Mock examiner feedback from the mock conducted on 24/06/24
Key Points
Recognize the Nature of the Case:
Identify early that the patient is a minor (15 years old) with a sexually transmitted infection (STI).
Understand this scenario is not a standard history-taking station but involves sensitive issues such as sexual abuse and power dynamics.
Data Gathering
Initial Questions:
Ask about the number and pain of swellings in the genital area.
Quickly identify the type of STI based on symptoms (e.g., single painful sore, multiple painful sores, etc.).
Sensitive Information:
Investigate the patient's sexual history briefly but effectively.
Ask about the age gap and the nature of the relationship discreetly but directly.
Check if the patient is being forced into the relationship or if there are elements of abuse or blackmail.
Importance of Key Issues:
Focus on understanding the main issue: the abusive nature of the relationship.
Ask about the patient's support system and if anyone is aware of her relationship.
Management
Transition to Management:
Move to management promptly after sufficient data gathering, especially upon hearing the two-minute bell.
Address the relationship and abuse before discussing the STI treatment.
Key Management Points:
Safety netting: Provide information on warning signs and what to do in case of worsening symptoms.
Follow-up: Arrange a follow-up with a senior or specialist.
Involve senior staff: Always mention involving a senior, particularly in cases involving minors and legal issues.
Leaflets and pamphlets: Provide informational materials about STIs, safe sex, and support resources.
Specific Actions:
Reassure the patient and explain the need for protected sex to prevent further infections.
Discuss the importance of a Pap smear, even if the patient is young and sexually active.
Emphasize the legal implications of the relationship and the necessity of informing a guardian or involving child protective services if needed.
Interpersonal Skills
Reassurance and Support:
Offer emotional support and reassurance throughout the consultation.
Be non-judgmental and open, encouraging the patient to share sensitive information.
Confidentiality:
Maintain the patient's confidentiality while gently probing into her support system and the awareness of her situation among her close ones.
Handling Sensitive Topics:
Tactfully handle discussions about the abusive relationship and ensure the patient understands the importance of addressing it.
Practice and Time Management
Developing an Internal Clock:
Practice timed scenarios to develop an internal sense of timing.
Aim to complete data gathering within four minutes to allow ample time for management.
Efficient Questioning:
Prioritize key questions that directly impact diagnosis and management.
Avoid dwelling on less critical aspects once the main issues are identified.
Additional Tips
Always Involve a Senior:
In scenarios involving minors, abuse, or legal issues, always mention involving a senior, regardless of the situation.
Legal and Ethical Considerations:
Understand and apply GMC guidelines regarding minors, sexual activity, and abuse.
Ensure the patient knows her rights and the importance of safe practices and legal protection.
Continuous Practice:
Regularly practice with a timer to improve efficiency and accuracy in both data gathering and management phases.
Reflect on each practice session to identify areas for improvement and adjust accordingly.
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