1. MOHAN KUMAR

2. SCENARIO 1 Dave is 55 and soon to retire. He has been self employed all his life and is selling his business to enable him to take early retirement, as both his children are now in full employment having finished their university degrees. He rarely sees his GP and has no PMH of note ‘I have been having palpitations Doc and its been bothering me’

3. SCENARIO 2 Marilyn is a 15 years old patient who last came to the surgery two years ago with sore throat which was treated with Penicillin. PMH:Nil Significant Examination Card: O/E Temp: 36.8, There is a small early cold sore on her lip.. Looks Nervous

4. SCENARIO 3 Jake Foster aged 38 He has had Type 2 diabetes for 10 years and is currently using metformin 850mg tds, gliclazide 80mg 2 bd, pioglitazone 45mg and sitaglitpin 100mg. On looking at the notes the Practice Nurse in diabetic clinic has commented BP is excellent (130/70), non smoker, alcohol = 12 units per week, BMI 25 (keen not to put on any more weight), to see GP in light of persistently elevated Hba1c (10.5%) re ? referral for conversion to insulin.

5. SCENARIO 4 Samina is 20 years old and works in the marketing department of a local company. She had little PMH of note other than acne in her teenage years and a recent attendance because of concerns over her irregular periods. She is unmarried and lives with her parents. BMI 29, prominent facial hair, mild acne and hair on her arms. No male pattern balding, voice normal, no hair on chest or back

6. SCENARIO 5 Man in late 30’s attends surgery because he has joined a gym and they have asked him to get a note to say he is okay He’s a smoker and has a raised cholesterol too. Just wants quick note doesn’t want to bother the Doctor and annoyed reception wants him to see one ‘ just for a note’

7. CSA ‘An assessment of a doctor’s ability to integrate and apply appropriate clinical, professional, communication and practical skills in general practice’.

8. WHY THEY FAIL? 6. Does not develop a management plan (including prescribing and referral) that is appropriate and in line with current best practice or make adequate arrangements for follow-up and safety netting. 8. Does not identify patient’s agenda, health beliefs & preferences / does not make use of verbal & non-verbal cues. 10.Does not develop a shared management plan or clarify the roles of doctor and patient 14. Does not recognise the challenge (e.g. the patient’s problem, ethical dilemma etc.)

10. SUBPLOTS WORRIED WELL UNWORRIED UNWELL ANGRY DEMANDING NON COMPLIANT/ UNDECIDED SEEKING SUPPORT FOR DUBIOUS THERAPY SEEKING SUPPORT FOR REFUSING THERAPY SEEKING EXPLANATION MISUNDERSTOOD DISEASE CYBERCHONDRIA FORGETFUL SCATTERED ANXIOUS ABOUT TREATMENT HIDDEN AGENDA LIST

11. DOCTOR’S AGENDA REASSURING APPROPRIATELY CLARIFYING SELLING BEAKING BAD NEWS CHALLENGING ADVISING COUNSELLING EMPATHISING UNEARTHING LINKING SUMMARISING DIAGNOSING EXPLAINING DEALING WITH UNCERTAINTY

12. CSA: The three domains 1.DATA-GATHERING, TECHNICAL & ASSESSMENT SKILLS : Organised and systematic in gathering information from history taking, examination and investigation Identifies abnormal findings or results and/or recognises their implications Data gathering does appears to be guided by the probabilities of disease Undertakes physical examination competently, or use instruments proficiently 2.CLINICAL MANAGEMENT SKILLS : Makes appropriate diagnosis Develops a management plan (including prescribing and referral) that is appropriate and in line with current best practice Follow-up arrangements and safety netting are adequate Demonstrates an awareness of management of risk and health promotion 3.INTERPERSONAL SKILLS: Identify patient’s agenda, health beliefs & preferences / does makes use of verbal & non-verbal cues. Develops a shared management plan or clarify the roles of doctor and patient Uses explanations that are relevant and understandable to the patient Shows sensitivity for the patient’s feelings in all aspects of the consultation including physical examination