Patient Instructions
Name of Patient:
David Moore
Description of the patient & instructions to simulator:
50 yr old, obese, bus driver
Recently attended surgery with a 6 month history frequency and nocturia (thought it might be your prostate). You had not noticed any other symptoms, although you have been a bit thirsty and tired, which you put down to the hot weather and long shifts. You have not lost any weight. No problems with your vision.
PMH = Hypertension
No Known Drug Allergies
DH = RAMIPRIL 10mg a day
You saw a locum GP who examined your tummy and did a pr exam to feel your prostate (which he said was normal) with a blood and urine test one week later. You have come for the result.
S/H
Married, two children, one married last year and one at university. Sedentary lifestyle due to long shifts as a bus driver. Non smoker, drinks very little.
He is not expecting a possible diagnosis of diabetes! He thinks it is his prostate - His ideas/knowledge of diabetes is very limited.
His immediate concern on being told is that his colleague was diagnosed as a diabetic, went on insulin and lost his job as a driver as a consequence!
Doctor’s (GP ST) Instructions
Name & age of patient
David Moore, 5o yrs old.
Summary Card
PMH: HTN
DH: Ramipril 10mg od
Allergies: nil
BMI 32
Alcohol hx: minimal.
Case Notes - Last few entries in records:
Attended with frequency and nocturia 6/12, no haematuria– abdo exam normal, pr = normal sized prostate MSU requested
MSU, Cr&es and a PSA were all normal
But Hba1c of 70 mmol/l
CSA EXAMINATION CARD
Patient Name: David Moore
Examination findings: BMI 30, BP 130/70
CSA Case Marking Sheet
Case Title: diabetes
Context for the Case:
n Explaining diabetes & Breaking Bad News
n Explaining the management of diabetes
n Explaining and considering impact on pts life.
Assessment Domain:
1. Data-gathering, technical and assessment skills
Positive descriptors:
n Explores what led up to him coming today.
n Explores pts initial expectations.
n Explores osmotic symptoms of diabetes.
n Explores ICE once bad news broken re diabetes
n Identifies the nature of his job and acknowledges the potential future DVLA implications of the diagnosis.
n Checks BP and smoking status / Negative descriptors:
n Fails to identify abnormal data or correctly interpret them.
n Fails to ask about osmotic symptoms
n Fails to explore ICE in the context of new DM diagnosis
n Fails to appreciate potential impact of diagnosis
n No check of BP or smoking status
Assessment Domain:
2. Clinical Management Skills
Positive descriptors:
n Recognises symptoms and the results confirm the diagnosis of diabetes.
n Offers comprehensible succinct explanation of diabetes which engenders hope and makes sense of management to come. Explains diagnosis of diabetes does not automatically mean insulin and job loss.
n Offers PIlelafet or signposts to other resources e.g. diabetes UK website
n Offers referral to structured education programme e.g. DESMOND
n Arranges PN appt regards basic education (diet etc), referral for podiatry and retinal screening referral
n Arranges urine ACR and lipids blood tests
n Arranges GP review to answer any questions and discuss future medical management / Negative descriptors:
n Does not suggest how diabetes may have developed.
n Explanation of diabetes too long winded, technical or fails to reflect patient ICE or make sense of management plan
n Does not form appropriate management plans.
n Follow up arrangements are absent or disjointed
n Runs out of time!
Assessment Domain:
3. Interpersonal skills
Positive descriptors:
Develops rapport
Uses a 'warning shot' re BBN
Allows the patient time to absorb the information
Sympathetic manner
Engender's hope
Non-judgemental re pt’s BMI and lifestyle / Negative descriptors:
n Blunt approach which surprises the patient.
n Does not allow time for patient to absorb info or ventilate emotion
n Lack of sympathy
n Does not encourage pts involvement in management.
n Engenders despondency!
Global Comments
Positive descriptors:
n list / Negative descriptors:
n list
Grading
Clear Pass o / Marginal Pass o / Marginal Fail o / Clear Fail o
Excellent o
2