Patient Instructions

Name of Patient:

Sarah aged 48

Description of the patient & instructions to simulator:

You have come to see your GP today as for the last 3 months you have been bleeding between periods.

You are concerned that you might be going through the menopause and want reassurance as to whether this is the case. If the Dr thinks you are peri-menopausal – you want advice about possible treatments.

Your periods remain regular, but in between you have been bleeding approx 2-3 times per cycle. The bleeding is light and not painful

You are up to date with your smears – all have been normal

No history of pain during, or bleeding after sex.

No discharge

You have 2 children, both teenagers, both normal vaginal deliveries.

Things are going well at home, you are normally fit and well

You have not been experiencing any mood swings or hot sweats.

You are using condoms as contraception, and don’ t think there is any chance of pregnancy.

Doctor’s (GP ST) Instructions

Name & age of patient

Sarah, age 48

Summary Card

Infrequent attender

Normal smear May 2012.

Skin rash July 2012 – settled with emollients and loratadine.

Previous 2 x vaginal deliveries

No relevant FH

No alcohol, never smoked

PMH – nil of note.

CSA EXAMINATION CARD

Patient Name:

Sarah

Examination findings:

Abdominal examination – normal

PV exam – normal appearance of vulva, vagina and cervix, no discharge. Anteverted uterus, no masses. Normal examination.

CSA Case Marking Sheet

Case Name: Intermenstrual bleeding. / Case Title:
Context of case
n  Recognition of intermenstrual bleeding.
Assessment Domain:
1. Data-gathering, technical and assessment skills
Positive descriptors:
n  Distinguishes between irregular periods and intermenstrual bleeding
n  Takes a thorough gynae and sexual history
n  Conducts PV exam. / Negative descriptors:
n  Fails to clarify details about pattern of bleeding
n  Does not ask about other PV symptoms
n  No sexual history.
Assessment Domain:
2. Clinical Management Skills
Positive descriptors:
n  Recognises need to refer for DAPH
n  Explains why hysteroscopy needed and what concerns are
n  Offers bloods for FBC, TFTs and menopause screen if patient requests / Negative descriptors:
n  Falsely reassures re. Symptoms and attributes to menopause.
Assessment Domain:
3. Interpersonal skills
Positive descriptors:
n  Elicits ICE and involves in management plan
n  Explains DAPH in sensitive manner
n  Good rapport / Negative descriptors:
n  Fails to explain without jargon – or in an abrupt manner.
n  Does not appreciate patient ideas re. Menopause.
Other aspects e.g. time keeping, consultation structure, comment on consultation skills etc
Positive descriptors:
n  / Negative descriptors:
n 
Grading: Clear pass = 3, Marginal Pass = 2, Marginal Fail = 1, Clear Fail = 0
Data Gathering Score = / Clinical Management Score =
Interpersonal Skills Score = / Total for case = (max = 9)
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