Standardized Patient Checklist

Open SP
Checklist

John Harrison 80 y.o.
 


 
Your Name ______________________ Resident Name _____________________

 

GLOBAL RATING

  1. John Harrison was satisfied with this resident physician encounter. YES NO

COMMENTS:

Your response to this item should be as “John Harrison” would respond – NOT as you, the standardized patient, would respond, knowing what the resident is being tested on in the checklist.

YES

  • You feel you would come back to this resident for the rest of your care.
  • You feel this resident was helpful OR will be able to help you (in your total care).

NO

  • You feel anything in the encounter with the resident would negatively impact Mr. Harrison significantly enough to cause him to consider seeing someone else for his care.

Your response on this item might not add up to the responses you will make on all of the other items on the checklist. That is fine. This item is included so that you can make a global assessment based on your own feelings about the encounter.

In addition, please keep in mind that these are residents who are still in training, NOT seasoned physicians. You should not be comparing their performance to your previous experiences with practicing physicians.

 

HISTORY

***General principle in dealing with MULTIPLE QUESTIONS buried in a single resident question:

Example: Do you drink alcohol or do you do any drugs?

  • Answer only the LAST question asked.
  • Give credit on the checklist for ONLY the questions you answer.

Please record how the resident elicited the following information:

  1. The resident asked about general well-being and recent health. (“Fine – I think I am doing pretty well, except for this feeling off balance.)

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY: The resident asked something like: “How have you been feeling lately?”

DONE INCORRECTLY: The resident used a closed ended question such as “So, you are doing fine, are you?” or s/he asked how you are but didn’t give you time to answer.

  1. The resident asked about whether I am taking my medications regularly. (“I expect so – My wife sees to it.”)

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY: The resident asked about whether you are taking your medications.

DONE INCORRECTLY: The resident asked whether you take your medications, but did not specify if you are doing it regularly or how often you miss your medications.

  1. The resident asked about whether I am taking other medicines, over the counter medicines, or any natural supplements. (“No, I only take what the doctor prescribes.”)

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY: The resident asked whether you are taking any other medicines AND asked whether you are using over-the-counter medicines AND asked whether you take any vitamins or supplements.

DONE INCORRECTLY: The resident asked if you are taking any other medicines OR over-the-counter medicines OR vitamins or supplements, but not all three categories.

  1. The resident asked, “How has your blood sugar been?” OR “If you have been checking your sugars, what have they been running?” (“I guess I would have to ask my wife – She takes notes about everything. I know she said they were a little high since I have put on this extra weight.”)

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY: The resident asked if you check your blood sugar at home AND if you answered (“Yes.”), the resident pursued and asked you what your results tend to be.

DONE INCORRECTLY: The resident asked about blood sugar or blood pressure but did not ask what the values are.

  1. The resident asked about loss of consciousness OR about passing out. (“No.” to any or all of these)

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY: The resident asked if you have ever recently lost consciousness AND if you answered (“No.”), the resident pursued and asked if you have felt as if you were going to lose consciousness.

DONE INCORRECTLY: The resident asked if you have lost consciousness but did not pursue any further.

  1. The resident asked about orthostatic dizziness (feeling like you are going to faint upon standing). (“Yes, just since the blood pressure medicine dose was increased.)

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY: The resident asked about symptoms of orthostatic dizziness. “Do you ever feel like you are going to faint upon standing?”

DONE INCORRECTLY: The resident asked about symptoms of orthostatic dizziness but did not help you understand what these symptoms might be.

  1. The resident asked about headache. (“No.”)

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY: The resident asked if you have been having headaches since you have been having your other symptoms.

DONE INCORRECTLY: The resident asked if you have ever had headaches but did not focus on the symptoms you came in with.

  1. The resident asked about any head trauma recently or with the falls (“No.”)

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY: The resident asked you if you have bumped OR hit your head recently OR with any of your falls.

DONE INCORRECTLY: The resident asked you if have ever had head trauma without explaining what constitutes trauma.

  1. The resident asked about chest pain OR shortness of breath. (“No chest pain. I do get worn out by walking any distance, but this is not really different from before. Seems to be a little better since you gave me that water pill.”)

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY: The resident asked you if you are having any chest pain OR chest tightness OR shortness of breath at rest OR with exertion OR if you ever have to stop what you are doing because of chest pain or shortness of breath.

DONE INCORRECTLY: The resident asked if you have chest pain or shortness of breath but didn’t help you describe it.

  1. The resident asked about visual changes. (“I think my vision is okay. I just saw the eye doctor last week. 20/30 in both eyes with my glasses.”)

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY: The resident asked you about visual changes and, when you answered that you recently saw the eye doctor, the resident asked if you have had any changes since then AND if your vision problem interferes with your reading or other daily activities.

DONE INCORRECTLY: The resident asked only if you have any vision problems and did not follow up on details.

  1. The resident asked about any numbness or weakness. (“I suppose my feet are a bit numb – and they burn. I am not as strong as I once was, so maybe I am a little weaker than usual.”)

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY: The resident asked you if you are having any numbness or weakness AND then follows up your answer with questions to determine if the numbness is peripheral or dermatomal AND to determine if it is worsening. The resident may have also asked questions to determine whether you have any focal or generalized neuropathy.

DONE INCORRECTLY: The resident asked you about numbness or weakness but didn’t help you by explaining what these words mean.

  1. The resident asked about whether or not you have urinary incontinence or trouble controlling your urine. (“No.”)

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY: The resident asked you if you have any difficulty with urinary incontinence OR leaking urine OR have to wear a pad in case you lose your urine unintentionally.

DONE INCORRECTLY: The resident asked you if you have urinary incontinence but did not help you understand the term.

  1. The resident asked about my beliefs, ideas, feelings or expectations about my balance problem. (“It is important for me to remain independent. I think it is important to take medication as prescribed to prevent disease complications, but I am not sure it is worth it because it keeps me from walking.”)

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY: The resident asked you questions that explored your ideas and feelings about what is wrong and the effect of your balance on your function or daily life.

DONE INCORRECTLY: The resident did not seek to understand your beliefs, etc. about your balance trouble.


PHYSICAL EXAMINATION

  1. The resident listened to my heart.

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY: The resident listened to your heart in 4 places with both sides of stethoscope AND listened under (not through) clothing.

DONE INCORRECTLY: The resident listened to fewer than 4 places OR listened through clothing OR did not listen with both sides of stethoscope (bell and diaphragm).

  1. The resident listened to my lungs.

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY: The resident listened to your back in 6 places with stethoscope AND listened under (not through) your clothing.

DONE INCORRECTLY: The resident listened to your back with stethoscope BUT listened in fewer than 4 places OR listened through clothing.

  1. The resident checked vibration sense of my feet.

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY: The resident instructed you to tell him/her if your felt vibration with the application of the tuning fork AND the resident used a 126 Hz tuning fork AND the resident assessed vibratory sense of PIP joint of great toe (bending joint of big toe) AND the resident checked both feet.

DONE INCORRECTLY: The resident did not give instruction prior to test OR the resident used 512 Hz tuning fork OR the resident tested the 1st MTP joint (bunion bump) OR the resident only checked 1 foot.

  1. The resident assessed proprioception in my feet.

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY: The resident instructed you that s/he was going to move your toe and that you were to say whether the toe was being moved up or down AND the resident held your other toes out of the way while testing AND the resident gripped the toe being tested on medial and lateral aspect.

DONE INCORRECTLY: The resident did not give instruction prior to test OR the resident did not hold other toes out of the way OR the resident gripped the toe being tested on dorsal and plantar aspect.

  1. The resident assessed my gait and balance

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY: The resident asked you to rise from a chair without using your arms AND to stand still for a minute AND to walk, turn around, and walk back to the chair. AND s/he asked you to stand in front of the chair AND asked you to stand with your feet together, arms out front with palms up AND then asked you to close your eyes AND then to relax AND the resident gave you three gentle nudges on the chest AND the resident asked you to sit down. During these maneuvers, the resident watched you walk AND stood close by in case you started to fall.

DONE INCORRECTLY: The resident asked you to get out of the chair but did not mention your arms OR the resident asked you to walk but was not standing close enough to steady you if you needed it OR had you stand but not walk OR the resident asked you to stand with your feet together and eyes closed without seeing if you could do it with your eyes open OR didn’t explain what s/he was going to do OR didn’t make sure the chair was behind you when s/he gave the gentle sternal nudge OR didn’t ask you to sit down.


PATIENT-PHYSICIAN INTERACTION

  1. The resident introduced him/herself to me.

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY: The resident told you their LAST name AND that they are a resident physician.

DONE INCORRECTLY: The resident ONLY told you that s/he is a resident OR that s/he was asked to come and see you.

  1. The resident accommodated my hearing difficulty.

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY: The resident recognized your hearing difficulty and adapted by speaking more slowly, in a lower pitch, slightly louder and by directly facing you when speaking AND by confirming that you were able to hear or comprehend with these changes OR s/he offered you his/her stethoscope and spoke into the bell AND confirmed that you were able to hear.

DONE INCORRECTLY: The resident spoke louder or made accommodation for your hearing difficulty but did not confirm that you could hear with his/her adjustments.

NOT DONE: The resident did not recognize hearing difficulty OR recognized but did not make accommodation for hearing difficulty.

  1. The resident behaved warmly, but professionally throughout the entire encounter.

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY: The resident respectfully demonstrated genuine care and concern.

DONE INCORRECTLY: The resident demonstrated genuine care and concern, but was overly familiar or personal with you.

NOT DONE: The resident was cold and distant OR condescending OR overly informal and chummy.

  1. The resident used words I could understand.

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY: You (as the patient) understood all the terms.

DONE INCORRECTLY: More than two terms were unfamiliar to you.

NOT DONE: Pretty much everything the resident said to you was in “medical-speak.”

  1. The resident encouraged me to ask questions and never avoided giving me an answer.

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE        UNSURE

DONE CORRECTLY: The resident specifically asked if you had questions AND answered them directly or promised to get the answer for you.

DONE INCORRECTLY: The resident did not specifically ask you if you had questions, but gave you the impression that you could ask questions and that you would get a direct answer.

NOT DONE: The resident never asked if you had any questions and gave you the impression of not being open to questions OR avoided giving answers to anything you asked.