PLAB 2 Mock Test Feedback :: 13/03/25 :: Paduhwan 30 :: Cases 1-5

Mock Date: 13/03/2025

Case 1:

Eye ENT Symptomatic Differentials:

Allergic Rhinitis Hay Fever

Action Items:

• Practice and Review the case in the OSCE workbench: Click Here

• Read the Mock Feedback Blog:  Click Here

• Additional Resources: Click Here

• Deep Dive into your performance below:

Scenario Summary:

You are an FY2 doctor in a GP surgery. Your patient, John Davis, a 40-year-old man, is concerned about persistent sneezing. He has been experiencing continuous sneezing for the past two months, which worsens when he is outside. He has a runny nose with clear fluid but no other symptoms like cough, fever, or itching. His family history includes a son with asthma and a brother with hay fever. John is worried about the impact of his symptoms on his work as an IT professional and wants to know the cause and management of his symptoms.

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 practicing, 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.	0:30	Partial	You asked for the patient's name and date of birth, but John only mentioned his first name and approximate age ("like 40 years old"). You should have confirmed the full name and exact date of birth.
Data Gathering	Use FODPARA for sneezing: Frequency, Onset, Duration, Progression, Aggravating factors, Relieving factors, Associated symptoms.	1:19, 1:26, 2:12, 2:15	Partial	You covered onset, duration, progression, and aggravating factors. However, frequency was not explicitly asked, and relieving factors were only partially covered. Make sure to ask directly about what makes the symptoms better.
Data Gathering	Rule out URTI: Ask about cough, fever, runny nose, sore throat, or swallowing problems.	2:38, 3:10, 3:55	Partial	You asked about fever and swallowing problems but did not ask about cough or sore throat. Make sure to ask about all key symptoms to rule out URTI completely.
Data Gathering	Rule out Tumors/Polyps: Ask about recent weight loss, problems with smell, nasal discharge, or bleeding.	3:04	Partial	You asked about nasal discharge and bleeding but did not ask about weight loss or problems with smell. These are essential in ruling out more serious conditions.
Data Gathering	Rule out Sinusitis: Ask about headaches between the eyebrows, especially when bending head down.	-	No	You did not ask about sinus headaches, which are crucial to ruling out sinusitis. Try asking, "Do you get headaches, especially between your eyebrows, or when bending forward?"
Data Gathering	Rule out Obstructive Sleep Apnea: Ask about sleep problems and frequent snoring.	-	No	You did not ask about snoring or sleep disturbances, which are important to rule out sleep apnea. A simple question like, "Has anyone told you that you snore a lot or stop breathing in your sleep?" would help.
Data Gathering	PMAFTOSA: Check for allergies, especially to house dust/pollen, and presence of pets.	-	No	You did not ask about allergies, exposure to dust/pollen, or pet ownership. These are crucial in cases of allergic rhinitis.
Data Gathering	ICE: Ideas, Concerns, and Expectations regarding the symptoms.	7:04, 7:17	Partial	The patient expressed concern when you mentioned carcinoma, but you did not explore his ideas or expectations regarding his sneezing. Ask directly, "What do you think is causing this?" and "What were you hoping we could do today?"
Data Gathering	Assess the impact of symptoms on daily activities or work.	4:44	Yes	You asked about how symptoms affected his work, and the patient explained how it interfered with his job and social interactions. Well done.
Data Gathering	Conduct ENT examination: Check ear, nose, and throat.	6:09	Yes	You stated that you would perform an ENT examination. Ensure you verbalize what you are looking for during the exam.
Management	Explain suspected allergic rhinitis and its common triggers.	-	No	You mentioned chronic rhinitis but did not clearly explain allergic rhinitis or common triggers like pollen, dust, or pet dander. Patients need a clear explanation to understand their condition.
Management	Prescribe non-drowsy antihistamines, prefer intranasal over oral.	-	No	You did not offer treatment options such as non-drowsy antihistamines or nasal sprays. These should be part of the initial management plan.
Management	Recommend saltwater rinses and nasal decongestants if needed.	-	No	You did not mention nasal rinses or decongestants, which are effective for symptom relief.
Management	Consider steroid spray if symptoms persist.	-	No	No mention of steroid nasal sprays, which are an important option for persistent symptoms.
Management	Suggest keeping a symptom diary to identify triggers.	-	No	Patients benefit from tracking their symptoms to identify patterns. This would have been a helpful recommendation.
Management	Advise on lifestyle adjustments (e.g., avoid parks in the morning, keep windows closed).	-	No	No lifestyle advice was provided, which is crucial for allergic rhinitis management. A simple statement like, "Try to keep windows closed during peak pollen times" would be helpful.
Management	Safety Netting: Return if fever or rashes develop.	-	No	You did not advise the patient on when to return if symptoms worsen. Always include a safety netting statement such as, "Come back if you develop fever, facial pain, or worsening symptoms."
Management	Follow-up: Review in two weeks to assess condition and effectiveness of measures.	-	No	You did not arrange a follow-up to check on the patient's progress. Always ensure follow-up is planned, especially when starting new treatments.
Management	Provide a leaflet about managing sneezing and allergic rhinitis.	-	No	You mentioned giving a newsletter about biopsy but did not provide educational material about allergic rhinitis, which would have been beneficial.
Interpersonal Skills	Acknowledge and validate the patient's emotions and concerns.	5:03, 7:17	Partial	You acknowledged the patient’s frustration about his nickname at work, but when he became distressed about cancer, your response was more factual than empathetic. Saying something like, "I understand this must be very worrying for you" would help.
Interpersonal Skills	Provide clear explanation of diagnosis and management plan.	-	No	The explanation was unclear and vague, especially about carcinoma. You need to explain things in simpler terms and ensure the patient understands before moving forward.
Interpersonal Skills	Show empathy and understanding of how symptoms impact the patient's life.	4:48	Partial	You showed some empathy for how symptoms affected his job but could have done more to acknowledge how it impacted his daily life and emotions.
Interpersonal Skills	Reassure the patient and address any remaining questions or concerns.	7:36	No	The patient expressed fear and confusion about biopsy and carcinoma, but your reassurance was minimal. Instead of simply stating that tests are needed, reassure the patient with something like, "This is just a precautionary step to rule things out. Most cases like yours turn out to be non-serious."

Feedback Statement Checklist

	Feedback Statements:	Needs Improvement
Consultation	Disorganised / unstructured consultation	✔️
Diagnosis
Examination
Findings
Issues
Management	Does not develop a management plan reflecting current best practice	✔️
Rapport	Does not appear to develop rapport or show sensitivity for the patient’s feelings and concerns	✔️
Listening
Language	Does not use language or explanations that are relevant and understandable to the patient	✔️
Time

Case 2:

Medicine Symptomatic Differentials

Codeine Constipation

Action Items:

• Practice and Review the case in the OSCE workbench: Click Here

• Read the Mock Feedback Blog:  Click Here

• Additional Resources: Click Here

• Deep Dive into your performance below:

Scenario Summary:

You are an FY2 doctor in the Orthopaedics and Trauma department. Your patient, Gwen McCarty, is a 70-year-old lady who had a hemi-arthroplasty 4 days ago due to a fracture of the neck of the femur. She has not passed stool since her admission and is currently taking co-codamol for pain management. Her pain is well controlled, and she is stable. Your task is to take a focused history, assess her condition, perform any relevant examination, and discuss the management plan with her.

My Performance:

🔍Let’s Deep Dive into your performance:

Domain	Point	Timestamp	Response	Remarks
Data Gathering	Patient identifiers: Confirm full name and age	01:34, 01:54	Yes	You confirmed the patient's full name and age
Data Gathering	Presenting Complaint: Ask about bowel movement history since admission	2:30	Yes	You asked about passing stool since admission, which covered this point well.
Data Gathering	History of Present Illness: Use OPDARA for constipation (Onset, Palliating/Provoking, Duration, Associated symptoms)	02:30 - 03:07	Partial	You covered some aspects (onset and associated symptoms like bloating and vomiting) but did not explore what makes it better/worse (palliating/provoking factors) or the exact duration explicitly. Asking, "Have you noticed anything that makes it better or worse?" and "When exactly did this start?" would have strengthened this.
Data Gathering	Past Medical History: Confirm no significant past medical history and allergies	02:07, 03:13	Partial	You asked about allergies but did not confirm any other past medical conditions apart from the leg fracture. Always ask, "Do you have any other medical conditions I should know about?"
Data Gathering	Medications: Confirm current medications, especially co-codamol	—	No	You did not ask about current medications. This was crucial as co-codamol (an opioid) is likely causing constipation. A direct question like, "Are you currently taking any medications, including painkillers?" would have helped.
Data Gathering	Diet and Lifestyle: Inquire about high fiber intake and hydration	—	No	You later advised increasing fluids and fiber but did not ask about the patient's current intake. Asking, "Have you been drinking enough fluids?" or "What have you been eating since admission?" would have been useful.
Data Gathering	Review of Systems: Check for gastrointestinal symptoms and red flags like severe pain or vomiting	02:40 - 03:10	Partial	You covered vomiting and bloating but did not ask about severe pain, weight loss, or blood in stool. A question like, "Have you had any severe tummy pain or noticed any blood in your stool?" would be good.
Data Gathering	ICE: Explore patient's Ideas, Concerns, and Expectations regarding constipation	04:21 - 04:45	Partial	You asked about her main concern and expectations, but you did not ask about her own thoughts on the cause of the constipation (Ideas). A question like, "Do you have any thoughts on why this might be happening?" would help.
Data Gathering	Effects on Daily Life: Assess impact on daily activities and recovery	—	No	You did not ask about how the constipation was affecting her recovery or daily activities. Asking, "Has this affected your ability to move around or eat properly?" would have been useful.
Management	Explain Findings: Discuss constipation likely due to co-codamol	05:06 - 05:43	Yes	You explained that the medication (opioid) is likely causing constipation. This was good.
Management	Routine Investigations: Plan for blood tests and abdominal x-ray	—	No	You did not mention any investigations. In a post-op patient, checking for obstruction or electrolyte imbalance is important. Saying, "We will do some blood tests and possibly an abdominal x-ray to rule out other causes" would have been ideal.
Management	Treatment: Adjust medication to paracetamol/Tramadol, administer phosphate enema, start oral laxatives	05:55 - 07:41	Partial	You planned stool softeners and increased fluids but did not mention a phosphate enema or the need to switch co-codamol to an alternative like paracetamol/Tramadol clearly. Stating, "We will switch your painkiller to one that doesn't cause constipation, and if needed, we’ll give you an enema to help" would be better.
Management	Diet and Hydration: Encourage high-fiber diet and adequate fluid intake	05:43 - 06:29	Yes	You advised increasing fluids and fiber-rich foods
Management	Mobility: Promote movement with physiotherapy to stimulate bowels	—	No	You did not mention mobility or physiotherapy, which is important post-surgery. A phrase like, "Moving around with the physiotherapists will help your bowels start working again" would have been good.
Management	Follow-up and Safety Netting: Monitor bowel movements and plan for discharge	06:27 - 08:53	Partial	You discussed monitoring but did not set clear expectations for follow-up or specific criteria for discharge. A statement like, "We will monitor your progress, and once your bowel movements are regular, we can discuss discharge" would be clearer.
Management	Patient Education: Explain phosphate enema and laxatives	—	No	You mentioned a stool softener but did not explain how laxatives or phosphate enemas work. A simple statement like, "The enema works by drawing water into your bowels to help move things along" would have been useful.
Management	Address Concerns: Reassure about pain management and discharge plan	08:11 - 08:53	Partial	You reassured her about pain medication but initially made it sound like you were stopping her pain relief completely, leading to resistance. Being clearer from the start would have helped.
Management	Summarize and Closure: Recap management plan and ensure patient understanding	—	No	You did not clearly summarize the plan at the end. A recap like, "So, just to summarize, we will adjust your medication, give stool softeners, encourage fluids and fiber, and monitor your progress" would have been helpful.
Interpersonal Skills	Introduction and Rapport: Greet and ensure comfort and privacy	01:27 - 01:51	Yes	You introduced yourself well and asked how she preferred to be addressed, which was good.
Interpersonal Skills	Empathy: Show understanding of patient's discomfort and concerns	02:34, 04:45	Partial	You acknowledged her concern but could have been more empathetic when she expressed frustration about waiting for treatment. Simple phrases like, "I understand this must be uncomfortable for you" would have helped.
Interpersonal Skills	Active Listening: Respond to patient cues and questions	07:09 - 08:53	Partial	You responded to some concerns but initially missed her frustration about discharge and pain relief. Reflecting back, "I see you're worried about how long this will take" would have helped.
Interpersonal Skills	Clear Communication: Use non-medical language and avoid jargon	04:11, 06:54	Yes
Interpersonal Skills	Patient Involvement: Ensure patient agrees with management plan	8:53	Yes	You ensured she agreed with the plan at the end.
Interpersonal Skills	Closure: Offer further assistance and ensure all questions are answered	—	No	You did not ask if she had any final questions or offer further assistance. Ending with, "Do you have any other questions or concerns?" would have been better.

Feedback Statement Checklist:

	Feedback Statements:	Needs Improvement
Consultation	Disorganised / unstructured consultation	✔️
Diagnosis
Examination
Findings
Issues
Management	Does not develop a management plan reflecting current best practice	✔️
Rapport	Does not appear to develop rapport or show sensitivity for the patient’s feelings and concerns	✔️
Listening
Language	Does not use language or explanations that are relevant and understandable to the patient	✔️
Time

Case 3:

Gynecology Symptomatic Differentials

Premature Ovarian Insufficiency

Action Items:

• Practice and Review the case in the OSCE workbench: Click Here

• Read the Mock Feedback Blog:  Click Here

• Additional Resources: Click Here

• Deep Dive into your performance below:

Scenario Summary:

This is a scenario where you, a FY2 in OBGYN, will see Margaret Evans, a 26-year-old woman, referred by her GP with a 20-month history of amenorrhoea. Your primary objectives are to discuss her test results, explain her diagnosis of premature ovarian insufficiency (POI), and address her concerns.

My Performance:

🔍Let’s Deep Dive into your performance:

Domain	Point	Timestamp	Response	Remarks
Data Gathering	Patient identifiers: Confirm full name and age	1:20	Yes	You correctly asked for the patient's full name and date of birth at the beginning. Well done!
Data Gathering	Confirm the reason for the visit: 20-month history of amenorrhoea	1:36	Yes	You confirmed the reason for the visit by asking the patient to explain what happened in her own words. Good approach!
Data Gathering	Explore associated symptoms: hot flushes, anxiety, mood changes	3:35, 3:44	Partial	You covered hot flushes and anxiety, but you missed explicitly asking about mood changes. Next time, directly ask if she has experienced any significant mood swings or depressive symptoms.
Data Gathering	Family history: Inquire about premature ovarian failure or genetic conditions	4:45	Yes	You asked about family history and got information about the patient’s mother experiencing early menopause. Well done!
Data Gathering	Menstrual history: Regularity, frequency, duration, pain, intermenstrual bleeding	2:27, 2:35	Partial	You covered regularity and intermenstrual bleeding but did not ask about frequency, duration, or pain. Always ask about the full menstrual history to rule out other possible causes.
Data Gathering	Sexual history: Sexual activity, contraception use, sexual health issues	2:54, 3:02	Partial	You asked about sexual activity and contraception use but did not explore sexual health issues (e.g., past infections, pain during intercourse). A more complete sexual history would help assess other potential causes.
Data Gathering	Rule out other conditions: Headaches, visual disturbances, nipple discharge, excess hair, acne	4:03, 4:09	Partial	You asked about excess hair growth but did not explore headaches, visual disturbances, nipple discharge, or acne. These are important in ruling out conditions like PCOS or pituitary disorders.
Data Gathering	Lifestyle factors: Diet, exercise, smoking, alcohol use	-	No	You did not ask about diet, exercise, smoking, or alcohol use. These factors can impact hormone levels and overall health, so remember to include them.
Data Gathering	Physical examination: General exam, BMI, abdominal and thyroid examination	5:32	Partial	You mentioned general examination and abdominal examination but did not explicitly state checking BMI and thyroid. Make sure to verbalize all components of your examination plan.
Data Gathering	Consider pelvic examination if sexually active	-	No	You did not discuss a pelvic examination, which could be relevant, especially given the patient’s concerns about fertility. Consider mentioning this as an option.
Management	Arrange investigations: Pelvic ultrasound, prolactin, TFT, testosterone levels	-	No	You did not discuss arranging these investigations. Even though the patient already had results, it's good to explain why certain tests were done or if any further tests are needed.
Management	Explain blood test results: Elevated LH and FSH, low estradiol	6:05, 6:38	Partial	You mentioned the anomalies in blood results but did not clearly explain what elevated LH, FSH, and low estradiol mean in simple terms. Next time, use layman's terms to help the patient understand.
Management	Discuss diagnosis: Premature ovarian insufficiency and implications	7:31	Yes	You explained premature ovarian insufficiency (POI) and its impact. Good job!
Management	Address fertility concerns: Discuss family planning and donor eggs	7:49, 8:16	Partial	You acknowledged the patient’s fertility concerns but did not fully discuss options like donor eggs or fertility preservation. Addressing this in detail would provide reassurance.
Management	Provide information on HRT: Manage symptoms and maintain bone health	8:26, 8:41	Partial	You introduced HRT but did not clearly explain its full benefits, including bone health and cardiovascular protection. Make sure to elaborate more on why it is important.
Management	Plan further investigations like prolactin levels and USG	-	No	You did not discuss further investigations. Even if initial tests point to POI, additional tests might be needed to confirm the diagnosis and rule out other causes.
Management	Schedule follow-up appointments for monitoring and management adjustment	-	No	You did not mention follow-up. It’s crucial to reassure the patient that this condition requires ongoing monitoring and adjustment of management.
Management	Offer educational resources: Leaflets on premature ovarian insufficiency	9:05	Yes	You mentioned giving a leaflet, which is great. Well done!
Interpersonal Skills	Use clear, non-medical language to explain the condition	6:31, 7:31	Partial	Some explanations were too technical (e.g., "anomalies in LH and FSH levels"). Try simplifying your language to ensure the patient fully understands.
Interpersonal Skills	Show empathy and provide reassurance about fertility and health concerns	7:49, 8:02	Partial	You acknowledged the patient’s distress but could have reassured her more explicitly about fertility options and long-term health.
Interpersonal Skills	Offer emotional support and guide to counseling resources if needed	-	No	You did not mention any counseling or psychological support. Given the impact of POI, offering counseling services would have been beneficial.
Interpersonal Skills	Encourage open communication: Invite questions and concerns	1:36, 5:56	Yes	You encouraged the patient to share concerns and asked if she understood. Good job!
Interpersonal Skills	Signpost throughout the consultation to ensure understanding	-	No	You did not consistently signpost the structure of the consultation. This would help guide the patient and make the discussion smoother.

Feedback Statement Checklist:

	Feedback Statements:	Needs Improvement
Consultation	Disorganised/unstructured approach – Some elements were missing (lifestyle factors, investigations)	✔️
Diagnosis
Examination
Findings
Issues		✔️
Management	Did not fully develop a plan reflecting best practice – Missed investigations, follow-up, fertility discussion.	✔️
Rapport	Lacked smooth transitions between parts of the consultation.	✔️
Listening	Did not pick up on the patient’s emotional distress fully.	✔️
Language	Used some medical jargon that may not have been fully understood.	✔️
Time

Case 4:

Counseling Condition:

Celiac Disease Endoscopy Biopsy

Action Items:

• Practice and Review the case in the OSCE workbench: Click Here

• Read the Mock Feedback Blog:  Click Here

• Additional Resources: Click Here

• Deep Dive into your performance below:

Scenario Summary:

You are an FY2 doctor in the Gastroenterology department. Your patient, Lucy Thompson, is a 55-year-old lady who presented with tiredness last week and had investigations done. Her tissue transglutaminase antibodies are positive, and her hemoglobin is 9.8 g/dl. You need to explain the results to her, discuss the indications for an endoscopy and biopsy, and inform her that an endoscopy is recommended.

My Performance:

🔍Let’s Deep Dive into your performance:

Domain	Point	Timestamp	Response	Remarks
Data Gathering	Patient identifiers: Confirm full name and age	1:42	Yes	You did well in confirming the patient's full name and age at the beginning of the consultation. This is a good practice to ensure patient safety.
Data Gathering	Confirm the reason for the visit and current symptoms: tiredness, bloating, abdominal pain	2:25 - 2:41, 4:18	Partial	You explored tiredness and bloating but did not explicitly ask about abdominal pain. Since the patient mentioned bloating, you could have followed up with, "Do you also experience any stomach pain along with the bloating?" to ensure you cover all key symptoms.
Data Gathering	Explore specific symptoms of celiac disease: diarrhea, constipation, weight loss	3:43 - 3:49	Partial	You asked about weight loss but did not ask about diarrhea or constipation, which are crucial symptoms of celiac disease. A good way to include this is by asking, "Have you noticed any changes in your bowel habits, such as diarrhea or constipation?"
Data Gathering	Inquire about family history of celiac disease or other autoimmune conditions	4:29 - 4:42	Yes	You successfully asked about family history, and the patient mentioned a cousin with celiac disease. Well done!
Data Gathering	Clarify patient’s understanding and concerns about symptoms and endoscopy	6:17 - 8:38	Partial	You asked if the patient knew about transglutaminase antibodies but did not check her understanding of her symptoms before jumping into test results. You also addressed her concerns about the endoscopy but could have asked, "What are your main worries about your symptoms?" earlier in the consultation.
Data Gathering	Understand patient’s expectations from the consultation	-	No	You did not explicitly ask, "What were you hoping to get out of today's visit?" This would have helped tailor your explanations and management plan to her concerns.
Management	Explain the positive tissue transglutaminase antibodies indicating possible celiac disease	6:17 - 7:03	Yes	You explained the meaning of transglutaminase antibodies in simple terms, which was great. However, you could improve by linking it more clearly to celiac disease at the start, e.g., "This test suggests you might have celiac disease, which affects how your body reacts to gluten."
Management	Describe the endoscopy procedure and its purpose in confirming celiac disease	8:05 - 8:31	Yes	You explained the procedure well and mentioned that a biopsy would be taken. Good job. However, the patient was quite anxious, and a more reassuring tone could have helped.
Management	Emphasize the importance of maintaining a gluten-free diet post-diagnosis	-	No	You did not mention the gluten-free diet, which is crucial in managing celiac disease. This should have been included after explaining the diagnosis. You could say, "If the diagnosis is confirmed, the main treatment is a strict gluten-free diet, which can help relieve your symptoms and prevent complications."
Management	Discuss potential follow-up procedures like repeat endoscopy and DEXA scan	-	No	You did not mention follow-up procedures like repeat endoscopy or a DEXA scan for bone health, which are important for long-term management. You could say, "Once we confirm the diagnosis, we may need to check your bone health with a DEXA scan, as celiac disease can affect calcium absorption."
Management	Mention the need for further blood tests to determine the type of anemia	7:33 - 7:56	Partial	You mentioned anemia but did not specify additional blood tests to determine the type (e.g., iron studies, B12, folate). A good way to include this is by saying, "We will do some further blood tests to check if your anemia is due to iron, B12, or folate deficiency."
Management	Suggest testing for first-degree relatives for celiac disease	-	No	You did not suggest screening first-degree relatives, which is important given the patient’s cousin has celiac disease. You could say, "Since celiac disease runs in families, I would recommend testing your siblings and children to check if they also have it."
Management	Arrange for a second opinion and possible referrals if needed	-	No	You did not discuss the option of a second opinion or referrals (e.g., to a gastroenterologist or dietitian). This is important for shared decision-making, especially if the patient is hesitant about the endoscopy.
Management	Provide educational materials like leaflets on celiac disease	9:15 - 9:19	Yes	You mentioned providing a leaflet, which is great. However, make sure to actively hand it over and say, "Here’s a leaflet with more information about celiac disease and its management."
Management	Ensure informed consent is obtained before any procedure	8:35 - 9:04	Partial	You reassured the patient about the procedure, but you did not explicitly confirm consent. Before proceeding, you should say, "Would you be comfortable proceeding with this test?" and ensure she agrees before arranging it.
Interpersonal Skills	Respect patient’s autonomy and provide choices whenever possible	8:35 - 9:04	Partial	You explained the endoscopy well, but when the patient resisted, you did not explore her hesitation further or offer alternatives like discussing with a specialist. Try asking, "What worries you most about the procedure?" before offering reassurance.
Interpersonal Skills	Acknowledge the patient’s anxiety and provide reassurance	8:32 - 9:10	Partial	The patient clearly expressed fear about the endoscopy, but your reassurance was brief. Instead of just saying she will be comfortable, you could have said, "I completely understand that this sounds worrying, but we will ensure you are sedated and won’t feel any pain."
Interpersonal Skills	Maintain a calm and empathetic demeanor throughout the consultation	2:44, 4:29, 6:42	Yes	You showed empathy in several places, like acknowledging the patient's symptoms and offering condolences. Well done!
Interpersonal Skills	Use layman’s terms to explain medical jargon	6:28 - 7:33	Yes	You explained transglutaminase and anemia well in simple terms. Good job!
Interpersonal Skills	Ensure patient understands each step of the investigation and treatment plan	8:05 - 9:26	Partial	You explained the endoscopy, but you did not check her understanding of the gluten-free diet or follow-up steps. You could ask, "Does this all make sense to you?" at the end.
Interpersonal Skills	Encourage questions and actively listen to patient’s concerns	8:06 - 8:38	Yes	You gave the patient space to express her worries, which was great.
Interpersonal Skills	Provide written instructions for follow-up care and dietary management	-	No	You mentioned a leaflet but did not specify dietary guidance. Make sure to give written instructions on the gluten-free diet.

Feedback Statement Checklist:

	Feedback Statements:	Needs Improvement
Consultation	Disorganised / unstructured consultation	✔️
Diagnosis
Examination
Findings
Issues
Management	Does not develop a management plan reflecting current best practice	✔️
Rapport	Does not appear to develop rapport or show sensitivity for the patient’s feelings and concerns	✔️
Listening
Language	Does not use language or explanations that are relevant and understandable to the patient	✔️
Time

Case 5:

Medicine Symptomatic Differentials

DKA First Presentation 16 Year Old

Action Items:

• Practice and Review the case in the OSCE workbench: Click Here

• Read the Mock Feedback Blog:  Click Here

• Additional Resources: Click Here

• Deep Dive into your performance below:

Scenario Summary:

You are an FY2 doctor in the Emergency department, and your patient is a 16-year-old schoolgirl named Emily Turner. She presents with abdominal pain, generalized weakness, increased thirst, and frequent urination. Her mother is in the waiting area. Emily is anxious about her health and the possibility of missing an important exam. Your task is to take a history, assess her condition, and discuss management with her.

My Performance:

🔍Let’s Deep Dive into your performance:

Domain	Point	Timestamp	Response	Remarks
Data Gathering	Confirm patient identifiers: full name, age	1:38	Yes	You appropriately confirmed the patient’s full name and age at the start of the consultation. Well done!
Data Gathering	Use SOCRATES for abdominal pain: Site, Onset, Character, Radiation, Associated symptoms, Timing, Exacerbating/relieving factors, Severity	2:39, 2:44, 2:52, 2:56, 3:04, 3:07, 3:12, 3:16, 3:21	Partial	You covered most of the SOCRATES components but missed radiation and severity. Next time, ensure you ask explicitly about whether the pain moves anywhere and how severe it is on a scale of 1-10.
Data Gathering	Assess for symptoms of diabetes: increased thirst, frequent urination, nocturia, generalized weakness	3:32, 3:37, 3:41, 3:45, 3:48	Yes	You effectively explored symptoms of diabetes, including thirst, frequent urination, nocturia, and tiredness. Good job!
Data Gathering	Rule out differentials: Anorexia Nervosa, Malignancy, Chronic Fatigue Syndrome	-	No	You did not explore alternative diagnoses like anorexia, malignancy, or chronic fatigue syndrome. You could have asked about appetite, unintentional weight loss, or persistent fatigue to rule these out.
Data Gathering	PMAFTOSA: Past medical history, Medication history, Allergies, Family history, Travel history, Occupational history, Social history, Activities of daily living	5:20, 5:21, 5:25, 5:29, 5:32	Partial	You asked about past medical history, medication history, and family history but missed allergies, travel history, occupational history, social history, and activities of daily living. These are crucial for identifying additional risk factors.
Data Gathering	Effect of symptoms on life: difficulty concentrating, disrupted sleep	3:50, 6:05	Yes	You asked about sleep disturbance due to frequent urination, which is relevant. Great job!
Data Gathering	ICE: Ideas about illness, Concerns about health and exam, Expectations from consultation	5:37, 5:40, 5:57, 6:02	Yes	You explored the patient’s ideas ("I don’t know"), concerns (mother’s worry), and expectations (relief from frequent urination). Well done!
Data Gathering	Conduct a systemic review to check for symptoms related to other systems	4:12, 4:23, 4:27	Partial	You asked about boils and infections, but a full systemic review should include neurological (tingling, blurred vision), cardiovascular (palpitations), and gastrointestinal (appetite changes, nausea, vomiting).
Data Gathering	Summarize findings to ensure understanding of her condition and concerns	6:48	Partial	While you briefly summarized the condition and concerns, you could have structured it better, ensuring the patient acknowledges understanding before moving on to management.
Management	Explain diagnosis: Type 1 Diabetes Mellitus and current Diabetic Ketoacidosis (DKA)	6:48, 6:53, 7:08	Partial	You explained diabetes but did not clearly define diabetic ketoacidosis (DKA), its severity, and why immediate management is crucial. Try to simplify medical terms and ensure the patient understands why this is an emergency.
Management	Immediate management: Recommend hospital admission, administer IV fluids and insulin, monitor urine output and glucose levels	7:51, 7:58, 8:10	Yes	You recommended admission, fluids, and insulin, which was excellent. Well done!
Management	Perform additional investigations like Chest X-ray (CXR) and consider catheterization if necessary	-	No	You did not mention CXR or catheterization, which could be necessary in severe DKA. Always outline additional investigations needed.
Management	Involve diabetic care team (nurses and specialists) and seniors	-	No	There was no mention of involving a senior or diabetic team, which is essential in managing a young patient with DKA.
Management	Patient education: Explain importance of immediate treatment, offer educational leaflets about diabetes and DKA	9:08	Partial	You provided a leaflet but did not sufficiently explain the importance of immediate treatment or long-term implications. Make sure to educate the patient properly.
Management	Discuss follow-up plans with diabetic team, arrange for continued support and education for managing diabetes	-	No	You did not discuss follow-up or long-term diabetes education. Always arrange support for chronic conditions like diabetes.
Interpersonal Skills	Communicate clearly and empathetically, listen actively to concerns and questions	7:00, 8:05	Yes	You showed good listening and clarification, especially when the patient was distressed about the diagnosis. Good job!
Interpersonal Skills	Reassure about treatment plan and explain each step	8:35	Partial	While you reassured the patient, more explanation on why hospital admission is needed could have helped.
Interpersonal Skills	Offer emotional support, acknowledge anxiety about exam, reassure that health is the priority	-	No	You did not acknowledge the patient’s distress about missing the exam. Saying something like, "I understand this is tough, but your health comes first. We can discuss ways to support your studies later." could have helped.
Interpersonal Skills	Encourage participation in decision-making, ensure she feels heard and preferences are considered	-	No	The patient resisted admission but you did not ask about her preferences or involve her in decision-making. Instead of just insisting on admission, try asking: "What are your thoughts about staying in the hospital? How can we make this easier for you?"
Interpersonal Skills	Show empathy and understanding of patient's situation and concerns	6:56, 7:51	Partial	You acknowledged her surprise at the diagnosis but missed validating her emotions about the impact on her life. More empathy could have been shown.
Interpersonal Skills	Maintain a calm and reassuring demeanor throughout the consultation	Entire Consultation	Yes	You remained professional and calm throughout. Well done!

Feedback Statement Checklist:

	Feedback Statements:	Needs Improvement
Consultation
Diagnosis
Examination
Findings
Issues	Does not recognise the issues or priorities in the consultation (did not stress severity of DKA enough).	✔️
Management	Does not develop a management plan reflecting current best practice (missed diabetic team involvement and follow-up).	✔️
Rapport	Does not appear to develop rapport or show sensitivity (did not acknowledge distress about exams).	✔️
Listening	Does not make adequate use of verbal & non-verbal cues (missed active listening in some areas).	✔️
Language
Time