Standardized Patient Materials

Open all SP Materials

 


 

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Open Training Materials

 

Michael/Michelle Thomas

SP Training Materials^

 

CASE SUMMARY

The patient is a 68-year-old man or woman who has had low back pain for the last four months.  The patient is otherwise healthy, and seeks to get an idea of where this low back pain might be coming from, as well as what could be done for it.

Your challenge as the Simulated Patient is threefold:

  1. Appropriately and accurately reveal facts and findings related to Mr. or Mrs. Thomas’s complaints
  2. Observe the resident’s behavior while you are performing as Mr. or Mrs. Thomas; and
  3. Accurately recall the resident’s behavior and accurately complete the performance checklist.


PRESENTATION/EMOTIONAL TONE:

You are 68 years old, college-educated, retired, and otherwise healthy. You are well groomed and dressed in your underclothing covered by a hospital gown, which is open to the back. You are cooperative, but not overly forthcoming with answers and questions. You make frequent eye contact and appear friendly.

Beginning of Encounter:

In response to the question, “What brings you in today,” you say, “My back has been bothering me for the last four months.”

The resident will likely follow-up with specific questions regarding your back pain, other symptoms and medications. These questions should be answered with simple responses to the direct questions. You should not offer information unless directly questioned by the resident.


HISTORY OF PRESENT ILLNESS/COMPLAINT:

Your pain first started approximately 4 months ago. You can’t recall anything specific that brought it on, but you had gone to visit your daughter and grandchildren several days before (ages 1 and 3 years, if asked).  It gradually started over a few days, on and off, but pain now occurs almost every day.  It lasts for several hours at a time. Currently you would rate it as a 5/10.  You used to do aerobics several times a week, but now are unable to do so because bending over worsens the pain. The pain is worse with coughing and sneezing, sitting for a long time in the car or at the computer, and bending over to do laundry. You get some relief after taking one or two tabs of Advil. Also, you have been experiencing some intermittent shooting pain down the back of the right leg as well. This, too, has been getting worse.


PAST MEDICAL HISTORY:

You have no other medical problems – “Lucky me.”
You have never had surgery
No allergies that you’re aware of
You take one multivitamin daily – Centrum Silver.


FAMILY HISTORY
:

Your father died at the age of 98 from “old age.” Your mother, age 90, is still alive – “Good genes, I guess.”


SOCIAL HISTORY:

You are happily married, and have lived with spouse of 30 years. You retired 2 years ago and are enjoying your retirement. Prior to that, you worked as an engineer for an auto company. You have one daughter who lives in northern Virginia, and you enjoy visiting with her and your grandkids on the weekends. You try to eat right and stay active by going to the gym three times a week.  Hobbies include traveling and photography.


SUBSTANCE USE:

You’ve never smoked, and rarely drink alcohol (you have champagne on New Year’s Eve and on your anniversary).


REVIEW OF SYSTEMS
:

If asked, you have never accidentally lost control of your urine or your stool. You have never experienced any numbness in the genital region, or any weakness in your legs that you’re aware of.


PHYSICAL EXAMINATION:

Residents will perform a physical examination. This may include listening to your heart and lungs with a stethoscope, but may only involve an examination of your back, as well as an examination of your legs and feet. The resident may examine your back or legs in ways that aren’t on the checklist – this is OK.

 

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Michael/Michelle Thomas

Abnormal Physical Exam Findings^

 

 

The biggest challenge of playing Michael/Michelle Thomas is mimicking abnormal physical exam findings.

During the physical exam, you will demonstrate:

    • Pain upon bending forward, but not backward.  However, you are slow and stiff when bending in all directions and turning from side to side.
    • Upon bending forward, you will report pain shooting down the back, as well as the outside, of your right leg.
    • You will report this same pain during the Straight Leg Raise.

  • When the examiner taps on your low back, jump as though uncomfortable.
  • When the examiner taps behind your feet to elicit your ankle reflexes, mentally attempt to hold your right foot absolutely still.

    • When the examiner is asking whether you can feel his/her touch on the back of your right leg, outside of your right leg, and the top of your right foot, you will say that it feels “kind of numb” – but you can feel it when he/she touches your other leg and foot just fine.  See the “L5” and “S1” patterns shown below – that’s where you are numb.

    • If the examiner asks you to point your right big toe upwards (towards your nose), you will be unable to do this.  Likewise, if the examiner asks you to point your foot towards to the floor (like a ballet dancer would point), or to “step on the gas” against resistance – you can do this, but only weakly.
    • When asked to walk on your toes or heels, you can do it with your left side, but your right foot will tend to stay flat on the floor.

 

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Open Resident Instructions
(Michael Thomas)

 

CLINICAL PERFORMANCE EXAMINATION

Resident Instructions^

Michael Thomas^

 

Station Length:         15 minutes maximum

Patient Name:            Michael Thomas

Station Instructions:

Michael Thomas is a 58 year old patient, new to our clinic.

Chief Complaint:      Low Back Pain

Weight: 90kg

BP: 120/80

RR: 20

HR: 80

Temp: 37

Pain scale 5/10.

 

Once you have obtained a focuses history and exam, you are to leave the room and complete the checklist on the computer.

 

 

 PLEASE DO NOT WRITE ON THIS PAGE

 

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Open Resident Instructions
(Michelle Thomas)

 

CLINICAL PERFORMANCE EXAMINATION

Resident Instructions

Michelle Thomas^

 

Station Length:         15 minutes maximum

Patient Name:            Michelle Thomas

Station Instructions:

Michelle Thomas is a 58 year old patient, new to our clinic.

Chief Complaint:      Low Back Pain

Weight: 65kg

BP: 120/80

RR: 20

HR: 80

Temp: 37

Pain scale 5/10.

 

Once you have obtained a focuses history and exam, you are to leave the room and complete the checklist on the computer.

 

 

 PLEASE DO NOT WRITE ON THIS PAGE

 

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Open Patient Chart
(Michael Thomas)

 

Patient Chart^

Michael Thomas^

 

Temp   37               BP       120/80                     HR      80                  

Patient Name    Michael Thomas                    Patient Age            58     

History Number  022557                            Chart Number             086254                   

RR       20                    HT                               WT      90 Kg           

Complaint:      Low Back Pain                                                                

Nurse’s signature        Diane Walters                          

Copied                                    Dictated

 

Reviewed w/attending

 

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Open Patient Chart
(Michelle Thomas)

 

Patient Chart

Michelle Thomas^

 

Temp   37               BP       120/80                     HR      80                  

Patient Name    Michelle Thomas                   Patient Age                  58     

History Number  022557                            Chart Number             086254                   

RR       20                    HT                               WT      65 Kg           

Complaint:      Low Back Pain                                                                

Nurse’s signature        Diane Walters                          

Copied                                    Dictated

 

Reviewed w/attending

 

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Open SP Checklist

 

Michael (Michelle) Thomas 58 y.o.

Standardized Patient Checklist^

 

Your Name ______________________ Resident Name _____________________


GLOBAL RATING

  1. Michael/Michelle Thomas was satisfied with this resident physician encounter.

YES        NO

COMMENTS:



HISTORY

Please record whether the resident elicited the following information.

If the resident DID elicit the statement, select “YES.”

If the resident DID NOT elicit the statement, select “NO.”

If you are unsure, select “UNSURE.”


Use the following guide to answer:

  1. The resident asked about my general well-being: “How are you doing?”

YES                NO                  UNSURE

  1.  The resident asked me to tell them about my back pain.

YES                NO                  UNSURE

  1. The resident asked me to describe the site or location of the pain. “Where on your back does it hurt?” (“In my lower back, right in the center where my spine is.”)

 YES                NO                  UNSURE

  1. The resident asked me to describe the “quality” of the pain. “What does it feel like?” (“Deep and achy.)”

YES                NO                  UNSURE

  1. The resident asked me to describe the “severity” of the pain on a scale of 1-10. (“About a 5.”)

YES                NO                  UNSURE

  1. The resident asked me to describe the “radiation” of the pain. “Does it go anywhere?” (“Actually, yes – it seems to shoot down my right let sometimes, right down the back.”)

YES                NO                  UNSURE

  1. The resident asked me how long I have had the pain. (“Around 4 months.”)

YES                NO                  UNSURE

  1. The resident asked me how long the pain lasts. (“Well, it started out bothering me for maybe a half an hour at a time, but now it lasts a couple of hours.”)

YES                NO                  UNSURE

  1. The resident asked me if anything makes the pain better or worse. (“Bending over definitely does – that’s why I had to drop aerobics. The car trips to Northern Virginia kill me. And sitting at the computer surfing the internet – that gets it going too. Sometimes even little things like coughing or sneezing make it worse.”)

YES                NO                  UNSURE

  1. The resident asked me if I had urinated or defecated on myself by accident, had numbness in my genitals, or had noticed leg weakness. (“No, not that I’m aware of.”)

YES              NO                UNSURE


PHYSICAL EXAMINATION

  1. The resident asked me to stand up for part of the exam.

DONE             NOT DONE

  1. The resident looked at my back while I was standing.

DONE             NOT DONE

  1. The resident asked me to bend forwards.

DONE             NOT DONE

  1. The resident asked me to bend backwards.

DONE             NOT DONE

  1. The resident asked me to bend from side to side.

DONE             NOT DONE

  1. The resident asked me to keep my hips and feet still while turning my upper body left and right.

DONE             NOT DONE

  1. The resident touched the bony parts of my lower back.

DONE             NOT DONE

  1. The resident touched the muscles around my lower back and buttocks.

DONE             NOT DONE

  1. The resident touched the skin on my legs and the tops of my feet and asked me if there were any areas of numbness.

DONE             NOT DONE

  1. The resident asked me to sit for part of the exam.

DONE             NOT DONE

  1. The resident pushed down on my knee or thigh while I was sitting, and asked me to push upwards against him/her.

DONE             NOT DONE

  1. While I was sitting, the resident asked me to kick my lower leg out while he/she pushed against it.

DONE             NOT DONE

  1. The resident asked me to point my toes upwards (towards the sky, or my nose).

DONE             NOT DONE

  1. The resident asked me to point my toes downwards (like a ballet dancer on tiptoe).

DONE             NOT DONE

  1. The resident tapped on my knees with a reflex hammer or side of their stethoscope.

DONE             NOT DONE

  1. The resident tapped on the back of my heel with a reflex hammer or the side of their stethoscope.

DONE             NOT DONE

  1. The resident asked me to lie down for part of the exam.

DONE             NOT DONE

  1. The resident asked me to straighten my leg and lift it upwards (either while I was seated or lying down), and asked if I had pain.

DONE             NOT DONE

  1. While lying on my back, the resident asked me to bend one knee and cross my ankle over my other knee, and asked if I had pain.

DONE             NOT DONE

  1. The resident asked me to walk normally.

DONE             NOT DONE

  1. The resident asked me to walk on my heels.

DONE             NOT DONE

  1. The resident asked me to walk on my toes.

DONE             NOT DONE


PATIENT-PHYSICIAN INTERACTION

How was the resident you saw at:

  1. Allowing you to answer questions without interrupting?

POOR             FAIR               GOOD

  1. Behaving warmly, but professionally throughout the entire encounter?

POOR             FAIR               GOOD

  1. Examining you in a way that felt professional and comfortable?

POOR             FAIR               GOOD