PLAB 2 Mock Test Feedback :: C.Diff Infection after Clindamycin :: Angry Patient

Mock Date: 27/11/2024

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 (Private) performance below

Scenario Summary:

You are an FY2 doctor in a GP surgery. Your patient, Jim Carter, a 65-year-old man, is very angry and wants to lodge a complaint. He was prescribed clindamycin for cellulitis four weeks ago, which led to severe abdominal pain and diarrhea. He was hospitalized and diagnosed with Clostridium difficile infection. He wants to know why he was given this medication and how such incidents will be prevented in the future.

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 full name and age	0:18	Yes	You confirmed the patient’s name and age effectively. Keep this up in all consultations.
Data Gathering	Confirm the reason for the visit and current symptoms	0:30	Partial	While you addressed the complaint broadly, you didn’t explicitly confirm the specific symptoms (e.g., abdominal pain and diarrhea). A clearer approach could have set a better structure for the consultation.
Data Gathering	Ask about the timeline of events: onset of abdominal pain and diarrhea after starting clindamycin		No	You did not explicitly ask about the timeline of symptoms after starting clindamycin. Asking "When did the symptoms start in relation to the antibiotic?" would have helped establish causation.
Data Gathering	Inquire about the severity and duration of abdominal pain and diarrhea		No	These aspects were not explored. For future consultations, inquire about how long and how severe the symptoms were to understand the patient's condition better.
Data Gathering	Confirm the resolution of symptoms: current health status, any lingering issues	4:15	Yes	You confirmed that the patient was currently fine. This was well done.
Data Gathering	Ask about any other medications taken during the period		No	This was not covered. Asking about other medications could reveal potential interactions or alternative causes of the symptoms.
Data Gathering	Confirm past medical history: No significant medical conditions	2:45	Yes	You effectively confirmed the absence of significant medical conditions. This was thorough.
Data Gathering	Medication history: No regular medications, allergic to penicillin	2:50	Yes	You appropriately asked about allergies and medication history. This was a complete and focused inquiry.
Data Gathering	Family history: Not relevant	2:55	Yes	Although family history wasn’t relevant, you clarified it. This was a good practice for completeness.
Data Gathering	Living situation: Lives alone, works as a paper salesman		No	You missed asking about the patient's living situation and occupation. Including this can give insight into potential psychosocial factors affecting the patient.
Data Gathering	Psychosocial history: Impact of hospitalization on work and daily life	1:15	Partial	While the patient mentioned missing work due to hospitalization, you didn’t explore how it impacted his daily life. A follow-up question could have demonstrated deeper understanding.
Management	Acknowledge and validate emotions: Apologize for the distress caused	01:10, 04:00	Partial	While you acknowledged the patient's distress, the apology felt limited and could have been more empathetic. For example, "I am very sorry for the distress caused; I can imagine how upsetting this must have been for you."
Management	Explain the reason for prescribing clindamycin	4:30	Partial	You explained clindamycin as a first-line treatment but didn’t clarify its use specifically for penicillin-allergic patients. Including this detail would enhance clarity.
Management	Explain potential side effects of clindamycin	4:40	Yes	You explained how clindamycin can cause C. difficile infections due to disruption of gut bacteria. This was clear and effective.
Management	Acknowledge the oversight: Apologize for not explaining potential side effects		No	You did not directly apologize for failing to explain the potential side effects. Adding this apology shows accountability and builds trust.
Management	Provide information on how to lodge a complaint	4:55	Partial	You mentioned assisting with the complaint but did not specify the procedure. Provide clear instructions, like contacting the GP practice manager, in future.
Management	Discuss preventive measures: Review guidelines, ensure patients are well-informed about meds		No	Preventive measures to avoid such issues in the future were not discussed. Highlighting these would have shown a proactive approach.
Management	Offer follow-up: Arrange a follow-up appointment to discuss findings and actions taken		No	You didn’t offer a follow-up appointment. Offering one would demonstrate commitment to resolving the patient's concerns comprehensively.
Management	Safety netting: Advise to seek medical attention if symptoms recur	6:10	Yes	You advised the patient to return if they experienced new symptoms. This was well done.
Interpersonal Skills	Empathy and support: Acknowledge patient's distress and apologize sincerely	1:10	Partial	You showed empathy, but your response could have been more personal and heartfelt. For instance, explicitly saying, "I’m sorry this happened and I understand how difficult it was for you."
Interpersonal Skills	Use simple language: Avoid medical jargon, explain in layman's terms	4:30	Yes	You explained the medical situation clearly, using terms the patient could understand.
Interpersonal Skills	Active listening: Allow the patient to express concerns without interruption	0:45	Partial	While you listened to the patient's concerns, there were moments where reassurance or further exploration was lacking. Letting them elaborate more freely would improve rapport.
Interpersonal Skills	Check understanding: Ensure patient comprehends the discussion, invite questions		No	You didn’t check if the patient understood the discussion or had additional questions. Always confirm understanding to ensure clarity.
Interpersonal Skills	Patient-centered approach: Involve patient in decision-making about future care		No	The consultation did not involve the patient in planning future care. Asking, "How would you feel about us taking this next step?" would make the approach more patient-centered.
Interpersonal Skills	Reassure: Offer hope for improvement with proper adjustments and preventive measures	4:40	Partial	While you mentioned resolving the issue, reassurance could have been stronger. For example, "With these steps, we can ensure this doesn’t happen again."

Feedback Statement Checklist

	Feedback Statements:	Needs Improvement
Consultation	Disorganised or unstructured (some areas needed a clearer approach to management and patient’s emotional needs)​.	✔️
Diagnosis
Examination
Findings
Issues	Does not recognize the issues or priorities in the consultation (e.g., patient’s key problem or immediate management of 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.	✔️
Listening	Does not make adequate use of verbal and non-verbal cues. Poor active listening skills.	✔️
Language	Does not use language or explanations that are relevant and understandable to the patient, including not checking understanding.	✔️
Time	Shows poor time management, probably taking too long over some elements at the expense of more important areas.	✔️