PLAB 2 Mock Test Feedback :: Cat Bite :: Dermatology

Mock Date: 13/11/2024

Action Items:

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

• Watch the Mock Test Video Recording:

• Read the Mock Feedback Blog:  Click Here

• Additional Resources: Click Here

• Deep Dive into your (Private) performance below

Scenario Summary:

John Bennett, a 36-year-old man, presents to the GP surgery after being bitten by a cat while on holiday in Turkey. He is concerned about the risk of infection and rabies. The wound was assessed and cleaned at a hospital in Turkey, and he was given painkillers. He has no significant past medical history, is allergic to penicillin, and is up-to-date with his tetanus vaccinations. He is anxious about potential complications from the bite.

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	Patient identifiers: Confirm full name and age	0:06	Yes	You confirmed the patient's name and age clearly.
Data Gathering	Confirm the reason for the visit: Address concerns about the cat bite	0:38	Yes	You directly addressed the patient's concerns about the bite and his worry about potential complications. Good work in acknowledging the patient's agenda early in the consultation.
Data Gathering	Explore the incident: Details about the cat bite, location, depth, and first aid	0:12, 1:04, 3:05	Partial	You confirmed the bite location (hand) and timing but missed asking specific details on the depth of the bite and whether any immediate first aid was taken. In future, ask more about immediate actions taken, as this can inform your infection assessment.
Data Gathering	Rule out infection: Ask about local and systemic signs of infection (redness, swelling, fever)	2:54, 3:12	Partial	You asked about some infection symptoms like redness and swelling, but you missed fever or other systemic signs that could indicate infection. Make sure to systematically go through both local and systemic infection indicators for thoroughness.
Data Gathering	Vaccination history: Confirm tetanus and rabies vaccination status	5:04	Yes	You asked about vaccinations and the patient confirmed tetanus, which is good. To be complete, mention rabies to clarify risk levels explicitly with the patient.
Data Gathering	Past medical, medication, and allergy history: Confirm no regular medications and penicillin allergy	3:42, 3:49	Partial	You covered medications and noted an allergy, but there was a slight miscommunication about "tranquilizer" allergy, which should have been clarified further. Also, explicitly confirm the patient isn't on any other regular medications as this helps avoid missed information.
Data Gathering	Social history: Smoking, alcohol use, living situation, and occupation	4:15 - 4:58	Yes	You gathered the full social history, covering smoking, alcohol, living situation, and occupation. Great job in building a fuller picture of the patient’s background and risk factors.
Data Gathering	Examine the hand: Look for erythema, tenderness, and assess neurovascular status	3:12	Partial	You inquired about redness and pain but missed a detailed examination of tenderness or neurovascular integrity (sensation and circulation). Try to be more thorough here to fully assess the injury impact on function and potential complications.
Data Gathering	Lymph node examination: Check axillary and cervical lymph nodes		No	This was not covered in the consultation. Remember to assess lymph nodes near bite sites to check for spreading infection, especially with bites from stray or unknown animals.
Management	Prophylactic antibiotics: Prescribe Metronidazole plus Doxycycline for 3 days due to penicillin allergy	5:15	Partial	You mentioned antibiotics but didn’t specify which type. Since the patient has a penicillin allergy, be sure to name specific alternatives. This avoids ambiguity and aligns with safe prescribing practices.
Management	Wound care: Irrigate with warm water or saline and cover with a clean dressing		No	You missed specific instructions for wound care, including cleaning and dressing. Take the opportunity to mention wound care steps to reduce infection risk and show thoroughness in managing animal bites.
Management	Analgesia: Recommend paracetamol or ibuprofen for pain relief	2:00	Yes	You acknowledged the patient's previous use of paracetamol, which aligns well with the pain management goal.
Management	Rabies vaccination: Seek senior opinion and consider rabies PEP vaccine regimen	6:31	Partial	You responded when the patient inquired about rabies, but consider raising it preemptively when discussing vaccinations to assure the patient and provide guidance on rabies protocols with more clarity.
Management	Aftercare: Schedule follow-up consultation and provide safety netting advice		No	You did not mention scheduling a follow-up or providing safety netting advice, which is essential in bite cases to monitor for delayed infections. Remember to offer this reassurance to avoid the patient feeling neglected post-consultation.
Management	Provide a leaflet on animal bites for additional information		No	No leaflet or additional information on animal bites was provided. Giving written information could reinforce verbal instructions and help the patient feel more informed.
Interpersonal Skills	Empathy: Acknowledge patient's concerns and provide reassurance	0:44, 2:39	Yes	Your empathy was evident when acknowledging the patient’s concerns about infection and the overall bite incident. This was well-handled, as you maintained a compassionate tone that likely reassured the patient.
Interpersonal Skills	Communication: Use layman's terms to explain medical terms and procedures	5:15, 6:31	Partial	Although your communication was clear, adding lay explanations about the purpose of antibiotics or why certain vaccines are considered could increase patient understanding. Avoid using technical terms unless the patient indicates familiarity.
Interpersonal Skills	Professionalism: Maintain a calm and respectful demeanor	Throughout	Yes	You maintained a professional and calm demeanor throughout the consultation, which helped in establishing a good doctor-patient rapport. Keep up this approach for smooth consultations.
Interpersonal Skills	Encourage questions: Allow the patient to express any concerns	2:39, 6:19	Yes	You created space for the patient to ask questions and explore concerns, particularly about rabies. This openness is beneficial for addressing patient worries comprehensively.
Interpersonal Skills	Ensure understanding: Confirm the patient understands aftercare instructions and safety netting advice		No	There was no check for understanding after the discussion of management steps. Confirming understanding is essential to ensure the patient follows through accurately with any aftercare steps.

Additional Remarks for Each Domain:

• Data Gathering: You gathered a lot of relevant information but missed confirming a few critical details, like infection symptoms and lymph node examination. To improve, follow a structured checklist that covers both localized and systemic symptoms, and explore first aid specifics to guide your management better.

• Management: Your management was partially covered but lacked certain elements such as specific wound care instructions, rabies vaccine protocols, and aftercare plans. In future, directly address these for a more comprehensive approach to patient safety and recovery.

• Interpersonal Skills: Your empathy and encouragement of patient questions were strengths, but ensure to clarify medical terms where necessary and confirm patient understanding of all advice provided. Simple language and reassurance are key in managing bite cases, especially where potential infection is a concern.

Feedback Statement Checklist

• Consultation: Disorganised structure was noted in the approach, with some incomplete follow-ups.

• Issues: Missed some key management priorities, like wound care and safety netting.

• Listening: Lacked full active listening, particularly for allergy details and systemic infection signs.

• Language: Could improve by simplifying explanations and confirming understanding.