• Candidate Instructions
  • Actor Instructions
  • Mark Sheet
  • Score

Location: You are an foundation year doctor on the acute medical take

Patient: 30 year old gentleman, has presented with a productive cough, fevers and some weight loss. Your consultants working diagnosis is bilateral apical TB. You have been asked to take a brief sexual history and discuss with the patient about a HIV test.

Task:

  • Take a focused sexual history from the patient
  • Consent this patient for a HIV test
  • Answer any questions that the patient may have
  • You are not expected to take a history regarding the working diagnosis of TB

– 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 30 year old male.

You are shocked that the doctor wants a HIV test, you have never had sex with a man, so you do not see why you would need to be tested.

You have never had a HIV test before but have been to a clinic were they took some swabs and urinated in a plastic cup.

If prompted, you have been in prison for 3 years and prior to that you used to inject drugs. For a period of about 5 years you were homeless. Because of your addiction to ‘the drugs’ your mind is all messed up so you are unable to recall all the details but you swear that you haven’t touched drugs since leaving prison. You now live with your partner (of the opposite sex.)

You were admitted to hospital last year with a bad case of pneumonia but apart from that you are otherwise well.

You have no; dysuria, urethral discharge or testicular pain

Your last sexual contact was 3 days ago with a female partner, have been in a monogamous relationship for 3 years. You had oral and vaginal sex. You do not use condoms but she is on the combined pill.

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


Male symptoms
Dysuria
Urethral discharge
Testicular pain


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


Benefits of HIV testing
Protect partner
Reduce risk of vertical transmission
Receiving treatment


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


Consent for test
Explain window period if recent sexual contact
Check patient understanding
Ask if patient happy to have HIV test


Result
Appropriately arranged a time to discuss the result


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


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


Question What are the different ways HIV can be transmitted?
Sexual
Blood products
IV drug use
Vertical transmission
Other appropriate answer


Question Explain what seroconversion is
What a person first develops antibodies to HIV
Typically occurs 2-6 weeks after exposure
Often asymptomatic
Some individuals may have fever, malaise, myalgia, pharygnitis and maculopapular rash


Question Which pathogens should newly diagnosed HIV positive patients be tested for?
TB
Toxoplasma
CMV
Hepatitis B & C
Syphilis



Score