• Candidate Instructions
  • Actor Instructions
  • Mark Sheet
  • Score

Location: You are a medical student in outpatient clinic

Patient: 45 year old patient presented with left lower abdominal pain and change in bowel habit

Task:
– You have been asked to explain the colonoscopy procedure and explore any concerns that the patient may have about it
– You are not required to discuss the risks of the procedure or gain consent
– After 6 minutes you will be asked a series of questions by the examiner.
– Answer any questions that 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 are required.

You are a 45 year old patient who has been referred to this outpatient clinic by your GP for left lower abdominal pain and diarrhoea. You have already seen the consultant and they asked for the medical student to explain the colonoscopy procedure.

The focus of this station is on explaining the colonoscopy procedure, at the beginning briefly explain to the student what the consultant and yourself have discussed so far – For the past 6 months you have had bouts of diarrhoea with pain on the left side. You are well and not on any regular medications. You do not smoke or drink. The consultant has said you will need to have a colonoscopy to investigate the cause of this diarrhoea and pain further.

You have heard of a colonoscopy as your friend had one but you are unsure what actually happens. You would like to know the following information:
– How should you prepare for the test (what should you do the day before the procedure)
– What will happen during the test
– What happens after the test
– You would like to know when you can go back back to work
– Ask if you are able to drive to and from the appointment

ICEF – you only disclose this if you are specifically asked

1. You are embarrassed about having the procedure. If the candidate prompts you on this state that you are worried about passing wind or opening your bowels during the procedure
2. You are worried about getting the results and what follow up you will get

If the candidate uses medical words you are expected to prompt them in order to clarify what they mean.

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
Role
Clarifies who they are talking to
Asks patient for preferred name


History Obtains a basic history from patient
Understands reason for attendance
Clarifies need for colonoscopy


Questioning
Encourages patient to ask questions


Baseline knowledge
Checks patient’s baseline knowledge regarding colonoscopy


Clarifies information
Clarifies information patient would like to know


ICEF ICEF
Explores ideas, concerns, expectations, feelings
Asks patient if they have any questions


Pre-procedure advice
No food day before
Clear fluids only
Laxative will be prescribed and should be taken as directed. This will force all the contents of your bowel to be removed


Procedure
Fiberoptic camera with light source
Insertion
Inflation of bowel with air
Camera moved to visualise length of bowel
Biopsies can be taken
When finished air removed and camera removed


Procedure extended
Procedure takes about 30 mins
Need to lay on side


Sedation
May be given as an injection before the procedure


Post-procedure
In recovery to ensure no anaesthetic concerns
Not to drive or operate heavy machinery after the procedure, ideally someone with accompany patient to appointment


Return to work
Day after procedure if feeling able


Follow up / results
Results are explained after the procedure if possible
Follow up appointment in outpatient clinic in 2-4 weeks (this will allow time for the biopsies to be reported)


Listening skills
Employs verbal listening skills
Employs non-verbal listening skills


Content delivery
Chunks information
Checks patient understanding


Patient score
Good rapport with patient
Active listening skills
Appropriate use of body language
Avoids medical jargon
Summarises and checks patient understanding


Question What is an alternative to a colonoscopy?
Barium enema
CT colonoscopy (allow CT abdomen with contrast)


Question What is the main disadvantages of CT imaging compared to colonoscopy?
Unable to take biopsies
Unable to visualise soft tissue differences e.g superficial ulcers


Question
Review the following image. What is your most likely diagnosis?

Diverticulosis



Score