• Candidate Instructions
  • Actor Instructions
  • Mark Sheet
  • Score

Location: Foundation doctor in orthopaedic day surgery

Patient: Was due to have an operation this morning as a day case for an arthroscopy and medical meniscectomy.

All routine surgery lists (including the patients operation) have had to be cancelled today at short notice as there has been a serious road traffic accident during the night which requires the need of all the operating theatres and beds.

Task, you are allowed the say the following:

  • The reason for the operation being cancelled
  • It is expected that the operation will be rescheduled within the month
  • There is no medical issue in delaying the operation in long term outcomes

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 55 year old patient who has arrived on this ward this morning, expecting to have your knee operation. You have had all the booking checks including your observations and the nurses have put you in this room as you ‘need to speak to the doctor,’ this is as much as you know at this point.

You have been waiting for something to be done on your knee for about 1 year. It took your GP almost 6 months to refer you and kept saying it was a sprain and wanted to ‘give it time to heal’. You then had to wait a further 3 months to get a special scan of your knee which showed the cartilage was badly torn and you needed to have an operation.

You are very keen to get this operation done and you feel that you have already waited far to long already. The quality of the service from the staff has been excellent but you feel that the NHS is over stretched.

If the candidate communicates well, displays appropriate empathy then share the following concerns:

You are a self employed carer and your poor knee is severely affecting your ability to do your job. You cannot bend fully and it locks and gives way. It aches all the time and it is affecting your job. You are worried about your financial situation and cannot afford to reduce your hours any more or take time off work.

Overall = you are angry and pick up on every small detail, you are upset and raise your voice. You are not reasonable and do not have insight into the situation. When  the doctor mentions about the road traffic accident you say “you are just trying to guilt me into this by making me seem like a bad person”. You say “i pay taxes, so i demand this is done today”, “this isn’t good enough and i want to make a complaint against you personally”

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
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
Explains context of consultation
Asks if patient has brought anyone else along to the consultation

Pre-knowledge Assesses what the patient already knows
Asks for events leading up to now
Determines what patient already knows or expects
Candidate summarises the situation so far

Delivery of information (1)
‘Warning shot’ - e.g, “i am here to talk about your operation and it’s not good news.”

Delivery of information (2)
Provides information in a sensitive but clear manner - e.g “Unfortunately your operation has to be rescheduled”

Delivery of information (3)
‘Chunks’ information to check patient has understood

Delivery of information (4)
Avoids medical jargon

Delivery of information (5)
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 the information
Responds appropriately to non-verbal cues - e.g, “you have been very quiet, what are you thinking about”
Displays appropriate empathy

Candidate explores:
Emotions related to hearing news
Recognises and validates concerns
Asks about any immediate questions
Addresses any ideas, concerns and expectations

Closing consultation
Makes appropriate arrangements for follow up

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