Standardized Patient Checklist

Open SP Checklist

Iraqi Patient Mrs. Hassan 45 y.o.

Conducting a Mental Health Examination/Post-Traumatic
Stress Disorder with Depression and Providing Appropriate Treatment

 


 

Your Name ______________________ Resident Name _____________________

 

  1. The resident appropriately greeted me and asked me how I have been feeling since my last visit.

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE

DONE CORRECTLY: The resident appropriately greeted and asked the patient how she has been feeling/doing since her last visit.

DONE INCORRECTLY: The resident appropriately greeted OR asked how she has been feeling since her last visit.

NOT DONE: The resident did not ask either.

  1. The resident probed for specific symptoms that are associated with depression, including appetite, sleep habits, energy level and crying spells.

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE

DONE CORRECTLY: The resident asked about at least 3 specific symptoms.

DONE INCORRECTLY: The resident asked about only 1-2 specific symptoms.

NOT DONE: The resident did not ask about any of these symptoms.

  1. The resident asked me if I am experiencing any of the following symptoms that are associated with post-traumatic stress disorder: nightmares, irritability, avoidance behavior (such as avoiding TV or radio news), or intrusive thoughts.

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE

DONE CORRECTLY: The resident asked about at least 2 of these symptoms.

DONE INCORRECTLY: The resident asked about only 1of these symptoms.

NOT DONE: The resident did not ask about any of these symptoms.

  1. The resident followed up on these symptoms by asking me if they relate to real events that occurred in my life in Iraq. For example, if nightmares are mentioned, the resident would ask if the nightmares are about real events that happened to me.

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE

DONE CORRECTLY: The resident followed up on all the symptoms described by the patient under #3.

DONE INCORRECTLY: The resident followed up on only 1-2 of the symptoms.

NOT DONE: The resident did not follow up on any of the symptoms.

  1. The resident probed more to learn about events in my life before coming to the U.S. (i.e., “Tell me more about what happened in Iraq that led to your leaving/becoming a refugee.” “How did you become a widow?” “Do you have any family back in Iraq?”)

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE

DONE CORRECTLY: The resident probed about other events in the patient’s life before coming to the U.S.

DONE INCORRECTLY: The resident probed a little, one or two questions.

NOT DONE: The resident did not probe at all.

  1. The resident responded with sympathy and understanding of the difficulties I have experienced.

DONE CORRECTLY        NOT DONE

DONE CORRECTLY: The resident expressed compassion for the patient’s loss and understanding of how difficult that must be.

NOT DONE: The resident did not express compassion or understanding.

  1. The resident explained the relationship between my psychosocial trauma and my current symptoms, both physical and mental (e.g., “You went through very difficult events in the past and now your body and mind are reacting to those events, giving you many of the symptoms you are having now – nightmares, avoiding TV or calling your daughter, poor sleep, poor concentration.”)

DONE CORRECTLY        NOT DONE

DONE CORRECTLY: The resident explained the relationship between the patient’s psychosocial trauma and her current symptoms.

NOT DONE: The resident did not explain the relationship between the patient’s psychosocial trauma and her current symptoms.

  1. The resident prescribed medication to treat my emotional symptoms.

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE

DONE CORRECTLY: The resident prescribed medication, explaining it will help the patient reduce her symptoms such as nightmares.

DONE INCORRECTLY: The resident prescribed medication, but did not explain the reason for giving it.

NOT DONE: The resident did not prescribe any medication.

  1. The resident explained the appropriate way to take the medication.

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE

DONE CORRECTLY: The resident explained that it needs to be taken for at least one month to see effects.

DONE INCORRECTLY: The resident said the patient needs to keep taking it without explanation as to how long it takes to see beneficial effects.

NOT DONE: The resident did not advise how long to take it or the reason why.

  1. The resident recommended that I continue taking the medication on a daily basis until I return to see him/her and explained refills.

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE

DONE CORRECTLY: The resident recommended that the patient continue taking the medication until the next visit AND explained refills.

DONE INCORRECTLY: The resident recommended taking the medication until next visit but did not explain refills.

NOT DONE: The resident did not provide medication instructions.

  1. The resident asked me to repeat the medication instructions to ensure that I understand them.

DONE CORRECTLY        NOT DONE

DONE CORRECTLY: The resident asked the patient to repeat the medication instructions.

NOT DONE: The resident did not ask the patient to repeat the medication instructions.

  1. The resident asked me if I agree with the plan or have other things to suggest.

DONE CORRECTLY        NOT DONE

DONE CORRECTLY: The resident asked the patient if she agrees with the plan or has other things to suggest.

NOT DONE: The resident did not ask the patient if she agrees with the plan or has other things to suggest.

  1. The resident recommended counseling.

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE

DONE CORRECTLY: The resident recommended counseling and explained how this will be arranged.

DONE INCORRECTLY: The resident recommended counseling but did not provide any explanation about how it will be arranged.

NOT DONE: The resident did not recommend counseling.

  1. The resident used easy to understand words for my “diagnosis” instead of technical medical terms.

DONE CORRECTLY        DONE INCORRECTLY        NOT DONE

DONE CORRECTLY: The resident used easy to understand words such as “sadness” rather than medical terms such as “depression” or “Post-Traumatic Stress Disorder.” If the resident used these terms, s/he explained them.

DONE INCORRECTLY: The resident sometimes used medical terms and/or didn’t explain them.

NOT DONE: The resident only used medical terms.

  1. As a patient, I would want to continue seeing this physician for my future care (circle one):
    1. Strongly Agree
    2. Agree
    3. Neutral
    4. Disagree
    5. Strongly disagree
  1. Comments (if needed):