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

Mock Date: 18/07/2025
Case 2:
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.	0:03, 0:21	Yes	You confirmed the patient’s name correctly, but you only asked for their date of birth and accepted “I’m 50 years old” without verifying the exact DOB. Please confirm the full DOB clearly next time.
Data Gathering	Acknowledge patient’s frustration and validate emotional response to the slow healing process.	3:51	Partial	You did express sympathy once (“I’m really sorry about that, Jayden”), but this could have been stronger and earlier, especially when the patient mentioned discomfort and frustration with the stockings.
Data Gathering	Elaborate the presenting complaint using SOCRATES to assess the ulcer comprehensively.	—	No	You did ask when it started and about discharge, but you missed key SOCRATES elements like site, character, radiation, associated symptoms, timing, exacerbating/relieving factors, and severity.
Data Gathering	Ask about changes in symptoms like increased pain, discharge, odour, or swelling to detect complications.	2:21–2:32	Partial	You asked about discharge and pain, but did not ask about odour or swelling. Next time, cover the full range of complication indicators.
Data Gathering	Assess compliance with compression stockings and explore any practical challenges using them.	1:47–2:12	Yes	Good job asking if he wore them and exploring whether they were too tight or causing itching.
Data Gathering	Inquire about previous ulcers or chronic venous disease, diabetes, or autoimmune disorders to identify contributing comorbidities.	—	No	You didn’t ask about previous ulcers, diabetes, or autoimmune disorders. These are important to explore when looking into reasons for delayed healing.
Data Gathering	Ask about current medications and known allergies to identify any factors impeding healing or contraindications.	3:00–3:06	Yes	You asked clearly and the patient denied both medications and allergies.
Data Gathering	Explore family history of venous disease or clotting disorders as a contributing risk factor.	—	No	Family history was completely missed. This is essential, especially in venous conditions.
Data Gathering	Ask about lifestyle factors like smoking, alcohol use, prolonged standing, exercise habits, and diet.	3:23–3:33	Partial	You asked about smoking and alcohol, but missed questions on prolonged standing, exercise, and diet. Make sure to assess these as they contribute significantly to venous insufficiency.
Data Gathering	Assess the impact of the ulcer on daily activities and quality of life, including work, mobility, and sleep	3:36–3:39	Partial	You asked how it affects him, and he said it’s uncomfortable, but you didn’t explore impact on mobility, sleep, or detailed activities. Dig deeper into functional impact next time.
Management	Explain the current diagnosis of a non-healing venous ulcer and clarify why healing is delayed despite compression.	5:12–5:32	Yes	You explained the pathophysiology of venous ulcers well and clearly related it to compression use and valve incompetency.
Management	Order appropriate blood investigations: FBC, ESR, CRP, HbA1c, Albumin, U&E to rule out infection, inflammation, and poor nutritional/healing status.	—	No	No blood investigations were mentioned. It would have shown thoroughness to suggest these when assessing a non-healing ulcer.
Management	Offer Paracetamol or other appropriate analgesia for symptom control and comfort.	—	No	Despite patient describing discomfort, no analgesia was offered. You should have offered Paracetamol or discussed pain relief options.
Management	Reinforce the importance of compression therapy in ulcer healing and long-term prevention.	5:32	Partial	You acknowledged he was wearing them and suggested changing the size, but you didn’t clearly explain the ongoing importance of compression therapy. A short reinforcing statement would have helped.
Management	Discuss alternative compression options like Velcro wraps or lighter stockings if current ones are uncomfortable.	—	No	You only mentioned changing size, but not alternatives like Velcro wraps or lighter compression. Providing more options shows awareness of patient comfort and improves compliance.
Management	Recommend adjunctive treatment with Pentoxifylline to improve circulation and support wound healing.	—	No	This important adjunct was not mentioned. It’s a common recommendation for venous ulcers and demonstrates current evidence-based practice.
Management	Refer to a Tissue Viability Nurse for expert wound dressing and assessment of ulcer care.	6:44	Yes	Good job — you referred the patient to the TVN for wound management.
Management	Arrange routine referral to the Vascular Team for potential surgical or advanced interventional assessment.	5:58	Yes	Clear explanation of referral and what to expect from the vascular team.
Management	Advise on lifestyle modifications: leg elevation, regular movement, weight loss if overweight, and avoiding trauma to the affected leg. Advice against smoking and alcohol that can delay the healing process	—	No	No lifestyle advice was offered. You should mention leg elevation, movement, or even avoidance of alcohol as supportive measures.
Management	Provide a leaflet about venous ulcers and compression stockings, with tips on managing symptoms at home.	7:05	Yes	You offered a leaflet with appropriate information.
Management	Safety netting: Advise the patient to seek immediate help if they notice any signs of infection, arterial insufficiency, or new ulceration, increased pain, redness, swelling, pus, fever.	7:41–7:56	Yes	Good safety netting done. Clear instructions were given on 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	No specific follow-up was scheduled. You should offer this to show continuity of care.
Interpersonal Skills	Use sensitive and empathetic language throughout the consultation.	3:51	Partial	Some empathy was shown, but more validation of frustration earlier in the consultation (around 0:43) would have helped.
Interpersonal Skills	Signpost the conversation to keep the patient informed about the next steps.	—	No	There was no clear signposting like “I’d now like to ask you about your medical history.” This helps the patient follow the consultation logically.
Interpersonal Skills	Address the patient's concerns and expectations by providing clear explanations and reassurance.	5:32, 6:44	Yes	You explained the plan well and addressed his request to change stockings. This was well done.
Interpersonal Skills	Ensure the patient understands the management plan and the importance of follow-up.	—	No	While you explained the plan, you did not check for understanding or emphasize the importance of follow-up explicitly.
Interpersonal Skills	Offer continuous support and encourage the patient to ask questions or express any further concerns.	7:19	Partial	You asked if anything else needs to be discussed, but this came too late. Offer support throughout and encourage questions early.
Interpersonal Skills	Address patient concerns directly, such as frustration with treatment or fear of worsening symptoms.	0:43, 3:51	Partial	The frustration was acknowledged but not directly addressed or explored in depth. “I understand this must be hard for you” or “That sounds very uncomfortable” would have helped.
Interpersonal Skills	Invite questions and offer ongoing support, reassuring the patient that they are being monitored and supported throughout the treatment process.	—	No	You didn’t explicitly invite questions or provide reassurance about ongoing support. Saying something like “We’ll keep a close eye on it” or “We’re here to help” would have shown patient-centered care.

	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	2	3