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

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.	2:00:11, 2:00:29	Yes	Well done confirming both name and age clearly at the start, establishing safe practice and rapport.
Data Gathering	Confirm presenting complaint by asking about tiredness and constipation elaboration.	2:01:01, 2:03:18	Partial	You elaborated on tiredness extensively, but constipation was only touched upon when she mentioned it herself. Next time, actively ask for details on bowel habit frequency, stool consistency, and associated symptoms to fully explore constipation.
Data Gathering	Ask about onset and duration of tiredness.	2:01:47, 2:01:54	Yes	Good direct questioning on when it started and for how long, showing structured history taking.
Data Gathering	Ask about variation of tiredness during the day.	2:02:13	Yes	You checked if tiredness varied throughout the day. Keep this up as it helps differentiate causes.
Data Gathering	Ask if tiredness is relieved by rest or sleep.		No	You did not ask if rest or sleep improves her tiredness. Next time ask, “Do you feel better after sleeping or resting?” to assess fatigue causes.
Data Gathering	Ask about impact of tiredness on daily activities and work performance.	2:02:25	Yes	You explored this well by asking about its effect on her work as a teacher.
Data Gathering	Ask about mood changes	2:02:58	Yes	You asked about mood changes clearly. Maintain this approach to rule out depression.
Data Gathering	Ask about constipation frequency and associated bowel changes.	2:03:18	Partial	You asked about constipation but didn’t ask frequency or stool type. Next time ask, “How often do you open your bowels and what is it like?” to assess severity and impact.
Data Gathering	Ask about bone pain particularly in back or hips to rule out Vitamin D deficiency.		No	You did not ask about bone pain. Next time, ask directly, “Have you noticed any pain in your back or hips?” to assess Vitamin D deficiency effects.
Data Gathering	Ask about muscle cramps or generalised weakness to assess for Vitamin D deficiency.		No	You asked about weakness but not about muscle cramps. Next time ask, “Do you get muscle cramps or spasms?” for a full deficiency assessment.
Data Gathering	Ask about past medical history, medication and family history	2:04:07, 2:04:33	Partial	You asked about family history and medications but missed past medical history entirely. Next time ask, “Have you had any significant illnesses in the past?” to complete the history.
Data Gathering	Ask about any tingling, numbness, or weakness in limbs to rule out neurological causes.	2:03:55	Yes	You asked about numbness and weakness effectively. Good inclusion.
Management	Explain that thyroid function tests are normal to reassure patient about hypothyroidism concerns.	2:06:22	Yes	Good reassurance about her thyroid results, directly addressing her concern.
Management	Explain that Vitamin D levels are low (20 nmol/L) and calcium is slightly low.	2:06:37	Yes	You explained her low Vitamin D and calcium levels clearly.
Management	Explain the role of Vitamin D in calcium absorption and bone/muscle health.	2:06:51	Partial	You mentioned Vitamin D deficiency causing her tiredness but didn’t explain its role in calcium absorption or bone/muscle health. Next time say, “Vitamin D helps absorb calcium, keeping your bones and muscles healthy.”
Management	Advise the patient to obtain 15–20 minutes of safe sunlight exposure daily to help improve Vitamin D levels.	2:07:36	Yes	You advised sunlight exposure well. Keep this practical approach.
Management	Start treatment with Vitamin D loading dose of 50,000 units once a week for 6 weeks.		No	You did not mention prescribing a loading dose. Next time say, “I will start you on a Vitamin D loading dose of 50,000 units weekly for six weeks to replenish your levels.”
Management	Advise maintenance dose of 1,000 units daily after loading phase to maintain Vitamin D levels.		No	You missed this maintenance advice. Include it by saying, “After the loading dose, we’ll continue with 1,000 units daily to keep your levels up.”
Management	Advise dietary Vitamin D intake with oily fish, egg yolks, red meat, liver, and fortified cereals or milk.	2:07:19	Partial	You advised fish and eggs but missed other sources like red meat, liver, and fortified foods. Next time list them all to empower her dietary choices.
Management	Consider calcium supplementation of 500–1000 mg elemental calcium daily if dietary intake is insufficient.		No	You did not discuss calcium supplementation. Next time say, “Depending on your dietary intake, we might also consider calcium supplements to support bone health.”
Management	Advise dietary calcium intake increase with dairy, leafy greens, and fortified foods.		No	You didn’t advise on calcium-rich foods. Next time mention dairy products, leafy greens, and fortified foods to address calcium deficiency.
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 potential referral. Next time explain, “If your Vitamin D remains low despite treatment, we may refer you to check for absorption issues.”
Management	Provide informational leaflets on Vitamin D deficiency and calcium balance.		No	You did not mention providing leaflets. Next time say, “I will give you a leaflet with this information so you can read it at home.”
Management	Arrange follow up in 6 weeks to assess symptom improvement and consider repeat Vitamin D levels.		No	You missed arranging follow-up. Next time say, “I’ll see you in six weeks to check if your symptoms have improved and repeat your blood tests.”
Management	Provide safety netting by advising to report worsening tiredness, numbness, confusion, unsteadiness, or severe constipation.		No	You missed safety netting. Next time say, “Please come back sooner if you feel worse, dizzy, confused, or severely constipated.”
Interpersonal Skills	Greet patient warmly and introduce yourself clearly with role.	2:00:02	Yes	You greeted and introduced yourself warmly. Good professional start.
Interpersonal Skills	Acknowledge and validate her concerns about possible hypothyroidism.	2:01:47, 2:05:19	Yes	You validated her thyroid concerns well. Continue this patient-centred approach.
Interpersonal Skills	Signpost before history taking: “Now, I will ask you some questions about your symptoms.”	2:00:46	Yes	You signposted before history taking effectively.
Interpersonal Skills	Signpost before management explanation: “Next, I will discuss your test results and treatment plan.”		No	You missed this management signpost. Next time say, “I will now explain your results and what we will do moving forward.”
Interpersonal Skills	Use empathetic, sensitive language while explaining diagnosis and treatment.	2:06:51, 2:07:19	Yes	You explained sensitively with good patient-centred language. Keep this up.

	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
3	1	4