CSA Simulator Instructions GPST/Candidate
Lisa Walker
30 year old Shop worker
Past medical history: Migraine, Non Smoker, 2 x NVD (2009, 2007) Sterilisation 2011
Last attendance April 2013 Coryzal symptoms, obs stable URTI Treat symptomatically.
Drug History No Current Repeat
NKDA
CSA Simulator Instructions
30 year old female 'Lisa Walker'
You have a history of migraines, which you have suffered with for the past 6 years and have been well
controlled with simple pain killers. Your last migraine was around 12 months ago. Over the past 1 month
you have been suffering with new headaches. They come on slowly, and are a dull type pain, you get
them a few times a week. You have also noticed a strange tingling sensation in you upper lip and
tongue with these headaches. There isn’t anything that triggers the headache and you have no other
symptoms.
At home you are married with two young children 8 and 9. You work full time in a shop which has been
particularly busy recently but your boss is supportive. Your relationship with your husband has
deteriorated and he is drinking a lot. He doesn’t drink in front of the children, but he isn’t supporting you
in looking after the home or children. He still holds down a job and isn’t violent towards you.
You are very stressed at present. Your mood is low due to stress with your husband and work and
home pressures. Your appetite and sleep are poor. You have no thoughts of self-harm or suicide.
You are worried about the headaches affecting your ability to work and take care of children. You don’t
think it’s anything serious and don’t want further tests, hoping for reassurance. You were wondering
what painkillers are best to take. If the doctor suggests that you are low in mood possibly depressed
acknowledge this may be correct and possible cause/aggravating factor.
CSA Case Marking Sheet
Case Name: Lisa Walker
Centre: click and enter scheme name
GP ST Name: click and enter gp st name
CSA Surgery Date: click and enter date
Case Title: Headache and Mental health problem
Context for the Case:

Ability to manage Headache and a Mental Health problem in primary care.

Developing and maintaining a relationship and a style of communication that treats the patient as
an equal and does not patronise the patient.

Acquiring knowledge of the patient’s relevant context, including family, social and occupational
factors.
Assessment Domain:
1.
Data-gathering, technical and assessment
skills
Positive descriptors:
Negative descriptors:

Takes an appropriate neurological history.

Inappropriate concentration on headache.

Identifies psychosocial problems.

Doesn’t discover possible history of Depression.

Takes further history of Depression.

Doesn’t take neurological history

Exclude suicide risk

Fails to identify physical, psychosocial problems.
Assessment Domain:
2.
Clinical Management Skills
Positive descriptors:

Feasible management

Reassurance

Explaining possibility of depression.

Treating headaches with simple analgesia /old
medications.
Negative descriptors:

Fails to take account of related issues or co
morbidity.

Unable to construct a problem list and prioritise.

Follow up arrangement are absent or disjoined.
Assessment Domain:
3.
Interpersonal skills
Positive descriptors:
Negative descriptors:

Empathy with situation.

Doctor’s centred management.

Address patients agenda

Not empathetic.

Enhances patient’s autonomy.
Global Comments
Positive descriptors:

Performs in an organised/consistent manner.

Recognised the challenge to a sufficient degree.

Patient-centred approach.

Good time management .
Negative descriptors:

Fails to perform in an organised/consistent
manner.

Does not recognise the challenge to a sufficient
degree.

Shows disproportionate or inappropriate doctor-
centeredness.

Fails to demonstrate good time management.
Grading
Clear Pass

Excellent

Marginal Pass
Serious Concerns
General Feedback/Comments

Marginal Fail

Clear Fail

Patient instructions
30 year old female.
You have a history of migraines, which you have suffered with for the past 6 years and have been well
controlled with simple pain killers. Your last migraine was around 12 months ago. Over the past 1 month
you have been suffering with new headaches. They come on slowly, and are a dull type pain, you get
them a few times a week. You have also noticed a strange tingling sensation in you upper lip and
tongue with these headaches. There isn’t anything that triggers the headache and you have no other
symptoms.
At home you are married with two young children 8 and 9. You work full time in a shop which has been
particularly busy recently but your boss is supportive. Your relationship with your husband has
deteriorated and he is drinking a lot. He doesn’t drink in front of the children, but he isn’t supporting you
in looking after the home or children. He still holds down a job and isn’t violent towards you.
You are very stressed at present. Your mood is low due to stress with your husband and work and
home pressures. Your appetite and sleep are poor. You have no thoughts of self-harm or suicide.
You are worried about the headaches affecting your ability to work and take care of children. You don’t
think it’s anything serious and don’t want further tests, hoping for reassurance. You were wondering
what painkillers are best to take. If the doctor suggests that you are low in mood possibly depressed
acknowledge this may be correct and possible cause/aggravating factor.
Doctors Instructions
Lisa
30 year old Shop worker
Past medical history: Migraine, Non Smoker, 2 x NVD (2009, 2007) Sterilisation 2011
Last attendance April 2013 Coryzal symptoms, obs stable URTI Treat symptomatically.
Drug History No Current Repeat
NKDA
EXAM CARD
Information to be given to doctor when prompted
Normal full neurological examination
BP 150/90 HR 88 Temp 36.5 RR 16 100% on RA
Normal Fundoscopy