PLAB 2 Mock Test Feedback :: 13/03/25 :: Paduhwan 30 :: Cases 6-10

Case 6:

Angry Patient

CP Child Refusing IV Cannula

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 Paediatric department. Your patient, Dwight Shrute, a 15-year-old boy with cerebral palsy, is being treated for a chest infection. His IV cannula has become blocked, and previous attempts to insert a new one have failed. His mother, Angela Shrute, is upset and refuses further attempts to insert the IV cannula. Dwight is currently tachycardic and has a fever. Your task is to talk to Angela about the importance of the IV line and address her concerns.

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	Patient identifiers: Confirm Angela Shrute's identity and relationship to Dwight Shrute	1:38 – 1:58	Yes	You did well in confirming Angela's name and her relationship to Dwight early in the conversation. This ensures you are speaking to the correct person and establishes rapport.
Data Gathering	Confirm the reason for Dwight's current hospitalization: Symptoms of fever, cough with sputum, and wheezing	2:41 – 2:49, 7:02	Partial	You confirmed that Dwight has a chest infection, but you did not explicitly ask about his specific symptoms such as fever, cough with sputum, and wheezing. Always ensure you gather a full clinical picture to guide management.
Data Gathering	Ask about the number of IV cannulation attempts and the outcome	4:28 – 4:36	Partial	You mentioned that the team had unsuccessfully tried to set the IV line, but you did not ask about the exact number of attempts or how it went. This detail could help assess the level of distress and guide alternative options.
Data Gathering	Inquire about Dwight's past medical history: Cerebral palsy, scoliosis, previous hospitalizations for chest infections	2:55 – 3:29	Partial	You confirmed Dwight has cerebral palsy and past admissions for chest infections, but you missed asking about scoliosis. A complete past medical history helps in anticipating complications.
Data Gathering	Medication history: Current treatment for pneumonia, any other medications Dwight is taking	N/A	No	You did not ask about Dwight's current medications apart from IV antibiotics. Always confirm full medication history, including any home medications or recent changes.
Data Gathering	Allergy history: Confirm if Dwight has any known allergies	N/A	No	This was not asked. Allergies are crucial, especially in cases requiring IV antibiotics. Always check for medication allergies.
Data Gathering	Living situation: Confirm Dwight lives with his parents and attends a special school	N/A	No	You did not ask about his living situation. Understanding this helps tailor supportive care and anticipate challenges in home care.
Data Gathering	Psychosocial history: Angela is the primary caregiver, her husband helps occasionally	3:37 – 3:56	Partial	You gathered that Angela is the primary caregiver, but you did not explore if her husband helps occasionally. This can be important for assessing caregiver burden.
Data Gathering	ICE (Ideas, Concerns, and Expectations): Angela's concerns about repeated IV attempts, her belief that Dwight may not need IV treatment, and her desire to make an official complaint	2:24 – 2:26, 6:45 – 6:49	Yes	You acknowledged Angela's concerns about the IV attempts, her belief that oral antibiotics should be an option, and her intent to make a complaint. Well done in addressing her agenda.
Management	Explain the importance of IV antibiotics for treating Dwight's chest infection and the risks of not receiving them	4:15 – 4:27	Yes	You explained why IV antibiotics are necessary due to his condition. This was essential in addressing Angela’s concerns.
Management	Discuss the use of numbing cream to minimize Dwight's discomfort during IV cannulation	5:12 – 5:18	Yes	You reassured Angela that numbing cream would be used, which was good in reducing her anxiety about the procedure.
Management	Ensure the most experienced doctor performs the IV cannulation to increase the chances of success	6:18	Yes	You assured Angela that an experienced phlebotomist would perform the procedure. Good job ensuring competence.
Management	Discuss alternative medications or methods if IV access continues to be problematic, while explaining that these may not be as effective	N/A	No	You did not mention alternative options like oral or intramuscular antibiotics if IV access remains difficult. Always explore backup plans for shared decision-making.
Management	Educate on preventive measures for recurrent chest infections: Feeding Dwight in an upright position, consulting a physiotherapist	N/A	No	You did not discuss preventive measures. This would have been helpful for long-term care.
Management	Safety Netting: Advise Angela to seek immediate medical attention if Dwight's condition worsens or if she has any further concerns	N/A	No	You did not explicitly provide safety netting advice. Ensure you inform caregivers about when to return to the hospital.
Management	Follow-Up: Arrange for a senior consultant to discuss further options if Angela remains uncomfortable with the current plan	8:16 – 8:44	Yes	You mentioned an incident report and involving hospital administration, which shows a good escalation plan.
Interpersonal Skills	Acknowledge and validate Angela's emotions: Express empathy for her distress and frustration	2:32 – 2:36, 4:50 – 4:55	Partial	You did express sympathy, but the delivery could have been stronger. Instead of "Sorry about your experience," you could have explicitly acknowledged her distress more deeply (e.g., "I can see how upsetting this must be for you").
Interpersonal Skills	Use simple language: Explain medical terms and procedures in layman's terms	4:15 – 4:27	Yes	You explained IV antibiotics and their necessity in understandable terms, which was effective.
Interpersonal Skills	Check understanding: Ensure Angela comprehends the discussion and invite her to ask questions	N/A	No	You did not actively check Angela's understanding. You could have asked, "Does that make sense?" or "Do you have any questions about this?"
Interpersonal Skills	Patient-centered approach: Involve Angela in decision-making about Dwight's treatment	5:07 – 6:10	Partial	You tried to reassure Angela but did not fully engage her in shared decision-making. When she asked for alternatives, you could have explored this more instead of just emphasizing IV antibiotics.
Interpersonal Skills	Active listening: Encourage Angela to express her concerns and frustrations	2:24 – 3:10	Yes	You allowed Angela to express her frustrations without interrupting, which was good.
Interpersonal Skills	Reassure: Offer hope for improvement with proper adjustments and support	7:27 – 7:49	Partial	You reassured her about the IV process, but you could have also reassured her about Dwight's recovery. A statement like, "With proper treatment, he should start improving soon," would have been helpful.
Interpersonal Skills	Express gratitude: Thank Angela for her understanding and cooperation	N/A	No	You did not thank her explicitly. A simple "Thank you for sharing your concerns with me" would have helped build rapport.

Feedback Statement Checklist:

	Feedback Statements:	Needs Improvement
Consultation	Disorganised / unstructured consultation	✔️
Diagnosis
Examination
Findings
Issues	Does not recognise the issues or priorities in the consultation	✔️
Management	Does not develop a management plan reflecting best practice	✔️
Rapport
Listening	Does not make adequate use of verbal & non-verbal cues	✔️
Language
Time

Case 7:

Medicine Symptomatic Differentials

Erectile Dysfunction Beta Blocker Raynauds Phenomenon

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 clinic. Your patient, Leo Hughes, a 52-year-old man, presents with erectile dysfunction and Raynaud’s phenomenon. He has a history of ischemic heart disease (IHD) and congestive cardiac failure (CCF) and is currently on a beta blocker prescribed by his cardiologist. Your task is to take a detailed history and discuss management options, keeping in mind the need to consult the cardiologist before making any changes to his medication.

My Performance:

🔍Let’s Deep Dive into your performance:

Domain	Point	Timestamp	Response	Remarks
Data Gathering	Patient identifiers: 'full' name, age	0:17	Yes	You did well by confirming the patient's full name and age at the beginning. This sets a professional tone for the consultation.
Data Gathering	Confirm the reason for the visit and current symptoms	0:31	Yes	You directly asked about the reason for the visit, and the patient was able to express his concern clearly. Good job ensuring the patient felt comfortable sharing.
Data Gathering	History of Presenting Complaint (ODPARA): Onset, duration, progression, aggravating and relieving factors, associated symptoms	1:17, 1:43, 1:56	Partial	You covered onset, duration, and progression, but you did not explore associated symptoms or what makes it better or worse in depth. You could have asked about morning vs. night differences, psychological impact, or any urinary symptoms.
Data Gathering	Specific History Questions: Satisfaction with sexual relationship, desire for sex, frequency and duration of erections, ability to maintain erection, issues with sexual desire, arousal, ejaculation, and orgasm	-	No	You did not ask about these aspects. These details are crucial in assessing the severity and underlying causes of erectile dysfunction. Next time, ask about frequency, ability to sustain erections, sexual desire, and ejaculation concerns.
Data Gathering	Past Medical and Family History (PMAFTOSA): Smoking, alcohol, drug use, detailed history of IHD and CCF	2:25, 3:26	Partial	You covered smoking and alcohol but did not explore any history of recreational drug use. Additionally, you could have asked more about past cardiac events and family history of similar conditions.
Data Gathering	Control of Existing Disease: Symptoms of IHD (e.g., chest pain, shortness of breath), symptoms of CCF (e.g., swelling in legs, fatigue, shortness of breath), compliance with medications	2:35, 2:41	Partial	While you discussed medication, you did not ask about compliance or whether the patient experiences symptoms like chest pain, shortness of breath, or swelling in the legs. This would provide a clearer picture of disease control.
Data Gathering	ICE (Ideas, Concerns, Expectations): What the patient thinks is causing the problem, concerns about sexual performance and Raynaud’s symptoms, expectations from the consultation	2:59, 7:04	Partial	You acknowledged the patient's belief about beta blockers being the cause, but you did not explore expectations thoroughly. You could have asked, "What were you hoping I could do for you today?" to clarify his needs.
Management	Diagnosis: Erectile dysfunction likely due to beta blocker; Raynaud’s phenomenon secondary to the same medication	4:48	Partial	You explained erectile dysfunction well but did not explore Raynaud’s phenomenon, which can also be linked to beta blocker use. Consider asking about cold-induced symptoms in the hands and feet.
Management	Immediate Management: Consult cardiologist before making any changes to beta blocker, discuss potential alternatives (e.g., ACE inhibitor or calcium channel blocker), prescribe Viagra with caution	6:07	Partial	You mentioned reviewing medications and referring, but you did not explicitly discuss alternative drugs or caution with prescribing Viagra. Next time, mention alternatives like ACE inhibitors or calcium channel blockers.
Management	Lifestyle Modifications: Address smoking and alcohol consumption, suggest ways to manage Raynaud’s phenomenon (e.g., keeping warm, avoiding triggers)	-	No	You did not provide lifestyle advice regarding alcohol moderation, exercise, or managing Raynaud’s symptoms. This is a key part of managing ED.
Management	Supportive Measures: Provide educational leaflet on erectile dysfunction, Raynaud’s phenomenon, and lifestyle changes	6:22	Partial	You mentioned a leaflet on erectile dysfunction but did not discuss Raynaud’s phenomenon or lifestyle changes. Ensure patients have comprehensive written material.
Management	Follow-Up: Schedule follow-up in 2 months to assess progress and make further adjustments	-	No	You did not schedule a specific follow-up to monitor progress. Always set a timeline for reassessment.
Interpersonal Skills	Building Rapport: Empathize with the patient’s concerns about erectile dysfunction and Raynaud’s phenomenon	0:41, 1:31	Partial	You showed empathy for the erectile dysfunction but did not explore or acknowledge Raynaud’s symptoms, which could have been linked. Try saying, "I understand how this might be frustrating for you."
Interpersonal Skills	Reassure: Offer hope for improvement with proper adjustments	6:38	Yes	You reassured the patient that adjustments could help and that there were treatment options available. This was well done.
Interpersonal Skills	Effective Communication: Use open-ended questions to encourage detailed responses, clarify medical jargon	5:19	Partial	You used some open-ended questions but also relied on closed ones. Additionally, "peripheral vascular disease" was not explained in lay terms initially. Always check patient understanding.
Interpersonal Skills	Patient-Centered Care: Respect the patient's preferences and concerns, provide reassurance and support for mental well-being	3:06, 7:04	Partial	You addressed the patient’s concerns about medications but did not explicitly ask about the emotional impact of the condition or provide reassurance beyond treatment. Ask, "How has this been affecting you emotionally?"

Feedback Statement Checklist:

	Feedback Statements:	Needs Improvement
Consultation	Needs improvement in organizing safety-netting and psychological exploration​.	✔️
Diagnosis
Examination
Findings
Issues	Does not recognise the issues or priorities in the consultation (Missed Raynaud’s, unclear on all contributors to ED)	✔️
Management	Does not develop a management plan reflecting current best practice (No alternative meds or clear action plan)	✔️
Rapport	Does not appear to develop rapport or show sensitivity for the patient’s concerns (Lacked depth in exploring the psychological impact of ED)	✔️
Listening
Language	Does not use language or explanations that are relevant and understandable to the patient (Peripheral vascular disease explanation was too technical)	✔️
Time	Shows poor time management (Spent time on some areas but missed essential follow-up and lifestyle advice)	✔️

Case 8:

Gynecology Symptomatic Differentials

Candidiasis

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:

Annie Samson, a 34-year-old lady, presents to the GP surgery with a complaint of white vaginal discharge persisting for the last two weeks accompanied by itching. She is concerned it might be an infection and fears it could be something serious, such as cancer. She seeks clarity, treatment, and information about cervical screening.

My Performance:

🔍Let’s Deep Dive into your performance:

Domain	Point	Timestamp	Response	Remarks
Data Gathering	Patient identifiers: Confirm full name and age	1:28	Yes	You asked for the patient's full name and age right at the start, which is good practice.
Data Gathering	Presenting complaint: Ask about the white discharge - duration, onset, nature (color, smell, consistency)	1:50, 2:06, 2:29, 3:04	Yes	You asked about the duration, color, and consistency. You also inquired about the smell, which was good.
Data Gathering	Associated symptoms: Inquire about itching, pain, fever, feeling of lumps, or bumps	2:41, 3:33	Partial	You asked about itching and pain but did not explore fever or the presence of lumps/bumps. Asking about systemic symptoms like fever would help rule out more serious infections.
Data Gathering	Sexual history: Recent partners, use of contraception, history of sexually transmitted infections	4:20, 4:27, 4:42, 4:50	Partial	You asked about recent partners and contraception but did not ask about a history of STIs. Asking about past infections would help assess recurrence risk.
Data Gathering	Lifestyle factors: Use of bubble baths, vaginal douching, shampoos during baths, or intrauterine contraceptive device (IUCD)	-	No	You did not ask about hygiene habits or possible irritants like soaps, which can contribute to candidiasis. This is crucial in patient education.
Data Gathering	Menstrual history: Regularity, frequency, duration, pain, intermenstrual bleeding, postcoital bleeding, age of menarche	5:06, 5:17, 5:28	Partial	You asked about regularity, frequency, and duration but did not ask about intermenstrual or postcoital bleeding. These could indicate other gynecological issues.
Management	Diagnosis: Suggest vaginal candidiasis (thrush) as the likely cause	7:24	Yes	You correctly identified vaginal candidiasis and explained the diagnosis to the patient.
Management	Treatment: Prescribe Clotrimazole 10% cream, 5gm to be inserted into the vagina as a single dose at night	8:00	Partial	You mentioned antifungal medication but did not specify Clotrimazole or dosage. Clearly stating the exact treatment ensures the patient understands.
Management	Preventative advice: Clean genitalia with water only, avoid soaps and antiseptics, dry properly after washing, wear cotton underwear	-	No	You did not give any preventative advice on hygiene measures, which is important to prevent recurrence.
Management	Safety netting: Advise to return if symptoms do not resolve within 7-14 days or if new symptoms arise	8:27	Partial	You mentioned a follow-up, but you did not explicitly advise what to do if symptoms persist or worsen before the follow-up. Clear safety netting ensures better patient compliance.
Management	Follow-Up: Schedule a follow-up appointment or provide clear instructions on when to return if the problem persists	8:27	Yes	You scheduled a two-week follow-up, which is good practice.
Management	Educational Leaflet: Provide a leaflet about candidiasis with self-care tips	8:19	Yes	You mentioned providing a leaflet, which is great for patient education.
Interpersonal Skills	Use clear and empathetic language	2:07, 4:09, 6:11	Partial	You showed empathy by acknowledging discomfort, but some phrases sounded rehearsed. Try to use natural expressions instead of stock phrases.
Interpersonal Skills	Ensure the patient feels heard and understood	2:07, 4:09, 6:11	Yes	You reassured the patient and encouraged them to share openly. This was well done.
Interpersonal Skills	Reassure the patient about the low likelihood of cervical cancer	-	No	You did not address the patient’s potential concerns about more serious conditions like cervical cancer. Brief reassurance can help alleviate anxiety.
Interpersonal Skills	Educate the patient about the importance of regular cervical screening	-	No	You did not mention cervical screening. This would have been an opportunity to encourage regular smear tests, especially given the patient’s age.
Interpersonal Skills	Document thoroughly and provide psychosocial support as needed	-	No	No mention was made of psychosocial aspects such as stress or emotional impact. Asking about concerns, stress, or embarrassment can help build rapport.

Feedback Statement Checklist:

	Feedback Statements:	Needs Improvement
Consultation	Disorganised / unstructured consultation	✔️
Diagnosis	Does not make the correct working diagnosis (partially specified treatment)	✔️
Examination
Findings
Issues	Does not recognise key issues (lifestyle factors missing)	✔️
Management	Does not develop a full management plan (preventative advice missing)	✔️
Rapport
Listening
Language
Time	Shows poor time management (some key points missed)	✔️

Case 9:

Medicine Symptomatic Differentials

Polymyalgia Rheumatica

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, Emma Pearson, is a 67-year-old lady experiencing muscle aches and pains. Your task is to take a focused history, assess the patient, and discuss initial management.

My Performance:

🔍Let’s Deep Dive into your performance:

Domain	Point	Timestamp	Response	Remarks
Data Gathering	Confirm patient's full name and age: Emma Pearson, 67 years old	0:36-0:40	Yes	You confirmed the patient's full name and age correctly at the beginning of the consultation. Well done!
Data Gathering	Acknowledge and validate patient's emotions and request to gather adequate information	1:15, 1:37, 3:02	Partial	You acknowledged the difficulty of the patient's situation, which is good. However, you could have validated her emotions more by explicitly showing empathy, e.g., "It sounds like this has been really tough for you. I can see why you’re concerned."
Data Gathering	Use SOCRATES to elaborate on joint pain: Site, Onset, Character, Radiation, Associations, Timing, Exacerbating/Relieving factors, Severity	1:25-3:33	Partial	You covered some aspects of SOCRATES (site, onset, character, timing, exacerbating/relieving factors). However, you missed radiation, associations, and a direct severity assessment (e.g., asking the patient to rate her pain out of 10).
Data Gathering	Ask about other joints, swellings, and previous episodes	4:00	Partial	You asked about joint problems but did not specifically inquire about swellings or previous episodes of similar pain. These are important for diagnosing inflammatory conditions.
Data Gathering	Inquire about symptoms suggestive of myositis, rheumatoid arthritis, SLE, trauma	3:22-3:41	Partial	You asked about trauma but did not screen for symptoms of myositis (e.g., muscle weakness), rheumatoid arthritis (e.g., morning stiffness, small joint involvement), or SLE (e.g., rash, photosensitivity, mouth ulcers).
Data Gathering	Screen for red flags like Giant Cell Arteritis (GCA) and cancer	N/A	No	You did not ask about headache, scalp tenderness, jaw claudication, or visual disturbances to rule out GCA. These are essential red flags in a patient suspected of having polymyalgia rheumatica (PMR).
Data Gathering	Perform a systemic review: PMAFTOSA, ICE (Ideas, Concerns, Expectations)	3:22-5:16	Partial	You asked about systemic symptoms like weight loss and night sweats, but you did not explore ICE (Ideas, Concerns, Expectations), which is critical for a patient-centered approach.
Data Gathering	Assess the impact on daily activities, work, and sleep	2:07, 4:41-4:45	Yes	You asked how the condition affected her daily activities and mobility. Well done!
Data Gathering	Summarize information to confirm understanding	N/A	No	You did not summarize the key points of the history to confirm mutual understanding. A short summary helps ensure clarity before moving to the next stage.
Management	Explain suspicion of polymyalgia rheumatica (PMR) and define PMR	N/A	No	You diagnosed the patient with osteoarthritis, which is incorrect. This patient’s symptoms (bilateral hip/shoulder pain, morning stiffness) suggest PMR. You should have explained what PMR is and why it fits the case.
Management	Discuss need for further investigations: Blood tests including FBC, U&E, LFT, inflammatory markers, etc.	N/A	No	You did not mention the need for inflammatory markers (ESR/CRP), which are crucial for diagnosing PMR.
Management	Await investigation results before starting steroids (Prednisolone)	N/A	No	You did not discuss steroids at all. The correct approach in PMR is to confirm inflammation with blood tests before starting Prednisolone.
Management	Increase Omeprazole dose to counteract steroid side effects	N/A	No	Since steroids were not discussed, the need for Omeprazole dose adjustment was also missed.
Management	Educate on steroid use, including the steroid blue card	N/A	No	Steroid education is important, especially regarding side effects, long-term use, and the need for a steroid card.
Management	Advise on lifestyle changes: stop smoking, manage weight, regular exercise	5:05-5:20	Partial	You asked about smoking and exercise, which is good. However, you did not actively advise the patient to quit smoking or engage in gentle exercise.
Management	Discuss importance of not abruptly stopping steroids	N/A	No	Since steroids were not mentioned, steroid tapering guidance was also missing.
Management	Monitor blood sugar and blood pressure regularly	N/A	No	PMR patients on steroids require regular blood glucose and blood pressure monitoring, which was not discussed.
Management	Consider bisphosphonates to prevent osteoporosis from long-term steroid use	N/A	No	Long-term steroid users require bisphosphonates + calcium/vitamin D to prevent osteoporosis.
Management	Safety Netting: Advise to seek immediate help if experiencing severe headache, temple pain, jaw pain, or visual problems	N/A	No	Since GCA was not considered, you missed safety netting for GCA symptoms, which is crucial.
Management	Highlight potential association with GCA and need for urgent treatment	N/A	No	You did not explain that PMR and GCA are related and that GCA requires urgent treatment to prevent blindness.
Management	Schedule regular follow-up visits to monitor PMR symptoms and potential complications	8:23	Partial	You scheduled a follow-up in two weeks, but for PMR, the first follow-up should be within one week to assess steroid response.
Management	Plan first follow-up in one week	8:23	No	You planned a two-week follow-up, but one week is the recommended timeframe.
Management	Provide a leaflet about PMR and the steroid blue card	N/A	No	No leaflets or educational materials were provided.
Management	Recap discussion and address any remaining concerns	8:00	Partial	You briefly addressed pain relief but did not recap the diagnosis and next steps in detail.
Interpersonal Skills	Use sensitive and empathetic language	1:15, 1:37	Partial	You showed some empathy but could have done more, e.g., acknowledging how the pain impacts her emotionally.
Interpersonal Skills	Signpost wherever required	N/A	No	You did not use signposting effectively to guide the consultation.
Interpersonal Skills	Ensure thorough history taking and clear explanation of condition and management plan	N/A	No	The history was incomplete (missing red flags), and the management plan was incorrect (OA instead of PMR).
Interpersonal Skills	Demonstrate empathy and effective communication throughout consultation	1:37	Partial	Some empathy was present, but you could have been more reassuring and validating.
Interpersonal Skills	Provide safety-netting advice clearly and ensure patient understands when to seek urgent help	N/A	No	You did not safety-net for GCA, which is critical.

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 10:

Medicine Symptomatic Differentials

Sleep Insufficiency Tiredness

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:

Patient: Luke Masterson, 30-year-old male, taxi driver.

Presenting Complaint: Difficulty sleeping for the past 4 months, frequent snoring, gasping for air, daytime tiredness, and sleepiness. Has fallen asleep while driving 2-3 times.

Concerns: Impact on daily life and driving safety.

Expectations: Diagnosis and effective treatment.

My Performance:

🔍Let’s Deep Dive into your performance:

Domain	Point	Timestamp	Response	Remarks
Data Gathering	Patient identifiers: Confirm full name and age	0:11	Yes	You correctly confirmed the patient’s full name and age at the start of the consultation. Good job on this!
Data Gathering	Confirm the reason for the visit and current symptoms	0:34, 0:43	Yes	You asked the patient why he was attending and clarified that it was due to his sleeping problem worsening. Well done!
Data Gathering	ODPARA for Sleeping Problems: Ask about onset, duration, pattern, aggravating and relieving factors	1:06, 1:10	Partial	You asked about onset and duration, but you did not systematically explore aggravating and relieving factors. A more structured approach (e.g., "What makes it better or worse?") would have been helpful.
Data Gathering	Inquire about associated symptoms: Snoring, gasping for air, daytime sleepiness	1:24, 1:29	Yes	You asked about snoring and gasping for air, and the patient volunteered information about excessive daytime sleepiness. This was well covered.
Data Gathering	Assess risk factors: Smoking, alcohol consumption, sleeping environment	3:28, 4:07	Partial	You asked about smoking and alcohol but did not explore the sleeping environment (e.g., sleeping position, mattress, pillows, or noise/light in the room). This is an important aspect to check.
Data Gathering	Impact on daily life: Ask about effects on work and activities, especially driving	1:35, 1:43	Yes	You asked about the impact on work and the patient revealed he had fallen asleep at the wheel. This was a crucial detail and well explored.
Data Gathering	ICE: Explore patient's ideas, concerns, and expectations	3:34, 3:39, 4:19	Yes	You explored the patient's ideas (he thought it might be serious), concerns (his driving and safety), and expectations (he wanted to know why this was happening and how to fix it). Well done!
Management	Explain likely diagnosis: Obstructive Sleep Apnea (OSA)	4:56, 5:08	Yes	You explained the diagnosis well and checked for understanding. Good job!
Management	Plan routine investigations: Blood tests including FBC, electrolytes, LFTs, TFTs	N/A	No	You did not mention ordering routine blood tests such as FBC, LFTs, or TFTs. These help rule out underlying conditions contributing to sleep apnea. Make sure to include these in your plan.
Management	Refer to sleep specialist for a sleep study	7:47	Partial	You mentioned a referral but did not explicitly state that it would be for a sleep study. Clarifying the purpose of the referral would improve patient understanding.
Management	Discuss treatment options: CPAP, mandibular advancement device	N/A	No	You did not discuss CPAP or mandibular advancement devices, which are first-line treatments. Ensure you cover all options so the patient knows what to expect.
Management	Provide lifestyle advice: Avoid sleeping on back, elevate head of bed, reduce pillows, avoid evening alcohol	5:40, 6:20	Partial	You advised on alcohol reduction and exercise but did not mention positional therapy (avoiding sleeping on the back, elevating the head, reducing pillows). Make sure to include these in your recommendations.
Management	Get in touch with social services to help with an alternative occupation till the condition improves	N/A	No	You did not mention referring to social services for occupational support, which would be crucial given the patient is a taxi driver and at risk. Consider advising on temporary adjustments.
Management	Advise on driving safety: Stop driving, inform DVLA if OSA confirmed	N/A	No	You missed a crucial safety issue. The patient should be advised to stop driving and inform the DVLA if diagnosed with OSA. This is a legal requirement in the UK.
Management	Provide patient education: Leaflet on obstructive sleep apnea	7:50	Partial	You mentioned giving a pamphlet but did not ensure understanding or encourage the patient to read it and ask questions. Emphasizing its importance would improve patient engagement.
Management	Arrange follow-up appointment and safety netting	7:56	Yes	You arranged a follow-up in two weeks, which was good practice.
Interpersonal Skills	Greet warmly and confirm identity	0:04, 0:11	Yes	You introduced yourself warmly and confirmed the patient's identity. Well done!
Interpersonal Skills	Show empathy and support: Acknowledge distress and impact on life	1:46, 2:02	Partial	You acknowledged the impact on work but could have shown more empathy when the patient expressed distress about falling asleep at the wheel. Phrases like, "That must have been really scary for you" would have helped.
Interpersonal Skills	Use clear communication: Avoid medical jargon, ensure understanding	5:14, 5:28	Yes	You explained OSA in simple terms, which was well done.
Interpersonal Skills	Adopt a patient-centered approach: Involve patient in decision-making	4:19, 7:50	Partial	While you asked about expectations, you could have involved the patient more in deciding management options. For example, asking, “How do you feel about trying CPAP?” would enhance shared decision-making.
Interpersonal Skills	Encourage active listening: Invite questions and additional details	5:36, 7:48	Yes	You invited questions multiple times and encouraged discussion. This was good!

Feedback Statement Checklist:

	Feedback Statements:	Needs Improvement
Consultation	The structure was generally logical, but management was incomplete.	✔️
Diagnosis
Examination
Findings
Issues	Did not recognize the legal aspect of DVLA notification, which is a key issue.	✔️
Management	Incomplete discussion of treatment options (CPAP, mandibular devices) and no mention of DVLA notification.	✔️
Rapport	Could have shown more empathy when the patient expressed distress.	✔️
Listening	Mostly good, but missed exploring the sleeping environment fully.	✔️
Language
Time