Year 3 REG/ITM and AKO 2

Year 3 REG/ITM and AKO 2

Name Patient Role: Ms Sproncken [‘Doctor, is my babyreally okay?’]

Information for teachers

Learning goals:

• Be able to perform an intake consultation as in a setting at the clinical rotations

• Practising ‘breaking bad news’ conversation

• To be able to deal with the emotions of the patient and your own emotions

• Point of interest attitude: How much affects 'this case’ you? Do you show? Are you oke with it? Or not?

Furthermore, it should be noted that the patient in this SPC has lived in the Netherlands for a few years but is originally from abroad (and therefore not a native English speaker).

Information for the SP

Patient record:

( ‘-’ = no specific instruction, fill in by yourself)

name: Mrs. Sproncken
age:actual age/ maximum 42 years old
gender: f
social background:-
appearance:-
character:-
mood:-Nervous, tense
level of education:-
hobbies -

Situation:

The SPC takes place at the obstetrics outpatient department of a hospital.

You are24 weeks pregnant, i.e. your last menstruation took place 24 weeks ago. You have not had any blood loss or vaginal discharge since.

To make it easier to imagine yourself in this situation: bring a cushion with you to put under your clothes during the consultation. This makes it look and feel more realistic.

You present at the Gynaecology / Obstetrics outpatient department. You have been referred by the midwifeyou visited earlier today for an extra checkup, because you feel less life than before. The midwifetried to examine the baby’s heart sounds, but could not find any. Your partner is not present for urgent reasons or does not really take part in the pregnancy.

All students receivea message via theSAS (student assistant) that the patient has to be seen urgently: they will either receive a telephone note from the midwife or a notification from the SAS. Allpatients are extremely worried, because they feelsomething is very wrong.

It should be noted that the patient in this SPC has lived in the Netherlands for a few years but is originally from abroad (and therefore not a native English speaker).

Opening sentence SP: ‘Doctor, is my baby really okay?’

Reason for contact (to be filled in the SP):You are very worried because you feel something is really wrong.

Expectations/ question to ask thedoctor(to be filled in the SP):

History:

a. Specifichistory: date first day of lastmenstruation: 24 weeks ago

Menstrual cycle has always been regular. No blood loss or abdominal pain since. No vaginaldischargesince.

b. General history:

allergy: none
medical history: none
use of medication: none
family history : no specific diseases
diet:normal
smoking: no
street drugs/alcohol: no
job:to be filled in by the SP
social situation:to be filled in by the SP

Additionalexamination:

The students can order a pregnancy ultrasound (they know this via the info provided by the SAS). To order the test, the students have to go to the SAS, who will give them the results immediately. The ultrasound shows that the foetusdoes not show any cardiac activity anymore (see exact message in this document).So, when the student-doctor leaves the room to get the results of the ultrasound, you (the SP) are waiting anxiously for the student-doctor to return.

Exact information as how the student receive this from the SAS:

Ultrasound results

Information for the student:

Ultrasound examination is of course usually performed in the presence of the patient. So, if you like, you can refer to the ultrasound images the patient has seen when you discuss the findings, for instance: ‘As you have just seen during the ultrasound examination, … …’.

Results ultrasound: Foetal size corresponds with the present gestational age (24 weeks). However, there is no life anymore: there is no cardiac activity.

Course of action:

First of all, it is common to wait at least a few days, especially to allow a natural mourning progress. Also, labour may start spontaneously. If not, childbirth has to be started artificially by means of intravenous and intramuscular administration of labour-inducing medication. It is of first importance that the woman does not suffer labour pains, so this pain should be prevented with medication.

Every SP will handle this advice differently (will be discussed in the training).

Medicalhistory:uneventful

ReactionSP toadvice/ course of action:

When you hear the bad news, you can respond in many different ways: disbelief (‘Are you sure?’), sadness, doubt (‘How is this possible? This can’t be true! The baby was kicking like crazy yesterday, could the ultrasound be wrong?, self-reproach (I should have been more careful, should not have worked out, should not have cycled), moments of silence.

You can show all responses in random order. You can reinforce your acting by asking the doctor a question and not listen to the answer. So you say something else (‘How will my husband respond?’) while the doctor is answering/talking to you.

Final questions:(These are questions you (the SP) can ask at the end of the consultation).

SP’s own notes:

Tip for the SP: remove the cushion when you give feedback. This will also give you an emotional break before you have to do the next SPC.

Information for theSPC Student-Assistant (SAS)

For the SAS:

Note: date =today’s datefor Ms Sproncken (SP xxx)

Ms Sproncken’s midwife has called the outpatient department todaywith the following message:

Ms Sproncken born(year of birth) XXXis now 24 weeks pregnant. The pregnancy has been normal so far. The patient came to my practice this morning for an unscheduled visit, because she had the feeling that ‘it was so quiet in her belly’.

Upon examination (doptone examination; listening to the foetal heart sounds) I could not find any cardiac activity. I have referred her to see you urgently.

The outpatient department responded thatMs Sproncken was to visit them as soon as possible for a checkup and at least ultrasound examination.

Handout in S-room: medical history andstudent instructions

Handout for SPs (e.g. envelope): none

Handout for student:

-If the studentasks you for the results of ultrasound examination.(SAS: Let the student read the information about the results, butkeep the form with the info yourself or make sure you have enough copies and ask the student to return it after the consultation).

-MaSP

Ultrasound results

Information for the student:

Ultrasound examination is of course usually performed in the presence of the patient. So, if you like, you can refer tothe ultrasound images the patient has seen when you discuss the findings, for instance: ‘As you have just seen during the ultrasound examination, … …’.

Results ultrasound: Foetal size corresponds with the present gestational age (24 weeks). However, there is no life anymore: there isno cardiac activity.

Course of action:

First of all, it is common to wait at least a few days, especially to allow a natural mourningprogress. Also, labour may start spontaneously. If not, childbirth has to be started artificially by means of intravenous and intramuscular administration of labour-inducing medication. It is of first importance that the woman does not suffer labour pains,so this pain should be prevented with medication.

Tell the students the following:

Carefully read the student instructionsyou find in the S-roomand see me if you have any questions. (The students have also been able to read theinstructions on Student Portal.)

The student can ask for an ultrasound examination. In that case, you give the student the written results. It is the student’s task to inform the patient about the results.

Background information:

The course of action (available to the students when they read the results of the ultrasound examination) is to wait at least a couple of days, this is especially to allow the mourning process to take place. Experience has shown that if labour is induced immediately, the women often have doubts afterwards, e.g. about whether their child was really dead. It is advised to wait first and then induce labour; this is still possible after two to three weeks. The women are given an IV drip to induce contractions, which means that a normal birth has to take place. Maximum painkilling medication is provided in most cases. If necessary, physical examination (abdominal examination, weight, BP) can be performed in all SPs.

2018-2019

Cluster: AKO Fase 2

Name Patient Role: Ms Sproncken [‘Doctor, is my baby really okay?’]

Informationfor students

You are a junior doctor at the gynaecology / obstetrics department of MUMC. You are about to see a patient (Ms Sproncken) who is 24 weeks pregnant and has to be seen urgently today. So this patient has been added to your schedule today.

Your assistant (the student assistant) will give you a short note about the telephone call of the referring midwife who has monitored the pregnancy until now. Basically, the pregnancy has been without complicationsso far, but something has changed over the past few days. Ask if the woman has more children yourself.

Subsequently, you perform a consultation with the patient, partly based on the note you received. If you want to order ultrasound examination, ask the patient to wait in the waiting area. Tell her you are going to arrange for an ultrasound and that an assistant will perform the ultrasound examination (in reality you would do this yourself and thus be able to give the results during the examination).

In this simulation, you leave the room to pick up the written results from the SAS.

You then continue the consultation based on the results of the ultrasound examination. You can perform physical examination if you want, but this will probably not be necessary.

It should be noted that the patient in this SPC has lived in the Netherlands for a few years but is originally from abroad (and therefore not a native English speaker).

You have 25 minutes for the consultation including the time for the SP’s feedback.

After 15 minutes you will hear a bell ring 3 times indicating that there are 5 minutes to go before the end of the consultation. After 20 minutes you will hear a bell ring once: the consultation and feedback now have to be concluded within 5 minutes.

Good luck!

Date latest version: aug 2017