• Candidate Instructions
  • Actor Instructions
  • Mark Sheet
  • Score

Location: You are a junior doctor in general practice.

Patient: 60 year old patient has attended clinic, the computer system says “related to recently deceased partner”. You read through the notes and see that patient had been seen by a FY2 and prescribed omeprazole for indigestion 6 months ago. Was then seen again by the GP a month later and prescribed omeprazole on repeat. A letter from the hospital two weeks ago shows the patient has passed away, CT scan showed pancreatic cancer and a post mortem is to be held at the request of the family.   

Task:
– Gather the reason for attendance
– Answer any questions the patient may have

Note to actor: Try to restrain yourself from volunteering too much information – you may do so when prompted (that is, by a specific question, not a general one). If a student is on the wrong line of clinical reasoning do not fuel this line of thinking, state no to the question as being ambiguous may prompt further questioning and does not allow the student to be appropriately tested. The aim of the exercise is to take a focused history; short answers may be required.

You are a 60 year old patient.

You and your partner came to see a trainee doctor at the practice 6 months ago. They said it is indigestion and prescribed a trial of omeprazole. This appeared to help a little but nowhere near what she used to be. The couple returned and saw another GP who prescribed the omeprazole again. A couple of months later your partner started to go yellow, felt very itchy and one night would not stop vomiting. You called ambulance and was taken to hospital. CT scan showed advanced pancreatic cancer with metastasis. A couple of days later your partner passed away in the hospital.

You are extremely annoyed, upset and frustrated about the last 2 months. You were told in the hospital that the signs of pancreatic cancer where there at the first appointment. Your partner was not examined, no blood tests, no scans and no follow up.

You believe if this was still done that your partner would still be alive now. You want to make sure no body else goes through what you are experiencing now and you want this junior doctor to be punished. You wish to make a formal complaint.

If the doctor asks about signs of depression, you show no symptoms of this, you are angry at the care your partner has received.

Ideas – you believe your partner would be alive if the foundation doctor did their job correctly

Concerns – that this could happen to another patient

Expectations – you want to make a formal complaint in order to ensure this does not happen again

Overall role = you are annoyed at the foundation doctor. You do not understand any medical jargon and require it to be explained if said by the candidate. You need to give the candidate opportunity to break down this station, you are required to give very long pauses in order to make the station uncomfortable. Make use of non-verbal cues if appropriate to show both happiness and sadness e.g hands on face covering eyes, shaking of head, ect.

If the candidate appears to have finished early remind them how long is left at the station and enquire if there is anything else they would like to ask, or whether they have finished. If they have finished, please remain silent and allow the candidate that time for reflection.

Category Question
Done
Excellent
Introduction Candidate appropriately introduced themselves with:
Full name
Medical school / year / grade
Clarifies who they are talking to
Asks patient for preferred name


Introduction Introduction
Gains consent for consultation
Mentions confidentiality


Assesses what the patient already knows
Asks for events leading up to now
What happened to partner
What patient feels went wrong


Exploration
Explores how candidate can help patient
Explores how patient is coping with bereavement


Apology
Allows patient to ventilate
Provides apology
Shows empathy
Listens to patient


Complaints procedure
Explains complaints procedure
Facilitates patient to do this
Arrange review with post mortem
Arrange review with practice manager and lead GP


Avoids jargon
Avoids medical jargon


Patient space
Provides patient with time to process information / does not try to fill the silences


When delivering information:
Candidate allows patient to lead consultation (does not talk endlessly to fill silence)
Does not attempt to solve problems
Listens and responds appropriately to cues


Following information
Responds appropriately to non-verbal cues if appropriate - e.g, “you have been very quiet, what are you thinking about”
Displays appropriate empathy


Candidate explores:
Emotions related to conversation
Recognises and validates concerns


Closing consultation
Makes appropriate arrangements for follow up
Briefly mentions ongoing bereavement support
Candidate offers leaflet on bereavement


Patient score
Good rapport with patient
Active listening skills
Appropriate use of body language
Avoids medical jargon
Logical structure / does not jump around topics in consultation
Summarises and checks patient understanding



Score