Patient Instructions
Name of Patient: Jane Smith age 76
Description of the patient & instructions to simulator:
Jane lives by herself, John, her husband, died 10 years ago.
Normally quite active, goes to the local church and walks her dog ‘Tess’ daily
Non smoker.
Little alcohol
Lives in a terrace house with steep stairs
Information divulged freely:
Opening line ‘I think I have an ear infection Doctor’
If GPSTs asks ’tell me more’
You can freely divulge 8 wks of feeling dizzy, feel like you are going to fall.
‘My friend Mavis had similar symptoms when she had an ear infection.’
Divulged when asked:
No ear pain, no discharge, no loss of hearing and no tinnitus
No headache
No chest pain or palpitations or shortness of breath.
No dizziness when turning in bed.
No dizziness when turning her head or looking up.
No slurred speech or weakness in face, arm or leg.
When she gets out of bed or out of a chair she feels unsteady.
She does not have true rotational vertigo.
No ear pain or discharge from ear/hearing loss. No headache. No muscle weakness.
Compliant with meds as prescribed.
No falls… yet – fears falling
Idea- Thinks has ear infection, dizzy for few weeks
Concerns: Fears falling especially when walking the dog
Expectations: Antibiotics for ear infection
Doctor’s (GP ST) Instructions
Name & age of patient Jane Smith aged 76
Summary Card
PMH: HT 2000, MI 2010, 2012 CKD3a
DH: Aspirin 75mg a day, Atorvastatin 20mg a day, Ramipril 10mg a day, Amlodipine 10mg a day, calcichew D3 1 bd,
Allergies:
Non smoker
Case Notes - Last few entries in records:
October: Influenza vaccination given
September: CKD/IHD/HT review – ACR normal, no angina, aware 999 rules, BP at target 130/70
CSA EXAMINATION CARD
Patient Name: Jane Smith
Examination findings: GPST must examine
Reveal finding only if examined
BP 122/90 sitting, standing 98/82
ENT no abnormalities.
HS normal. Pulse regular 85.
CSA Case Marking Sheet
Context of case
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Assessment Domain:
1. Data-gathering, technical and assessment skills
Positive descriptors
· Elicits ICE
· Psycho social- lives alone and fear of falling.
· Red flags- headache, deafness, arm/leg weakness, tinnitus, ear pain, discharge. CP/palpitations.
· Elicits symptoms are postural
· Focused exam- ENT (ears examined). HR, BP include lying and standing. / Negative descriptors:
· Fails to explore psycho social impact of symptoms
· ICE note explored
· Doesn’t ask about symptoms on changing posture
· Does not cover red-flags
· Inept or missing examination
Assessment Domain:
2. Clinical Management Skills
Positive descriptors:
· Explains postural hypotension
· Reduces antihypertensive Rx e.g. amlodipine to 5mg
· Appropriate follow up BP check
· Appropriate follow up for review of symptoms / Negative descriptors:
· Does not make correct diagnosis
· Gives Abx for ear infection/ offers Epley manoeuvre etc.
· Doesn’t reduce dose of antihypertensive
· No f/u or safety netting.
Assessment Domain:
3. Interpersonal skills
Positive descriptors:
· Established and maintains good rapport
· Shows empathy for psycho-social impact
· Engenders hope re resolution / Negative descriptors:
o Lack or rapport
o No empathy
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