PLAB 2 Mock Test Feedback :: Barrett's Oesophagus :: Counseling

Mock Date: 20/11/2024

Action Items:

• Practice and Review the case in the OSCE workbench: Click Here

• Read the Mock Feedback Blog:  Click Here

• Additional Resources: Click Here

• Deep Dive into your (Private) performance below

Scenario Summary:

You are an FY2 doctor in the outpatient department. Your patient, James Clark, is a 53-year-old man with a history of GERD who recently had an endoscopy with a biopsy. He is here to discuss his biopsy results and management plan.

My Performance:

🔍Let’s Deep Dive into your performance:

The Domain-wise evaluation shows areas where you did well and others where you have room to grow. 

• A "Yes" means you covered that point effectively

• A "Partial" indicates that you did some of it well but missed some key details. 

• A "No" means there was an important opportunity that wasn’t addressed.

Don’t worry if you see several areas marked "No" or "Partial"—this is common and simply highlights where you can focus your learning. 

By reflecting on these areas and practicing, you’ll be able to improve and feel more confident in your consultations. Remember, every bit of feedback is an opportunity to grow, and you’re on the right path by taking these steps.

Timestamps are provided to show exactly when during the consultation you covered or missed key points. Reviewing these can help you see how well you're managing your time and where you might need to be more efficient in addressing important areas.

Domain	Point	Timestamp	Response	Remarks
Data Gathering	Establish rapport: Greet the patient warmly and confirm identity	00:06-00:14	Yes	You greeted the patient by name and confirmed their identity effectively. This set a warm tone for the consultation. Great start!
Data Gathering	Inquire about the duration and severity of GERD symptoms	00:30-01:05	Yes	You elicited a clear timeline of the patient's symptoms and their severity, which helped establish the history comprehensively. Well done!
Data Gathering	Ask about compliance with omeprazole and any side effects	02:02-02:26	Partial	While you explored the lack of efficacy of Omeprazole, you missed asking explicitly about compliance or potential side effects. For next time, ensure you inquire if the patient has been taking the medication as prescribed.
Data Gathering	Discuss lifestyle factors: smoking, alcohol consumption, diet, and occupation	06:31-06:47	Partial	You addressed the patient’s diet and occupation but did not ask about smoking or alcohol consumption. Including these factors would provide a fuller picture of the lifestyle influences on GERD.
Data Gathering	Explore the nature of nighttime symptoms and their impact on sleep and daily life	01:22-01:44	Yes	You gathered detailed information about how the symptoms affect the patient’s sleep and daily functioning, which is essential for tailoring management.
Data Gathering	Ask about any other symptoms, such as weight loss, difficulty swallowing, or pain	N/A	No	You did not inquire about potential red-flag symptoms like weight loss or difficulty swallowing. For completeness, always screen for associated symptoms that might indicate complications or alternative diagnoses.
Management	Explain endoscopy results: Barrett’s esophagus, no dysplasia or neoplasia	02:33-03:48	Yes	You explained the results in understandable terms, highlighting key findings and implications. Excellent job breaking down medical jargon!
Management	Discuss the need for regular endoscopies every 3 years	03:58-05:10	Partial	You mentioned the importance of follow-up endoscopies but did not fully address the patient’s reluctance or provide alternative solutions like sedation during the procedure.
Management	Advise on lifestyle modifications: quit smoking, reduce alcohol, healthy diet	06:48-07:02	Partial	You discussed dietary changes but did not advise on smoking or alcohol reduction. Aim to provide a comprehensive lifestyle advice plan in future encounters.
Management	Review medication: effectiveness and adherence to omeprazole	02:02-02:26	Partial	While you addressed the need for a stronger medication, you didn’t explicitly review adherence or explore if dose adjustment had been tried.
Management	Provide written information: leaflets about Barrett’s esophagus and lifestyle changes	N/A	No	You didn’t offer written information or resources. Next time, bring up the availability of patient leaflets to reinforce your advice.
Management	Safety netting: Emphasize importance of follow-up and early detection	07:34-08:01	Partial	You suggested follow-up but didn’t emphasize the critical role of early detection in managing Barrett’s esophagus. Consider stressing this more explicitly to ensure the patient understands the importance of monitoring.
Interpersonal Skills	Use simple, non-medical language to explain the condition and results	02:59-03:48	Yes	Your explanation of Barrett’s esophagus was clear and simple, avoiding unnecessary jargon. Great work!
Interpersonal Skills	Show empathy for the patient’s symptoms and concerns	02:02-02:26	Partial	While you acknowledged the patient’s difficulties, opportunities to validate their feelings further (e.g., during their concerns about endoscopy discomfort) were missed. Empathy can be shown not just through words but tone and non-verbal cues.
Interpersonal Skills	Encourage the patient to adopt healthier lifestyle choices	06:48-07:02	Partial	You touched upon dietary changes but didn’t strongly encourage or explore strategies for implementation. You could have provided more practical suggestions or set goals with the patient.
Interpersonal Skills	Allow the patient to ask questions and express concerns	Throughout	Yes	You gave the patient ample opportunities to share their thoughts and ask questions, which fostered a patient-centered dialogue. Well done!
Interpersonal Skills	Reassure the patient about the manageable nature of their condition	03:48-04:35	Partial	While you reassured them about the absence of cancer, you didn’t fully address their anxiety about the potential progression of Barrett’s esophagus. Providing specific statistics or emphasizing the effectiveness of monitoring could enhance reassurance.
Interpersonal Skills	Respect the patient’s choices and decisions	05:11-05:34	Yes	You respected their reluctance about endoscopy and suggested working with the surgical team to find alternatives. This demonstrated respect for their preferences.

Additional Remarks for Each Domain:

Data Gathering:You managed to build rapport and cover most critical points well. However, to improve, ensure you explore all lifestyle factors and screen for red-flag symptoms like dysphagia or weight loss. Try to incorporate signposting when moving between topics—it’ll help structure your approach better.

Management:You explained the medical details clearly and aligned your advice with the patient's needs. However, consider offering additional resources like leaflets and elaborating on safety netting. These steps will strengthen your educational impact and reinforce understanding.

Interpersonal Skills:Your language was clear and accessible, but moments of missed empathy reduced the impact. Always validate the patient's emotions, especially when they express fear or discomfort. It’s OK to pause and emphasize that their feelings are understood before moving forward.

Feedback Statement Checklist

Area to Work On

Checked

Remarks

Consultation

☑

Focus on logical, structured questioning, ensuring all key areas (e.g., red flags) are covered systematically.

Issues

☑

Ensure all key aspects of the condition (e.g., lifestyle changes, compliance) are explored in detail.

Time

☑

Improved time allocation would allow for more thorough exploration of omitted areas like red flags and compliance.

Listening

☑

Show more active listening by addressing all cues given by the patient, such as their discomfort with endoscopies.

Language

☑

Ensure clarity in all parts of the consultation, avoiding any remaining traces of jargon and checking understanding more explicitly.