Problem based learning “Child Health” April 13
How to use this booklet
You will be working in small groups and should work through the scenarios one page at a time.
Most pages will involve either a consultation role play or a group task. Before moving on to the next page the group must define any learning needs prompted by the material.
The learning needs must be allocated to individuals who will feedback next week
You will not get through the whole booklet today but will need to scan the remaining pages at the end of the session to define all the learning needs for next week.
Mia is age 12m and was previously well.
You saw her last Friday evening with a URTI.
The findings at the time were that she was coryzal and fractious but not unwell.
Temp 37.8, no other focal signs.
You gave your usual advice relating to viral URTIs and advised her Mum to seek further advice over the weekend if Mia became more unwell.
She has been brought back to see you by both her Mum and Dad on Tuesday morning. You can see on systmone that she was admitted to PAU on Saturday morning following a febrile convulsion said to be related to “tonsillitis”.
Today Mia looks quite well. Her parents look very anxious.
Chose two of the group to be Mia’s parents and one person to be the doctor. The instructions for Mia’s parents are in a separate envelope. They will need a few minutes to agree their roles.
Run the consultation for 10 mins. Mia’s parents should give feedback and the group should give structured feedback using the following sheet.
Define learning needs
Instructions for Mia’s parents.
Take a few minutes to plan how you will behave as Mia’s parents
You are both teachers and Mia is your only child.
Mia’s maternal uncle has epilepsy.
You were very frightened by the febrile convulsion which lasted several minutes (“ it seemed like forever”) and rang 999.
The junior hospital doctor confidently diagnosed ‘tonsilitis’ and wondered why the GP had not prescribed antibiotics.
You are concerned that the GP did not give antibiotics “which would have prevented the fit”
You are concerned about the effect of the fit on Mia’s development and whether she will
1. have another febrile fit
2 develop epilepsy
You want advice on how to prevent further febrile convulsions and whether if will be possible to get an urgent appt if she gets another temperature.
Part of the challenge in this consultation is managing ICE for 2 patients. Feel free to make the consultation quite challenging!
Talk over each other and make asides that the Dr will need to manage.
CSA SCORING SHEET FOR OBSERVERS
Data Gathering and Examination Skills
Positive Negative
Clinical Management Skills
Positive Negative
Interpersonal Skills
Positive Negative
Additional notes e.g. consultation structure, time management, agenda setting etc
3 things to change or try
1
2
3
Liam is age 6 and has one sister age 8m. He has been brought to see you by his Mum/Dad as he has been complaining of abdominal pain on and off for the past 3w.
Choose one of the group to be Liam’s parent and one to be the doctor.
Part of the challenge of this consultation is explaining the medical condition and the rational for treatment.
The instructions for Liam’s parent are in a separate envelope.
Liam’s parent should give feedback and the group should feedback using the following sheet.
Define learning needs
Instructions for Liam’s parent
Liam has always had a tendency to constipation but has been worse since the birth of his sister Millie 8m ago.
Your sister (Liam’s aunt) has ulcerative colitis.
Over the past 1m his appetite has been less good and he has had intermittent lower abdominal pain. He has only been passing small amount of hard stool and has been soiling both his pants and pyjamas.
He is very upset as other children at school are making fun of him as he “smells”.
You have spoken to the Health Visitor whilst attending with Millie who suggested ‘using a star chart’. She also suggested seeing the GP to exclude a ‘surgical problem’. This has worried you a great deal.
Your partner has tried telling Liam off without any benefit.
If the GP suggests laxatives you may be worried about ‘damaging his bowel’.
Your preference would be to give a small amount of laxative for a short period.
Make the doctor work hard to reassure you and explain both the condition and treatment.
Examination findings
Sigmoid loading palpable in LIF
Faecal leakage at anal margin.
Otherwise appears well.
CSA SCORING SHEET FOR OBSERVERS
Data Gathering and Examination Skills
Positive Negative
Clinical Management Skills
Positive Negative
Interpersonal Skills
Positive Negative
Additional notes e.g. consultation structure, time management, agenda setting etc
3 things to change or try
1
2
3
You are contacted by the Head of a local junior school with a request to give a talk to the parents of year 5.
She is concerned about the teachers’ observation concerning the increasing number of overweight children in the school.
She has noted media comments on the adverse effects of excessive weight gain in childhood.
She wonders how children should be defined as overweight and obese and what interventions can be offered by both parents and health professionals.
Brainstorm the areas that you should cover and define learning needs
Paula has made an appointment to see you. She has told the receptionists that she wants to discuss Dale who is age 2 but who she has not brought with her today.
Choose one of the group to be the doctor and one to be Paula.
The instructions for Paula are in a separate envelope.
At the end of the consultation both Paula and the group should give feedback.
Define learning needs
Instructions for Paula.
You have 2 children, Dale age 2 and Wesley age 9m. Your husband Mark is an HGV driver.
You have been struggling with Dale’s sleep for months and are now exhausted.
Dale has his own bedroom but, as you are still renovating the house, Wesley sleeps in your bedroom.
He is very difficult to get to bed and tends to stay downstairs until he falls asleep usually watching the 10pm news. He wakes frequently in the night and comes into your bedroom. To get some sleep you usually end up letting him get into your bed or you sleep in his bed with him.
You have tried persuading him to stay in his own room by offering drinks or reading a book.
Your worries are:
· He will wake Wesley if he cries in the night
· You are worried that your husband will not be safe driving his lorry if his sleep is very broken
· Your mother-in -law feels that children ‘should not be left to cry at night’
· The neighbours can hear Dale through the party wall.
· You are completely exhausted and wonder if a sedative for Dale would be the answer.
Don’t give all these concerns to the doctor straight away, offer some cues instead.
CSA SCORING SHEET FOR OBSERVERS
Data Gathering and Examination Skills
Positive Negative
Clinical Management Skills
Positive Negative
Interpersonal Skills
Positive Negative
Additional notes e.g. consultation structure, time management, agenda setting etc
3 things to change or try
1
2
3
You are duty doctor for the practice on a Monday afternoon. One of your partners spoke to the mother of Jamie-Lee , age 3, who was thought to have chicken pox and an appointment was arranged for 3pm with yourself.
Jamie-Lee attends with her mother Donna and her partner Darren.
Darren has only recently moved into the practice area and sits in the corner, heavily tattooed, muscular and subliminally threatening.
Jamie-Lee has indeed got chicken pox. She is cheerful and is not unwell.
Whilst examining her you note finger shaped bruises on her left cheek with a small bruise on the tip of her left ear extending to its medial surface.
What is the differential diagnosis?
Discuss in your group what action should now be taken.
What are the possible problems and what might you need to do?
What information do you need readily available to deal with this problem?
Define any learning needs
Measles is coming to an area near you!
Most of you will not have seen measles in your training but historic low levels of immunization mean that the current epidemic in South Wales could be replicated in any part of the country.
Which of the following statements about measles are true?
· The vaccination is given once at 13m?
· A catch up campaign is currently running to prevent further outbreaks?
· Children with egg allergy should not have MMR?
· Parents who decline MMR vaccination should be offered single vaccines as an alternative.
· The incubation period is 14 days?
· Koplik spots are seen on the buccal mucosa at the same time as the rash appears?
· The rash appears all over the body at the same time?
· Once the rash appears the temperature starts to fall?
· The exclusion time from school is 7 days from the onset of the rash?
· Lymphadenopathy is prominent
Brainstorm 10 complications…
Brainstorm a list of other viral exanthems that might cause diagnostic confusion. List the features that distinguish them from measles.
Define learning needs
Reversing the inverse care law…
After graduating from the prestigious Pennine training scheme you have accepted a partnership in Slagthorpe on Trent an area of high deprivation and low employment.
Your practice serves a large council estate where unemployment, low income and single parent families seem to be concentrated.
Consider the barriers that may exist preventing the children in your practice area:
1. reaching their full potential
2. receiving high quality medical care.
Think of imaginative ways that the practice may be organized to overcome these potential barriers.
What facilities in the community need your support.?
Who will you need to work with to achieve these aims?
How does the financial structure of general practice penalize your practice in Slagthorpe?
Define learning needs