Feedback:: Vascular Ulcer:: Attempt 1:: A PLAB 2 Mock

Mock Date: 18/07/2025
Case 1:
Topic:: Medicine symptomatic differential CaseUID:: Vascular5
Case Name: Venous Ulcer
Action Items:
Practice and Review the case in the OSCE workbench:	Click Here
Watch the (Private) Mock Test Video Recording:	Click Here
Read the Case Blog:	Click Here
Additional Resources:	Click Here
Deep Dive into your (Private) performance below:
Scenario Summary:
You are a General Practitioner in a GP clinic. Your patient, Mr. Jaden Albers, a 50-year-old male, is returning for a follow-up regarding a venous ulcer diagnosed two months ago. Despite using compression stockings, the ulcer has not healed, and the patient is frustrated and seeking alternative treatment options.
My Performance:
🔍Let’s Deep Dive into your performance:
The Domain-wise evaluation shows areas where you did well and others where you have room to grow.
A "Yes" means you covered that point effectively
A "Partial" indicates that you did some of it well but missed some key details.
A "No" means there was an important opportunity that wasn’t addressed.
Don’t worry if you see several areas marked "No" or "Partial"—this is common and simply highlights where you can focus your learning.
By reflecting on these areas and practising, you’ll be able to improve and feel more confident in your consultations. Remember, every bit of feedback is an opportunity to grow, and you’re on the right path by taking these steps.
Timestamps are provided to show exactly when during the consultation you covered or missed key points. Reviewing these can help you see how well you're managing your time and where you might need to be more efficient in addressing important areas.

Domain	Point	Timestamp	Response	Remarks
Data Gathering	Confirm the patient's full name and age	1:00	Partial	You confirmed the patient's name and asked for date of birth, but the patient only said “I’m 50 years” without providing a full DOB. You should have gently prompted again for the exact DOB to ensure accurate identification.
Data Gathering	Acknowledge patient’s frustration and validate emotional response to the slow healing process	01:00–01:05	No	You did not acknowledge or validate the patient's clear frustration with the compression stockings or slow healing. When the patient said they don't think it's working, you could have said something like, "I'm sorry you're feeling this way. I can see this has been frustrating for you."
Data Gathering	Elaborate the presenting complaint using SOCRATES to assess the ulcer comprehensively	01:02–01:04	No	You asked a few related questions (e.g., pain, tightness), but you didn't go through SOCRATES systematically. You missed onset, character, radiation, associated symptoms, time course, exacerbating/relieving factors, and severity.
Data Gathering	Ask about changes in symptoms like increased pain, discharge, odour, or swelling to detect complications	1:04:15	Yes	You asked about discharge, changes in skin color, fever, groin lumps, and swelling. This was done well.
Data Gathering	Assess compliance with compression stockings and explore any practical challenges using them	01:03:50–01:04:10	Yes	You asked if the patient had used the stockings as instructed and explored the discomfort in detail. Good job.
Data Gathering	Inquire about previous ulcers or chronic venous disease, diabetes, or autoimmune disorders to identify contributing comorbidities	—	No	You missed asking about any history of similar ulcers, varicose veins, DVT, diabetes, or autoimmune conditions. This is crucial to assess the chronicity and contributing factors.
Data Gathering	Ask about current medications and known allergies to identify any factors impeding healing or contraindications	01:05:00–01:05:12	Yes	You asked about medications and allergies directly and received a clear answer.
Data Gathering	Explore family history of venous disease or clotting disorders as a contributing risk factor	—	No	Family history wasn’t asked. A quick, “Does anyone in your family have similar leg issues or blood clots?” would have been helpful.
Data Gathering	Ask about lifestyle factors like smoking, alcohol use, prolonged standing, exercise habits, and diet	—	No	You missed all lifestyle risk factors. You could have briefly asked, “Can I ask about your smoking, alcohol, and daily activity?” around 01:05 after past medical history.
Data Gathering	Assess the impact of the ulcer on daily activities and quality of life, including work, mobility, and sleep	—	No	You didn’t ask how the ulcer is affecting his daily life. For instance, you could’ve said, “Has this affected your ability to walk, sleep or do daily tasks?”
Management	Explain the current diagnosis of a non-healing venous ulcer and clarify why healing is delayed despite compression	1:06:18	Yes	You gave a good explanation of why venous ulcers occur and why healing may be delayed.
Management	Order appropriate blood investigations: FBC, ESR, CRP, HbA1c, Albumin, U&E to rule out infection, inflammation, and poor nutritional/healing status	—	No	Blood tests were not mentioned. You could have said, “I’d also like to do some blood tests to check for any signs of infection or poor healing.”
Management	Offer Paracetamol or other appropriate analgesia for symptom control and comfort	—	No	Pain relief was not offered. Asking, “Are you in any pain right now? I can give you something to help,” would have shown empathy and care.
Management	Reinforce the importance of compression therapy in ulcer healing and long-term prevention	1:06:38	Yes	You explained the rationale behind compression therapy clearly.
Management	Discuss alternative compression options like Velcro wraps or lighter stockings if current ones are uncomfortable	—	No	You didn’t mention any alternative options even after the patient said the stockings were uncomfortable. This would have been a great time to discuss Velcro wraps or lighter compression.
Management	Recommend adjunctive treatment with Pentoxifylline to improve circulation and support wound healing	—	No	You missed this. Even a brief, “There are medications like Pentoxifylline that can support circulation — we could consider that,” would’ve earned marks.
Management	Refer to a Tissue Viability Nurse for expert wound dressing and assessment of ulcer care	1:07:03	Partial	You mentioned wound care vaguely (“vascular tissue nurse”), but not clearly enough to suggest a tissue viability nurse. Clarify team roles in your future consults.
Management	Arrange routine referral to the Vascular Team for potential surgical or advanced interventional assessment	1:07:13	Yes	You referred the patient to the vascular team for further assessment. Well done.
Management	Advise on lifestyle modifications: leg elevation, regular movement, weight loss if overweight, and avoiding trauma. Advice against smoking/alcohol	—	No	None of these were discussed. A quick list during management summary would have covered this.
Management	Provide a leaflet about venous ulcers and compression stockings, with tips on managing symptoms at home	1:07:42	Yes	You said you would provide a leaflet.
Management	Safety netting: Advise the patient to seek immediate help if they notice any signs of infection, arterial insufficiency, or new ulceration	1:07:49	Yes	You clearly advised on red flags and when to go to A&E.
Management	Schedule a nurse review in 2 days to ensure a better stocking fit and a GP follow-up in 2 weeks to assess healing	—	No	You didn’t arrange any formal review or follow-up. You could have said, “We’ll see you in two weeks and arrange a nurse review in the next couple of days.”
Interpersonal Skills	Use sensitive and empathetic language throughout the consultation	—	No	You did not show clear empathy when the patient said the stockings were uncomfortable or that the wound was worsening. A simple, “I’m really sorry to hear that, it must be difficult,” would have helped.
Interpersonal Skills	Signpost the conversation to keep the patient informed about the next steps	01:00:54; 01:05:20; 01:06:08	Yes	You used signposting effectively to transition between history, exam, and management. Good flow.
Interpersonal Skills	Address the patient's concerns and expectations by providing clear explanations and reassurance	1:06:13	Yes	You answered the patient’s concern regarding alternative management and explained things clearly.
Interpersonal Skills	Ensure the patient understands the management plan and the importance of follow-up	—	Partial	You explained the plan but did not clearly check for understanding or ensure the patient was on board. You can ask, “Does this all make sense to you?” or “Any questions?”
Interpersonal Skills	Offer continuous support and encourage the patient to ask questions or express any further concerns	—	No	There was no invitation for the patient to ask more questions. Next time, ask: “Is there anything else worrying you?”
Interpersonal Skills	Address patient concerns directly, such as frustration with treatment or fear of worsening symptoms	—	No	You missed a key moment to empathise when the patient expressed frustration. Try using reflective phrases like, “It sounds like this has been quite tough for you.”
Interpersonal Skills	Invite questions and offer ongoing support, reassuring the patient that they are being monitored and supported	—	No	You didn’t explicitly invite questions or reassure the patient about ongoing monitoring. This could have been done right after outlining the plan.

	Feedback Statements:	Needs Improvement
Consultation	Disorganised / unstructured consultation. Includes illogical and disordered approach to questioning. You did not demonstrate sufficiently the ability to follow a logical structure in your consultation. For example, your history taking may have appeared disjointed, with your line of questioning erratic and not following reasoned thinking. You may have undertaken practical tasks or examination in an illogical order that suggested you did not have a full grasp of the reason for completing them or a plan for the consultation.	✔️
Diagnosis	Does not make the correct working diagnosis or identify an appropriate range of differential possibilities.	✔️
Examination	Does not undertake physical examination competently, or use instruments proficiently.
Findings	Does not identify abnormal findings or results or fails to recognise their implications. You did not identify or recognise significant findings in the history, examination or data interpretation.
Issues	Does not recognise the issues or priorities in the consultation (for example, the patient’s key problem or the immediate management of an acutely ill patient). You did not recognise the key element of importance in the station. For example, giving health and lifestyle advice to an acutely ill patient.	✔️
Management	Does not develop a management plan reflecting current best practice, including follow up and safety netting.	✔️
Rapport	Does not appear to develop rapport or show sensitivity for the patient’s feelings and concerns, including use of stock phrases. You did not demonstrate sufficiently the ability to conduct a patient centred consultation. Perhaps you did not show appropriate empathy or sympathy, or understanding of the patient’s concerns. You may have used stock phrases that show that you were not sensitive to the patient as an individual, or failed to seek agreement to your management plan.	✔️
Listening	Does not make adequate use of verbal & non-verbal cues. Poor active listening skills. You did not demonstrate sufficiently that you were paying full attention to the patient’s agenda, beliefs and preferences. For example, you may have asked a series of questions but not listened to the answers and acted on them.
Language	Does not use language or explanations that are relevant and understandable to the patient, including not checking understanding. The examiner may have felt, for example, that you used medical jargon, or spoke too quickly for the patient to take in what you were saying.
Time	Shows poor time management. You showed poor time management, probably taking too long over some elements of the encounter at the expense of other, perhaps more important areas.	✔️

Data_gathering	Management	IPS
2	1	1