• Candidate Instructions
  • Actor Instructions
  • Mark Sheet
  • Score

Location: You are an foundation year doctor in sexual health

Patient: 21 year old female patient has attended the drop in sexual health clinic

Task:
– Take a focused sexual history from the patient
– Answer any questions that the patient may have
– After 6 minutes you will be asked a series of questions by the examiner

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 21 year old female. You start the consultation by admitting to the doctor that you feel embarrassed as you have never been to a sexual health clinic before.

You are not to sure how the system works but you have come for a check up, you have no symptoms.

You have a regular long-term partner of 3 years who you do not use condoms with. You use the combined oral contraceptive pill.

Only give information if prompted – you have recently got back from holiday and you had a casual encounter. You did not use protection, you had oral and vaginal sex. At the time you had a lot to drink and you cannot remember all the details.

You are worried you have got an STI and you might pass it onto your regular partner. You are worried he will find out and leave you. So far you have not had sex with your regular partner.

You have never had an STI screen or HIV test before. You have had not been vaccinated against hepatitis A or B.

You drink heavily once a week. You have tried recreational drugs once but you have no intention of doing this again.

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
Explains confidentiality


Female symptoms
Vaginal discharge
Vulval itching
Abdominal pain
Dyspareunia


Female symptoms
Intermenstrual bleeding
Post coital bleeding
Contraception
Risk of pregnancy


Previous partner
Last sexual contact
Male / female partner
Regular / casual
Length of relationship / one off contact
Type of sex
Use of condoms
Partner symptoms


Previous partners extended
Records the details above for last 2 partners
Number of sexual partners in the last 3 months


HIV risk assessment
Previous HIV test
Partners from high risk countries
Same sex or bisexual partner
History of IVDU or partners with IVDU
History of paying or being paid for sex
History of HIV positive partners
History of unsafe blood transfusion
History of sexual assault


History continued
Past medical history
Drug history and Allergies
History of sexually transmitted infections


Social history
Alcohol
Recreational drugs


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


Patient
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


Question What investigations would you like to do in this patient?
Pharyngeal swab
Vulvo-vaginal swab
HIV
Syphilis
Hepatitis B



Score