar erythema, clubbing and leuconychia, checks for flap. Inspects arms for scratch marks, petechiae, spider naevi. Examines mouth – angular stomatits, glossitis, ulcers, dentition. Fetor hepaticus Inspects chest – comments on gynacomastia, spider naevi, loss of body hair. Inspects abdomen – visible masses, scratch marks, scars, distension, caput medusa,. Superficial palpation – all 9 divisions. Palpates observing pts face for signs of distress Deep palpation – all 9 divisions of the abdomen Palpates for hepatomegaly Palpates for splenomegaly Percusses for liver and spleen, starting in the RIF. Ballots the kidneys Auscultates for bowel sounds Checks fluid thrill Checks for shifting dullness Makes reference to exam of ext. genitalia. Suggests DRE required Summarises examination . Ask the student to summarize their examination findings. Please give a global rating of this student: FAIL BORDERLINE Comment on strengths: Comment on weaknesses: PASS