Case Scenario: Teaching a Medical Student About the Referral Process

Summary:

This scenario involves a doctor teaching a third-year medical student about the referral process in the NHS. The student has doubts about different types of referrals and their significance. The focus is on ensuring clear communication, assessing the student’s prior knowledge, and engaging in an interactive teaching session.

Key Points:

Understanding the Teaching Role

• The simulated patient (student) is not a doctor; avoid using medical jargon.

• Avoid excessive questioning if the student lacks prior knowledge.

• Keep the teaching interactive by asking what the student wants to learn.

Establishing Rapport

• Start with pleasantries: Address the student by name and ask about their experience in medical school.

• Use a conversational tone to make the session engaging.

Data Gathering

• Ask the student what they already know about referrals.

• Identify gaps in their understanding.

• Use ICE (Ideas, Concerns, and Expectations) to clarify their learning needs.

Teaching Structure

• Outline the topics to be covered at the start (e.g., types of referrals, contents of a referral letter, and patient communication).

• Confirm understanding after each section by asking questions.

• Provide real-life clinical examples to illustrate points.

Important Considerations:

• Avoid Overloading Information: Focus on what the student needs to know rather than providing excessive details.

• Engagement Over Monologue: Teaching should be interactive, not just a one-way lecture.

• Encouragement: Praise correct responses and gently correct mistakes to maintain a positive learning environment.

• Time Management: Teaching sessions are time-constrained, so structure the discussion efficiently.

Diagnostic Approach:

• Step 1: Assess the student’s current knowledge of the referral process.

• Step 2: Clarify misconceptions and address specific doubts.

• Step 3: Explain different types of referrals and their urgency levels.

• Step 4: Discuss the contents of a referral letter and how to communicate this to a patient.

• Step 5: Reinforce learning by summarizing key points and inviting further questions.

Management:

Types of Referrals:

• Immediate Referral: Requires urgent hospital admission (e.g., vision loss in giant cell arteritis).

• Urgent Referral: Must be seen within 48 hours (e.g., suspected childhood cancer).

• Two-Week Wait Referral: Used for suspected adult cancer cases.

• Routine Referral: Managed within an 18-week period.

Referral Letter Components:

• Patient Details: Name, NHS number, DOB.

• Doctor’s Details: Name and designation.

• Urgency Level: Immediate, urgent, routine.

• Presenting Complaint: Summary of symptoms.

• Examination Findings & Investigations: Relevant clinical data.

• Reason for Referral: Justification for specialist input.

Patient Communication:

• Explain why the referral is necessary.

• Address concerns and expectations.

• Avoid unnecessary jargon.

• Offer follow-up for any additional questions.

Communication Skills:

• Use clear, simple language to ensure understanding.

• Regularly check if the student is following along.

• Encourage active participation by asking, “What do you think so far?” or “Can you summarize what we just discussed?”

• Use positive reinforcement to encourage engagement.

• Avoid stock phrases that sound rehearsed; be natural in responses​​.

Ethical Considerations:

• Ensure that the student feels comfortable asking questions.

• Respect different learning paces and avoid making the student feel inadequate.

• Provide accurate information based on evidence-based guidelines.

Additional Resources:

• NHS Referral Guidelines: To understand national standards.

• GMC Good Medical Practice: For professionalism in medical teaching​.

• PLAB 2 Examiner Top Tips: Guidance on passing teaching stations​.