Reset 10 mins Pause Candidate instructionsActor instructionsMark sheet Score Location: You are a medical student in outpatient clinic Patient: 45 year old patient presented with left lower abdominal pain and change in bowel habit Task: – You have been asked to explain the colonoscopy procedure and explore any concerns that the patient may have about it – You are not required to discuss the risks of the procedure or gain consent – After 6 minutes you will be asked a series of questions by the examiner. – Answer any questions that the patient may have Note to actor: Try to restrain yourself from volunteering too much information – you may do so when prompted (that is, by a specific question, not a general one). If a student is on the wrong line of clinical reasoning do not fuel this line of thinking, state no to the question as being ambiguous may prompt further questioning and does not allow the student to be appropriately tested. The aim of the exercise is to take a focused history; short answers are required. You are a 45 year old patient who has been referred to this outpatient clinic by your GP for left lower abdominal pain and diarrhoea. You have already seen the consultant and they asked for the medical student to explain the colonoscopy procedure. The focus of this station is on explaining the colonoscopy procedure, at the beginning briefly explain to the student what the consultant and yourself have discussed so far – For the past 6 months you have had bouts of diarrhoea with pain on the left side. You are well and not on any regular medications. You do not smoke or drink. The consultant has said you will need to have a colonoscopy to investigate the cause of this diarrhoea and pain further. You have heard of a colonoscopy as your friend had one but you are unsure what actually happens. You would like to know the following information: – How should you prepare for the test (what should you do the day before the procedure) – What will happen during the test – What happens after the test – You would like to know when you can go back back to work – Ask if you are able to drive to and from the appointment ICEF – you only disclose this if you are specifically asked 1. You are embarrassed about having the procedure. If the candidate prompts you on this state that you are worried about passing wind or opening your bowels during the procedure 2. You are worried about getting the results and what follow up you will get If the candidate uses medical words you are expected to prompt them in order to clarify what they mean. If the candidate appears to have finished early remind them how long is left at the station and enquire if there is anything else they would like to ask, or whether they have finished. If they have finished, please remain silent and allow the candidate that time for reflection. Category Question Done Excellent Introduction Candidate appropriately introduced themselves with: Full name Role Clarifies who they are talking to Asks patient for preferred name History Obtains a basic history from patient Understands reason for attendance Clarifies need for colonoscopy Questioning Encourages patient to ask questions Baseline knowledge Checks patient’s baseline knowledge regarding colonoscopy Clarifies information Clarifies information patient would like to know ICEF ICEF Explores ideas, concerns, expectations, feelings Asks patient if they have any questions Pre-procedure advice No food day before Clear fluids only Laxative will be prescribed and should be taken as directed. This will force all the contents of your bowel to be removed Procedure Fiberoptic camera with light source Insertion Inflation of bowel with air Camera moved to visualise length of bowel Biopsies can be taken When finished air removed and camera removed Procedure extended Procedure takes about 30 mins Need to lay on side Sedation May be given as an injection before the procedure Post-procedure In recovery to ensure no anaesthetic concerns Not to drive or operate heavy machinery after the procedure, ideally someone with accompany patient to appointment Return to work Day after procedure if feeling able Follow up / results Results are explained after the procedure if possible Follow up appointment in outpatient clinic in 2-4 weeks (this will allow time for the biopsies to be reported) Listening skills Employs verbal listening skills Employs non-verbal listening skills Content delivery Chunks information Checks patient understanding Patient score Good rapport with patient Active listening skills Appropriate use of body language Avoids medical jargon Summarises and checks patient understanding Submit your answers to get your score.