PLAB 2 Mock Test Feedback :: Missed Glass in Foot Xray :: Angry Patient

Mock Date: 18/12/2024

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 performance below:

Scenario Summary:

You are an FY2 doctor in the Emergency Department. Two days ago, you saw an 8-year-old boy, George Marley, who had injured his left foot. Initially, the x-ray showed mild soft tissue injury, and he was discharged with painkillers. However, a radiologist later identified a glass fragment in the soft tissue of his foot. You need to inform George's father, Gary Marley, about this finding over the phone, address his concerns, and ask him to bring George back to the hospital for further management.

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: George Marley, 8 years old		No	You did not confirm the full patient identifiers explicitly. Always confirm these details at the beginning to ensure you are speaking about the correct patient and demonstrate organized consultation. Consider asking directly, "Can I confirm your son's name and age, please?" to establish clarity.
Data Gathering	Confirm the father's name: Gary Marley		No	Although you addressed the parent, you did not explicitly confirm his name as Gary Marley. This step is crucial to personalize the consultation and avoid confusion. Ensure to say, "Can I confirm I’m speaking with Mr. Gary Marley?" at the start.
Data Gathering	Confirm the first line of the address		No	Address confirmation was not covered. This helps confirm the identity of the patient and demonstrates a thorough approach. Consider adding this check early in your consultation.
Data Gathering	Ask about the current condition of George: pain level, ability to bear weight, signs of infection	02:30-03:15	Partial	You asked about fever, redness, and swelling but missed explicitly asking about George's ability to bear weight. This is critical for assessing functional impairment. Make sure to ask, "Is George able to put weight on his foot, or does he need help walking?"
Data Gathering	Review the sequence of events: injury at the beach, initial hospital visit, x-ray findings, current symptoms	03:30-04:15	Yes	You reviewed the sequence of events well, including the initial hospital visit and x-ray findings. This was well done.
Data Gathering	Verify what Gary has been told so far and what treatment was given	03:30-04:00	Partial	You confirmed some details but did not comprehensively check what the father was told regarding discharge or painkillers prescribed. Always verify understanding to fill in any gaps. For example, "Can I confirm what you were told at discharge and the medications prescribed?"
Data Gathering	Ask about any new symptoms: fever, redness, swelling, discharge from the wound	02:30-03:15	Partial	You asked about fever, redness, and swelling but missed explicitly asking about discharge. Ensure you include all signs of infection. Add, "Have you noticed any discharge or fluid coming from the wound?"
Data Gathering	Confirm current medications: painkillers prescribed by the hospital	03:15-03:30	Partial	You mentioned painkillers but did not confirm the name or dosage. Ensure you check this explicitly: "Can I confirm what painkillers were prescribed, and are they helping with the pain?"
Data Gathering	Check for any allergies: No known allergies		No	Allergies were not discussed. This is an essential step in all consultations to ensure patient safety. A simple question like, "Does George have any allergies to medications or anything else?" would suffice.
Management	Explain the error: missed glass fragment in the initial x-ray	05:00-05:30	Yes	You explained the error clearly and acknowledged the missed glass fragment. This was done well.
Management	Apologize for the oversight and any distress caused	05:15-05:30	Yes	You apologized appropriately for the oversight, which showed empathy and responsibility.
Management	Explain the need for immediate return to the hospital for glass removal	05:30-06:00	Yes	You explained the necessity of returning to the hospital for the removal procedure. This was clearly communicated.
Management	Discuss the procedure for removing the glass and pain management	06:15-06:45	Partial	You briefly mentioned reviewing and removing the glass but did not detail pain management during or after the procedure. Include more details like, "We’ll ensure his pain is well-controlled during and after the procedure."
Management	Explain potential complications if the glass is not removed: infection, need for antibiotics	06:45-07:00	Partial	You did not explain all complications explicitly. You could add, "If the glass isn't removed, there's a risk of infection, which might require antibiotics or further interventions."
Management	Reassure that George does not need a tetanus shot	08:15-08:30	Yes	You reassured the father effectively regarding tetanus, mentioning that glass does not usually require a shot.
Management	Document the incident and complete an incident reporting form	07:15-07:45	Yes	You mentioned completing an incident report, which was well covered.
Management	Inform the consultant and arrange for them to speak with Gary	07:45-08:00	Yes	You informed the father about involving a consultant, which was appropriately addressed.
Management	Refer to PALS for feedback and support	08:00-08:15	Yes	You provided information about PALS, ensuring the father knew how to raise concerns. This was well done.
Management	Arrange a follow-up appointment to discuss findings and actions taken		No	Follow-up was not arranged explicitly. Always ensure you close with, "We’ll arrange a follow-up appointment to discuss the findings and next steps."
Interpersonal Skills	Greet and introduce yourself: Confirm the father's name and relationship to George	00:30-01:00	Partial	You introduced yourself but did not confirm the father's name or his relationship to George. Ensure to state, "Can I confirm you are George’s father, Mr. Gary Marley?" for clarity.
Interpersonal Skills	Check if it is an appropriate time to talk	01:00-01:15	Yes	You asked if it was a good time to talk, which was courteous and professional.
Interpersonal Skills	Use simple language to explain the situation and next steps	05:00-06:30	Yes	You used clear and understandable language to explain the situation, which was effective.
Interpersonal Skills	Acknowledge and validate Gary's feelings of frustration and anger	05:30-06:00	Partial	You addressed Gary's frustration but did not fully validate his emotions. Acknowledge further by saying, "I understand how upsetting this must be for you, and I am truly sorry for the distress caused."
Interpersonal Skills	Allow space for Gary to express his emotions and concerns	05:15-05:45	Yes	You gave Gary space to express his frustration and concerns, which was handled well.
Interpersonal Skills	Reassure Gary of the hospital's commitment to rectify the situation and support George	05:45-06:00	Yes	You reassured Gary about the hospital's commitment effectively, which was appropriate.
Interpersonal Skills	Invite questions and ensure Gary understands the information provided	08:00-08:15	Partial	You invited questions but did not check for understanding consistently. Always ask, "Does that make sense to you, or do you have any other questions?"
Interpersonal Skills	Express empathy and support throughout the conversation	05:15-06:00	Partial	You expressed empathy in parts but could have demonstrated more supportive language throughout. For example, "I’m here to support you through this, and we’ll ensure George gets the best care."

Feedback Statement Checklist

	Feedback Statements:	Needs Improvement
Consultation	Ensure a more structured approach and address all points systematically.	✔️
Diagnosis
Examination
Findings
Issues
Management
Rapport	Develop stronger patient-centered communication, including acknowledging and validating emotions fully.	✔️
Listening	Improve active listening by asking follow-up questions based on responses and checking understanding.	✔️
Language
Time

Additional Remarks

Data Gathering

You missed confirming key identifiers like the father's name and address. Remember to confirm these early in the consultation to establish clarity and rapport. Be systematic in reviewing the patient's condition, including all symptoms and treatment details. Missing items like allergies or discharge can lead to safety risks.

Management

You communicated the error and need for follow-up well, but additional detail on complications and pain management would enhance your explanation. Don’t forget to schedule follow-up explicitly to close the consultation comprehensively.

Interpersonal Skills

Your language and tone were generally appropriate, but deeper validation of emotions and consistent empathy would make the conversation more patient-centered. Use phrases like, "I can see how frustrating this is for you," to show understanding.