EXAMINER’S MARKING SHEET
STATION NO. 4 – Chest pain
SCHOOL
STUDENT’S NAME
EXAMINER’S NAME
INSTRUCTIONS TO STUDENT – Part A - You are a Trainee Intern assigned to a General Practice. Please take a
history from this patient who has recently experienced chest pain. After 7 minutes, you will be asked the most likely
diagnosis. You will then be asked to provide some education to the patient.
Part B – This patient has angina and knows how to use his GTN spray. Please discuss with him how to manage further
episodes of chest pain. You have 2 minutes.
CONTENT & TASK – (What the student did)
SCORE
Appropriate rapport and open ended questions -
1
/4
Clearly characterises the chest pain:
(a) Character, intensity and duration
(b) location and radiation
(c) associated symptoms, alleviators and aggravators
Identifies classical risk factors:
● smoking, hypertension, diabetes, hyperlipidaemia, family history
2
/2
Explores previous symptoms and past history -
3
/2
Explores alternative conditions:
● pulmonary, GI and musculoskeletal, relationship of pain to posture and respiration
After 7 minutes, stop student and ask for most likely diagnosis ● Identifies ischaemic heart disease as most likely diagnosis
4
/1
Then, read Part B instructions to student –
Educates patient with:
(a) Clear description of how to manage further episodes of angina, particularly unstable symptoms
(b) Allows opportunity for and answers questions appropriately
(c) Checks information received by patient
5
/3
/12
TOTAL
PROCESS – (How the student did it)
EXAMINER - Please score the student (from 0 to 6) on how well they conformed to the following description:
The student displayed –
▪
accurate and focused application of excellent skills
▪
integrated, smooth and coherent performance
▪
effective and efficient completion of the station task
/2
2
0
1
3
4
(Lowest)
PATIENT - Please ask the patient/actor how likely they would be to return to this doctor:
0
(Unlikely)
/6
5
1
(Likely)
6
(Highest)
2
(Very likely)
/8
TOTAL
Safety Issue
Did the student do, or neglect to do, anything that would have directly harmed the patient? If
yes, please explain (use reverse side).
YES
/
NO
Overall assessment of how the student did on this station - (This is used to set the pass mark for all students.)
Please rate the student’s overall performance compared with a beginning Trainee Intern. (Circle one number only.)
0
Deficient
1
2
3
4
Minimum
standard for TI
5
6
7
Proficient
NOTES FOR EXAMINERS
At 10 minutes, a bell will ring. The student should finish their sentence and leave.
At 11 minutes, a bell will ring. The next student should enter the room and begin.
Examiners should decide the marks and overall performance independently from each other.
Station No. 4
INSTRUCTIONS FOR STUDENT
Part A
You are a Trainee Intern assigned to a
General Practice.
Please take a history from this patient
who has recently experienced chest pain.
After 7 minutes, you will be asked the
most likely diagnosis.
You will then be asked to provide some
education to the patient.
Station No. 4
INSTRUCTIONS FOR STUDENT
Part B
This patient has angina and knows how
to use his GTN spray.
Please discuss with him how to manage
further episodes of chest pain.
You have 2 minutes.
Station No. 4
INSTRUCTIONS FOR SIMULATED PATIENT
(Male, age 55)
You are a 55 year old labourer. You have visited your GP as an urgent appointment following
an episode of central chest pain during exertion in the last week. You were doing labouring
duties when the pain started. The pain radiated from the central chest to the left shoulder,
was tight in character and lasted 5-10 minutes continuously. It was moderately severe (6 out
of 10). There was no change in symptoms with breathing or posture. You felt sweaty but had
no shortness of breath or nausea, and no other cardiac symptoms such as palpitations,
lightheadedness or fainting. Your symptoms resolved after resting.
You have had 3 prior episodes of similar pain. The first occurred at work while lifting a
wheelbarrow. The pain was tight, lasted 5 minutes, did not radiate from the chest and eased
after you finished lifting. The second episode occurred after dinner while sitting in a chair
watching a tense rugby match on television. Again, the pain lasted 5 minutes and resolved
spontaneously. The third episode occurred recently during an argument with a work
colleague. The pain was similar in location and character, and lasted 10 minutes.
You smoke 20 cigarettes a day. Your cholesterol has never been measured. There is no
history of diabetes. On several occasions the occupational nurse has mentioned your blood
pressure is mildly elevated but you are on no treatment for hypertension. Your father died
suddenly aged 51 of uncertain cause. There is no other family history of other medical
illness.
You have no history of prior hospital admissions or major medical illness. You are on no
regular medications. You do have a penicillin allergy (rash). You do have intermittent
burning epigastric discomfort after meals that occurs once per month, but you’ve had no
investigations for this.
You have had a prior work-related injury to your left shoulder which required physiotherapy
and rehabilitation, and occasionally causes discomfort in the left upper chest and shoulder.
You have no history of cough, sputum production, spewing of blood, ankle swelling or
features of deep vain thrombosis. You’ve had no immobilisation, history or emergency or
recent travel.
The student will be asked to take a history of your complaint. After 7 minutes, the student
will be stopped and asked to give the most likely diagnosis. Then, the student will be
instructed to explain to you how to manage any further episodes of chest pain you may
experience. The student would also usually ask if you have any questions. If they do, ask
“How do I know if it’s bad enough to call an ambulance?”
The student will be given marks for the way that s/he establishes rapport with you as
well as for the “medical content” of the answers.
If the student asks you a closed-ended question, then you should reply to that question
only. If the student asks you an open-ended question, you should feel free to expand on
the answer you give.
Do your best to put yourself in the actual role of the patient and respond as you might in
that situation. If you feel uncomfortable, for example, you would offer less information.
Station No. 4
QUESTION EXAMINER WILL ASK PATIENT
Please ask the patient/actor how likely they would be to
return to this doctor.
0
(Unlikely)
1
(Likely)
2
(Very likely)