Patient Instructions
Name of Patient:
Geoffrey Shunt
Description of the patient & instructions to simulator:
36 year old lawyer.
Angry that his scheduled surveillance colonoscopy has been postponed due to the junior doctors strike.
Has a strong family history of bowel cancer.
Father was diagnoses late in his early 60’s and died two years later (3 months ago)
Older brother has just been diagnosed in his late 40s
Ideas – he will get cancer.
Concerns – he may have cancer or it may be developing especially with the delay in his colonoscopy
Expectations – He wants his cancelled colposcopy expedited preferably in the next few weeks
Feels his concerns are not being addressed.
Does not have any red flag symptoms (no change in bowel habit, weight loss or bleeding)
No new changes in symptoms.
(NB// Will become calmer as his concerns are elicited and will become tearful when talking about his father.
Becomes reassured when given credible reassurance regards NH of colorectal cancer, symptoms, signs, the role of screening a clear explanation for the need for surveillance colonoscopy is given- as a precaution only as he has no symptoms)
Married, high pressure job as lawyer
Drinks 28 units per week
Non smoker
Doctor’s (GP ST) Instructions
Name & age of patient
Geoffrey Shunt, 36y Male
Summary Card
PMH: Colorectal surveillance programme due to FH of colorectal cancer
DH: No regular medications. PRN paracetamol over the counter
Allergies: NKDA
None smoker. No alcohol for the past 5 years.
Case Notes - Last few entries in records:
Last came to the GP’s 3 months ago after his father had died. Brother has colorectal cancer – referred gastro re ? needs surveillance colonoscopies.
CSA EXAMINATION CARD
Patient Name: Geoffrey Shunt
Examination findings:
If examination offered:
Abdominal Exam: Normal
Rectal Examination: soft stools in rectum. No masses. No bleeding or mucus. No external abnormalities.
CSA Case Marking Sheet
Case Title & Context
n Angry patient & worried re bowel cancer
Assessment Domain:
1. Data-gathering, technical and assessment skills
Positive descriptors:
n Reasons for upset
n Determines ICE and family history
n Red flags covered
n Examination / Negative descriptors:
n Reasons for upset not explored
n FH missed
n Fails to elicit ICE
n Misses Red Flags
n No examination
Assessment Domain:
2. Clinical Management Skills
Positive descriptors:
n Explains purpose of surveillance
n Explains the NF of colorectal cancer
n Provides credible reassurance based on Hx and Ex findings
n Offers to write to the consultant to see if the colonoscopy can be re- booked sooner in light of patient anxieties
n Sign posts to hospital PALS if wanting to make a complaint
n Safety-netting / Negative descriptors:
n No explanation.
n No apology
n No credible reassurance given
n Agrees to fast track patient
n No safety netting
Assessment Domain:
3. Interpersonal skills
Positive descriptors:
n Allows ventilation
n Actively listens
n Apology for inconvenience and upset of postponed appointment
n Empathises re dad and bother and situation / Negative descriptors:
n Defensive
n Political about industrial action
n Misses ICE
n Confrontational body language
n No empathy
n No apology
Other aspects e.g. time keeping, consultation structure, comment on consultation skills etc
Positive descriptors: / Negative descriptors:
Patronising (patient is a lawyer!)
Grading: Clear pass = 3, Marginal Pass = 2, Marginal Fail = 1, Clear Fail = 0
Data Gathering Score = / Clinical Management Score =
1