Patient Instructions
Name of Patient:
Gemma Lawson Age 30
Description of the patient & instructions to simulator:
Gemma, recently married, found out that she was pregnant three weeks ago, she had been planning this so had started folic acid. She has worked out she is 8 weeks by dates.
A ’girl’ down the street has just had a baby and it has ‘'Down’s Syndrome’, she wants to know if there is anything she can do to prevent it or if she can have some tests to see if her baby is ‘ok’.
She is a non smoker and has not been drinking alcohol since she and her partner started trying for a baby.
She is a part time teaching assistant.
She knows Down’s Syndrome causes children “to look not quite right” and have learning difficulties
If asked she is unsure if she would want a termination if her baby was found to have Down’s syndrome but she would want to know, so that they could make a decision.
Ideas – knows little about Down’s Syndrome
Expectation – to be told about and offered a test if available
Concerns – her baby may have Down’s Syndrome
Doctor’s (GP ST) Instructions
Name & age of patient Emma Lawson age 30
Summary Card
PMH: Asthma as a child
DH: Nil
Allergies: None
:
Case Notes - Last few entries in records:
18months ago – pill check
Non smoker, BMI 21, BP normal
No CI – microgynon issued
CSA EXAMINATION CARD
Patient Name: Emma Lawson
Examination findings: All normal
CSA Case Marking Sheet
Context of case
n Antenatal screening for Down’s
Assessment Domain:
1. Data-gathering, technical and assessment skills
Positive descriptors:
n Identifies gestation
n Explores knowledge of Down’s and antenatal screening/scanning
n Identifies ICE
n Checks re folic acid, smoking, alcohol etc / Negative descriptors:
n Fails to work out gestational age
n ICE not explored
n Does not explore patient understanding re Down’s
n Fails to ask about folic acid, smoking and alcohol
n Fails to identify views re TOP & Down’s
Assessment Domain:
2. Clinical Management Skills
Positive descriptors:
n Explains what Down’s Syndrome - succinct explanation
n Explains her risk is about 1 in 800 based on maternal age
n Explains concept of screening test and what other conditions it also screens for (Edawards and Patau syndrome) and timing of triple (nuchal USS, BHCG and PAP-A 10 to 14/40) & quadruple test (14/40 to 20/40)
n Explains the outcome re risk threshold and possible subsequent need for diagnostic test if risks > 1 in 150 and v briefly what it entails (CVS & Amniocentisis)
n Arranged MW review to sort out booking and explaining tests
n Offers PILealflet re healthy pregnancy and antenatal screening
n Offer review to address any questions / Negative descriptors:
n Unable to explain Down’s syndrome without using jargon
n Unable to explain tests, when they can be performed and for what they test
n Does not explain difference between screening test and diagnostic test
n Does not explain that the result is expressed as a risk.
n Does not explain what would be offered if risk > 1 in 150
n No MW follow up arranged
n No offer of PIlealfet or further in formation
Assessment Domain:
3. Interpersonal skills
Positive descriptors:
n Identifies patient ICE
n Non judgemental
n Empathetic
n Maintains rapport
n Comes to a shared plan / Negative descriptors:
n Little or no rapport
n No empathy
n No shared decision making
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