Patient Instructions
Name of Patient:
Gemma Lawson Age 30
Description of the patient & instructions to simulator:
Gemma, recently married, found out that she was pregnant three weeks ago, she had been
planning this so had started folic acid. She has worked out she is 8 weeks by dates.
A ’girl’ down the street has just had a baby and it has ‘'Down’s Syndrome’, she wants to know
if there is anything she can do to prevent it or if she can have some tests to see if her baby is
‘ok’.
She is a non smoker and has not been drinking alcohol since she and her partner started
trying for a baby.
She is a part time teaching assistant.
She knows Down’s Syndrome causes children “to look not quite right” and have learning
difficulties
If asked she is unsure if she would want a termination if her baby was found to have Down’s
syndrome but she would want to know, so that they could make a decision.
Ideas – knows little about Down’s Syndrome
Expectation – to be told about and offered a test if available
Concerns – her baby may have Down’s Syndrome
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Doctor’s (GP ST) Instructions
Name & age of patient Emma Lawson age 30
Summary Card
PMH: Asthma as a child
DH: Nil
Allergies: None
:
Case Notes - Last few entries in records:
18months ago – pill check
Non smoker, BMI 21, BP normal
No CI – microgynon issued
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CSA EXAMINATION CARD
Patient Name: Emma Lawson
Examination findings: All normal
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CSA Case Marking Sheet
Case Name: Emma Lawson
Case Title: Antenatal screening
Context of case

Antenatal screening for Down’s
Assessment Domain:
1.
Data-gathering, technical and assessment skills
Positive descriptors:
Negative descriptors:

Identifies gestation


Explores knowledge
antenatal screening

Identifies ICE

Checks re folic acid, smoking, alcohol etc
of
Down’s
and
Fails to work out gestational age

Does not explore patient understanding re
Down’s

Fails to ask about folic acid, smoking and
alcohol

Fails to identify views re TOP & Down’s
Assessment Domain:
2.
Clinical Management Skills
Positive descriptors:
-

Unable to explain Down’s syndrome
without using jargon

Explains her risk is about 1 in 800 based on
maternal age

Unable to explain tests, when they can be
performed

Explains concept of screening test and
timing of triple test (nuchal USS, BHCG
and PAP-A 10 to 14/40) & quadruple
blood test (14/40 to 20/40)

Does not
explain difference between
screening test and diagnostic test

Does not discuss the implications of testing

No MW follow up arranged

No offer of PIlealfet or further in formation


Explains what Down’s Syndrome
succinct explanation
Negative descriptors:
Explains the outcome re risk threshold and
possible subsequent need for diagnostic
test if risks > 1 in 150 and v briefly what it
entails (CVS & Amniocentisis)

Arranged MW review to sort out booking
and explaining tests

Offers PILealflet re healthy pregnancy and
antenatal screening

Offer review to address any questions
Assessment Domain:
3.
Interpersonal skills
Positive descriptors:
Negative descriptors:

Identifies patient ICE

Dismissive

Maintains rapport

Lacking rapport

Comes to a shared plan

Loses the patient with explanations

Doctor centred
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