Standardized Patient Materials

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Open SP Training
Materials

David/Dana Singer

SP Training Materials^

 

CASE SUMMARY:

The patient is a 47-year-old who has had low back pain for the last year. The patient has a history of tobacco abuse. S/he seeks to get an idea of where this low back pain might be coming from as well as what treatment options are available.

Your challenge as the Simulated Patient is threefold:

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


PRESENTATION/EMOTIONAL TONE:

You are _47_ (39-49) years old, high school educated 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. Your affect expresses some underlying frustration.  You want some relief for your back pain.


Beginning of Encounter:

In response to the question, “What brings you in today,” you say, “This back pain is killing me.”

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.  The resident will also perform an exam. During the exam, you should act like you are in some pain – you can even exaggerate this a bit.

The resident will also make some management recommendations. They will likely recommend physical therapy and x-rays. They will want to prescribe you regular doses of an anti-inflammatory medicine, like Naprosyn or ibuprofen, and possibly a muscle relaxant, like Flexeril. If they do, you should “push back” a little – “I already took an over the counter ibuprofen once, and it didn’t work – I really think that Percocet will help me.” The resident should explain why they will not prescribe your Percocet (or another narcotic pain reliever), and you will agree to try it.


HISTORY OF PRESENT ILLNESS/COMPLAINT:

Low back pain has been going on for a year.  It is constant, deep, aching and gnawing; pain in the middle of the back is intermittent and sharp. On a good day pain is a 6-7/10, on a bad day 10/10. On bad days you are unable to get out of bed or to do household chores such as cooking, cleaning or yard work. You have missed a few days of work recently because of the pain as well as losing sleep because of the pain. Also, you have had occasional numbness in the lateral aspect of the left thigh. Both legs are painful up to the waist. Legs are weak, and you have had several falls recently. You have used a few of the significant other’s Percocet, which helped a lot.


PAST MEDICAL HISTORY:

Depression
Anxiety

Surgical History:

Tonsillectomy age 11

Allergies:        Ibuprofen causes a rash

Medications:

Tylenol – You sometimes take up to 6 at a time, which barely touches the pain.


FAMILY HISTORY:

Mother – diabetes
Father – hypertension, alcoholism


SOCIAL HISTORY:

Occupation – Certified Nursing Assistant at a nursing home
Lives with girlfriend/boyfriend
Smokes 1-2 packs of cigarettes per day since the age of 16
Admits to occasional marijuana use, last use about 3 months ago
Drinks 3 or 4 beers every night.


REVIEW OF SYSTEMS:

If asked about depression, you say not really, except that the pain is starting to make you feel depressed.


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 are not on the checklist – this is OK.


RECOMMENDATIONS:

The resident will make management recommendations. These may include x-rays, physical therapy, and medications. The medications will likely be an anti-inflammatory medicine (like naprosyn or ibuprofen), and a muscle relaxant (like flexeril).

 

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David/Dana Singer

Abnormal Physical Exam Findings^

 

The biggest challenge of playing David/Dana Singer is mimicking abnormal physical exam findings.


During the physical exam, you will demonstrate:

    • Pain upon bending backward and forward

 

 

 

 

 

 

 

 

 

    • Tenderness all over your back

 

 

 

 

 

 

 

  • Pain in your back, but not down your legs, with Straight Leg Raise

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Open Resident
Instructions (David Singer)

CLINICAL PERFORMANCE EXAMINATION (CPX)

Resident Instructions^

David Singer^

 

Station Length:          15 minutes maximum

Patient Name:            David Singer

Station Instructions:

David Singer is a 47 year old patient, new to our clinic.

Chief Complaint:  Low Back Pain

Weight: 90kg

BP: 140/90

RR: 20

HR: 60

Temp: 37

 

 

Once you have obtained a focused history and exam, you are to make treatment recommendations to the patient, then leave the room and complete a checklist on the computer.

 

 

PLEASE DO NOT WRITE ON THIS PAGE

 

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Open Resident
Instructions (Dana Singer)

CLINICAL PERFORMANCE EXAMINATION (CPX)

Resident Instructions

Dana Singer^

 

Station Length:          15 minutes maximum

Patient Name:            Dana Singer

Station Instructions:

David Singer is a 47 year old patient, new to our clinic.

Chief Complaint:  Low Back Pain

Weight: 65kg

BP: 140/90

RR: 20

HR: 60

Temp: 37

 

 

Once you have obtained a focused history and exam, you are to make treatment recommendations to the patient, then leave the room and complete a checklist on the computer.

 

 

PLEASE DO NOT WRITE ON THIS PAGE

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Open Patient Chart
(David Singer)

Patient Chart^

David Singer^

 

 

Temp   37               BP       140/90                     HR      60                  

Patient Name    D. Singer                              Patient Age                          

History Number  022557                            Chart Number             086254       

RR       20                    HT                               WT      90 Kg           

Complaint:      Low Back Pain                                                                

Nurse’s signature        Diane Walters                          

Copied                                    Dictated

 

Pain “12/10”. Needs something “strong” for pain.

 

Reviewed w/attending

 

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Open Patient Chart
(Dana Singer)

Patient Chart

Dana Singer^

 

Temp   37               BP       140/90                     HR      60                  

Patient Name    D. Singer                              Patient Age                          

History Number  022557                      Chart Number             086254       

RR       20                    HT                                    WT      65 Kg           

Complaint:      Low Back Pain                                                                

Nurse’s signature        Diane Walters                          

Copied                                    Dictated

 

Pain “12/10”. Needs something “strong” for pain.

 

Reviewed w/attending

 

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Open SP
Checklist

David/Dana Singer 47 y.o.

Standardized Patient Checklist^

 

Your Name ______________________ Resident Name _____________________

 

GLOBAL RATING

  1. David/Dana Singer 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 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 across the middle and on both sides.”)

YES                 NO                   UNSURE

  1. The resident asked me to describe the “quality” of the pain.  “What does it feel like?” (“Dull, achy, and gnawing most of the time – but when it gets bad it feels sharp, too.”)

YES                 NO                   UNSURE

  1. The resident asked me to describe the “severity” of the pain on a scale of 1-10.  (“Right now it’s about an 8, butlast week it was definitely a 10.”)

YES                 NO                   UNSURE

  1. The resident asked me to describe the “radiation” of the pain.  Does it go anywhere? (“It sometimes shoots down both of my legs, front and back.”)

YES                 NO                   UNSURE

  1. The resident asked me to how long I have had the pain. (“About a year.”)

YES                 NO                   UNSURE

  1. The resident asked me to how long the pain lasts. (“My back hurts all the time.”)

YES                 NO                   UNSURE

  1. The resident asked me if anything makes the pain better or worse. (“Nothing makes it better, except the Percocet, which worked pretty well.  Last week, when I missed work, it hurt no matter what I did – sit, stand, anything.”)

YES                 NO                   UNSURE

  1. The resident asked me if I had urinated (peed) or defecated (stooled) on myself by accident, had numbness in my genitals, or had noticed leg weakness.  (“My legs definitely feel weak sometimes – I’ve even fallen acouple times because both of them will just give out on me all of a sudden.”)

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


PHYSICIAN RECOMMENDATIONS

  1. The resident made recommendations for managing my back pain.

DONE                         NOT DONE

  1. The resident changed their recommendations when I told them only Percocet would help.

DONE                         NOT DONE

  1. The resident explained why they wouldn’t give me Percocet.

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