PLAB 2 Mock Test Feedback :: Investigation Counseling ::: Vit D Deficiency :: Attempt 1

Mock Date: 04/07/2025
Case 1:
Topic: Counseling
Case Name: Vitamin D Deficiency
Action Items:
Practice and Review the case in the OSCE workbench:	Click Here
Watch the (Private) Mock Test Video Recording:	Click Here
Read the Case Blog:	Click Here
Additional Resources:	Click Here
Deep Dive into your (Private) performance below:

Scenario Summary:
You are seeing Mrs. June Osborne, a 55-year-old schoolteacher, who is concerned she may have hypothyroidism like her sister. She has been experiencing tiredness and constipation.
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	Confirm patient identity by asking full name and age.	0:13	yes	You asked June for her name and age directly at the start. Well done for establishing identity early.
Data Gathering	Confirm presenting complaint by asking about tiredness and constipation elaboration.	01:00, 04:20	partial	You asked about tiredness in detail but did not fully explore constipation beyond frequency (e.g. stool consistency, straining, incomplete evacuation). Next time, ask for stool type, straining or any bleeding to complete constipation elaboration.
Data Gathering	Ask about onset and duration of tiredness.	1:52	yes	You asked about duration (‘five or six months’). Good clarity here.
Data Gathering	Ask about variation of tiredness during the day.	–	no	You did not ask if tiredness varies during the day. Next time ask “Is your tiredness worse at any particular time of the day or is it constant?”
Data Gathering	Ask if tiredness is relieved by rest or sleep.	2:03	yes	You asked if anything makes it better and explored sleep. Good.
Data Gathering	Ask about impact of tiredness on daily activities and work performance.	–	no	You did not ask how her tiredness affects work or daily life. Next time ask “How is this affecting your ability to work or manage at home?”
Data Gathering	Ask about mood changes	2:55	yes	You asked directly about mood. Well done.
Data Gathering	Ask about constipation frequency and associated bowel changes.	4:20	partial	You asked about constipation and passing gas but missed stool type, hard stools, straining, incomplete evacuation or bleeding. Remember to explore stool characteristics fully.
Data Gathering	Ask about bone pain particularly in back or hips to rule out Vitamin D deficiency.	2:37	yes	You asked about bone pain. Good coverage.
Data Gathering	Ask about muscle cramps or generalised weakness to assess for Vitamin D deficiency.	–	no	You did not ask about muscle cramps or general weakness specifically. Next time ask “Have you noticed any cramps or general weakness in your muscles?”
Data Gathering	Ask about past medical history, medication and family history	03:52, 04:13	yes	You asked about PMH, medications, allergies, and family history of hypothyroidism. Good.
Data Gathering	Ask about any tingling, numbness, or weakness in limbs to rule out neurological causes.	–	no	You did not ask about neurological symptoms. Next time ask “Any tingling, numbness or weakness in your arms or legs?”
Management	Explain that thyroid function tests are normal to reassure patient about hypothyroidism concerns.	–	no	You did not explain that thyroid tests were normal despite her concerns. Next time clearly state “Your thyroid function tests are normal, so this is not due to hypothyroidism.”
Management	Explain that Vitamin D levels are low (20 nmol/L) and calcium is slightly low.	6:08	yes	You explained low Vitamin D and calcium. Good clarity.
Management	Explain the role of Vitamin D in calcium absorption and bone/muscle health.	–	no	You did not explain Vitamin D’s role. Next time say “Vitamin D helps your body absorb calcium and keeps your bones and muscles strong.”
Management	Advise the patient to obtain 15–20 minutes of safe sunlight exposure daily to help improve Vitamin D levels.	–	no	You did not advise on sunlight exposure. Next time mention this as a simple lifestyle measure.
Management	Start treatment with Vitamin D loading dose of 50,000 units once a week for 6 weeks.	–	no	You did not mention starting Vitamin D loading dose. Remember treatment details for safe prescribing.
Management	Advise maintenance dose of 1,000 units daily after loading phase to maintain Vitamin D levels.	–	no	You did not advise on maintenance dose. Next time state this clearly to ensure continued treatment.
Management	Advise dietary Vitamin D intake with oily fish, egg yolks, red meat, liver, and fortified cereals or milk.	–	no	You did not advise dietary Vitamin D sources. Next time provide examples to empower patient choices.
Management	Consider calcium supplementation of 500–1000 mg elemental calcium daily if dietary intake is insufficient.	–	no	You did not consider calcium supplementation. Next time mention this to ensure bone health support.
Management	Advise dietary calcium intake increase with dairy, leafy greens, and fortified foods.	–	no	You did not advise on calcium-rich foods. Next time mention milk, cheese, yogurt, greens, fortified juices.
Management	Inform the patient that if Vitamin D levels do not improve with treatment, referral to Gastroenterology will be considered to investigate possible malabsorption conditions affecting Vitamin D absorption.	–	no	You did not mention this. Next time say “If levels don’t improve, we may need to check your gut absorption with a specialist.”
Management	Provide informational leaflets on Vitamin D deficiency and calcium balance.	7:45	yes	You gave a leaflet. Well done for supporting patient understanding.
Management	Arrange follow up in 6 weeks to assess symptom improvement and consider repeat Vitamin D levels.	–	no	You did not arrange follow-up. Next time say “I will see you in six weeks to review symptoms and repeat your blood tests.”
Management	Provide safety netting by advising to report worsening tiredness, numbness, confusion, unsteadiness, or severe constipation.	7:54	partial	You advised to call if constipation worsens or falls occur but did not cover tiredness worsening, numbness, confusion, or unsteadiness. Next time include these for robust safety netting.
Interpersonal Skills	Greet patient warmly and introduce yourself clearly with role.	0:09	yes	You introduced yourself clearly as Dr Precious. Good start.
Interpersonal Skills	Acknowledge and validate her concerns about possible hypothyroidism.	1:25	yes	You acknowledged her worries about thyroid. Good validation.
Interpersonal Skills	Signpost before history taking: “Now, I will ask you some questions about your symptoms.”	–	no	You did not signpost before history. Next time say “I’ll now ask you some questions about your symptoms to understand better.”
Interpersonal Skills	Signpost before management explanation: “Next, I will discuss your test results and treatment plan.”	5:54	partial	You partially signposted but not clearly. Next time say “I will now explain your results and what we will do next.”
Interpersonal Skills	Use empathetic, sensitive language while explaining diagnosis and treatment.	6:08	partial	You were polite but explanation lacked clarity and confidence about treatment. Next time be more structured and reassure effectively with confident, simple explanations.

	Feedback Statements:	Needs Improvement
Consultation	Disorganised / unstructured consultation. Includes illogical and disordered approach to questioning. You did not demonstrate sufficiently the ability to follow a logical structure in your consultation. For example, your history taking may have appeared disjointed, with your line of questioning erratic and not following reasoned thinking. You may have undertaken practical tasks or examination in an illogical order that suggested you did not have a full grasp of the reason for completing them or a plan for the consultation.	✔️
Diagnosis	Does not make the correct working diagnosis or identify an appropriate range of differential possibilities.	✔️
Examination	Does not undertake physical examination competently, or use instruments proficiently.	✔️
Findings	Does not identify abnormal findings or results or fails to recognise their implications. You did not identify or recognise significant findings in the history, examination or data interpretation.	✔️
Issues	Does not recognise the issues or priorities in the consultation (for example, the patient’s key problem or the immediate management of an acutely ill patient). You did not recognise the key element of importance in the station. For example, giving health and lifestyle advice to 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. You did not demonstrate sufficiently the ability to conduct a patient centred consultation. Perhaps you did not show appropriate empathy or sympathy, or understanding of the patient’s concerns. You may have used stock phrases that show that you were not sensitive to the patient as an individual, or failed to seek agreement to your management plan.
Listening	Does not make adequate use of verbal & non-verbal cues. Poor active listening skills. You did not demonstrate sufficiently that you were paying full attention to the patient’s agenda, beliefs and preferences. For example, you may have asked a series of questions but not listened to the answers and acted on them.	✔️
Language	Does not use language or explanations that are relevant and understandable to the patient, including not checking understanding. The examiner may have felt, for example, that you used medical jargon, or spoke too quickly for the patient to take in what you were saying.
Time	Shows poor time management. You showed poor time management, probably taking too long over some elements of the encounter at the expense of other, perhaps more important areas.	✔️

Data_gathering	Management	IPS
2	1	3