PLAB 2 Mock Test Feedback :: Foreign Body in Oesophagus :: Angry Patient

Mock Date: 12/03/2025

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. Two days ago, you saw a 4-year-old girl, Haley Winters, who had swallowed a button. After an x-ray, you discharged her as the x-ray appeared normal. However, a radiologist later identified a button in her esophagus. You need to call Haley’s mother, Alex Jones, to bring Haley back to the hospital urgently.

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 patient identifiers: Haley Winters, 4 years old, mother's name Alex Jones	00:20 - 00:50	Yes	You correctly confirmed the child’s name and age early in the conversation. This was well done.
Data Gathering	Confirm the reason for the call and current symptoms	00:51 - 01:02	Partial	You explained the reason for the call but did not explicitly check for current symptoms before discussing the X-ray findings. It would have been better to first ask if the child is experiencing any symptoms.
Data Gathering	Ask about the initial incident: How did Haley swallow the button?		No	You did not ask how the child ingested the button. This would have provided context for potential complications. Next time, ask, “Can you tell me how she swallowed the button?” early in the conversation.
Data Gathering	Assess current condition: Any symptoms like nausea, vomiting, abdominal pain, difficulty breathing?	06:25 - 06:27	Partial	You asked about eating and drinking, but you did not inquire about nausea, vomiting, abdominal pain, or breathing difficulties. Always ask explicitly about red-flag symptoms.
Data Gathering	Check if Haley is eating and drinking normally	06:22 - 06:27	Yes	You asked and confirmed that she is eating and drinking fine. This was a good step.
Data Gathering	Review past medical history: Any significant past medical history?		No	You did not ask about past medical history, which could be relevant to complications. Always check for underlying conditions such as reflux, previous surgeries, or congenital abnormalities.
Data Gathering	Medication history: Is Haley on any regular medications?		No	You did not ask if Haley is taking any regular medications. Some medications could worsen complications. A simple “Is she on any regular medications?” would suffice.
Data Gathering	Family history: Any relevant family history?		No	No attempt was made to gather family history. While not always critical, it can sometimes provide insight into underlying risk factors.
Data Gathering	Allergy history: Any known allergies?		No	You did not ask about allergies. This is essential in case any intervention, such as sedation or surgery, is required. Make sure to ask, “Does she have any allergies to medications or anything else?”
Data Gathering	Living situation: Who does Haley live with?	07:39 - 07:47	Partial	You got some psychosocial history regarding her mother’s work and the presence of an older sibling, but you didn’t explicitly ask about the living situation. Asking, “Who does she live with at home?” would have been ideal.
Data Gathering	Psychosocial history: Mother's work situation and current availability	02:02 - 07:50	Yes	You gathered extensive information about the mother’s challenges, including work obligations and lack of childcare. This was well done.
Management	Explain the radiologist's findings: Button in the esophagus	01:17 - 01:37	Yes	You clearly stated the radiologist’s findings, which was good.
Management	Apologize for the oversight and explain the need for immediate action	01:42 - 01:53	Yes	You apologized and explained that she shouldn’t have been discharged. This was appropriate.
Management	Explain the next steps: Repeat x-ray, possible endoscopy if button is still in the esophagus		No	You mentioned the need to return to the hospital but did not discuss specifics like repeat X-ray or endoscopy. Next time, say, “We will do another X-ray to check if the button has moved. If it’s still there, we may need an endoscopy to remove it.”
Management	Discuss potential complications if not addressed promptly	05:40 - 06:15	Yes	You explained possible irritation, bleeding, and infection, which was good.
Management	Offer assistance: Provide a letter for the employer, arrange transportation or childcare if needed	04:50 - 05:28	Partial	You offered a letter for her employer, which was excellent, but did not explore childcare or transportation options. Asking, “Would you need any help with childcare or transport arrangements?” would make this more comprehensive.
Management	Safety netting: Advise on signs to watch for and when to seek immediate medical attention		No	You did not mention specific red-flag symptoms (e.g., difficulty breathing, drooling, worsening pain). Always include safety netting in case the mother cannot bring the child immediately.
Management	Follow-Up: Ensure Haley is brought to the hospital as soon as possible	04:20 - 04:44	Yes	You insisted on same-day evaluation, which was appropriate.
Management	Document the incident and ensure it is discussed in the next clinical meeting		No	You did not mention documentation or hospital follow-up for learning purposes. Saying, “I will make sure this is discussed in our next meeting to avoid similar mistakes” would have reassured the parent.
Interpersonal Skills	Introduce yourself and state the purpose of the call	00:05 - 00:32	Partial	You introduced yourself but did not clearly state the purpose upfront. Instead of saying, “I’ll explain in a bit,” start with, “I am calling regarding your daughter’s recent visit as there are important updates on her X-ray.”
Interpersonal Skills	Confirm it is a good time to talk		No	You did not ask if it was a good time, which would have been helpful as the mother was busy. A simple “Is now a good time to talk?” would have been polite.
Interpersonal Skills	Use simple, clear language to explain the situation	01:17 - 06:15	Yes	You explained complications well in understandable terms, which was good.
Interpersonal Skills	Acknowledge and validate the mother's emotions and concerns	02:13 - 02:20	Yes	You acknowledged her frustration and apologized, which was empathetic.
Interpersonal Skills	Provide reassurance and support throughout the conversation	02:50 - 07:31	Yes	You reassured her, apologized multiple times, and offered help, which was appropriate.
Interpersonal Skills	Encourage questions and address them empathetically	06:25 - 07:21	Yes	You answered her concerns regarding complications and next steps.

Feedback Statement Checklist

	Feedback Statements:	Needs Improvement
Consultation
Diagnosis
Examination
Findings
Issues	Does not recognise the issues or priorities in the consultation – Did not check all symptoms before discussing findings.	✔️
Management	Does not develop a management plan reflecting current best practice – Missed details about repeat imaging and endoscopy.	✔️
Rapport
Listening	Does not make adequate use of verbal & non-verbal cues – Did not confirm if it was a good time to talk.	✔️
Language
Time

Additional Remarks

Remarks on Data Gathering:

You gathered some crucial details, but there were notable gaps in past medical history, medication history, allergies, and symptoms. Next time, systematically go through these aspects. Use structured questioning: “I’d like to ask a few quick questions about Haley’s health and history before we discuss the next steps.”

Remarks on Management:

You conveyed urgency well, but missing details on repeat imaging, endoscopy, safety netting, and follow-up documentation reduced clarity. Structure your explanation better:

1. Apologize and explain findings

2. Immediate next steps (repeat X-ray, possible endoscopy)

3. Potential complications

4. Support offered (letters, childcare, transport)

5. Safety netting (what to watch for, when to return immediately)

   
   

Remarks on Interpersonal Skills:

You showed good empathy and reassurance. However, missing signposting and checking if it was a good time to talk made the conversation feel abrupt. Try:

• Starting with a purpose statement

• Checking availability

• Signposting when changing topics (e.g., “Before I explain the next steps, can I check a few things about her symptoms?”)