What is expected from the candidate in contraception case?
- Candidate establishes rapport and introduces himself to the client.
- Candidate uses effective communication skills.
- Candidate assesses the current situation of the client (regarding postnatal, breastfeeding, last intercourse).
- Candidate assesses current and previous medical history (chronic disease, conditions, cancers, STDs).
- Candidate enquires about previous contraceptive and menstrual history.
- Candidate assesses past gynecological history.
- Candidate offers all suitable contraceptives for the client showing pros and cons.
- Candidate helps the client to choose and encourages the patient to take her own decision.
- Candidate responds to client concerns and illustrates usage of the chosen contraception.
- Candidate asks the client to return for follow-up.
What is expected from the candidate in ANC case?
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Candidate establishes rapport with the patient.
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Candidate assesses personal and social histories:
- age (both couple)
- address
- occupation (both couple)
- duration of marriage
- consanguinity
- special habits
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Candidate assesses menstrual history:
- asks about first day of last menstrual period (LMP) and calculate the expected date of delivery (EDD) and inform the pregnant.
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Candidate assesses current obstetric history:
- symptoms of pregnancy (low back pain, heartburn)
- enquires about dangerous signs (hypertension, severe persistent headache, vomiting, loss of feeling fetal movement, escape of liquid amniotic, vaginal bleeding, and swelling of face and extremities)
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Candidate assesses current medications, supplementations, and investigations:
- (lab tests & ultrasound (US))
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Candidate assesses past obstetric history:
- Pregnancy (history of gestational diabetes, labor (date and mode of delivery), and puerperium of previous pregnancy, history of previous abortion, birth weight (approximately), mode of infant feeding and family planning methods used, if any.)
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Candidate assesses the emotional and psychological situation of the patient:
- (elicits concerns and expectations of the client)
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Candidate assesses the past medical, surgical, and other histories:
- e.g. diseases e.g. diabetes mellitus (DM), hypertension (HTN), chest diseases, tuberculosis (TB), heart diseases, epilepsy, urinary tract infections (UTIs) or renal diseases, viral infection (Rubella), and sexually transmitted diseases (STD).
- obstetric and gynecological operations, and other surgical operations e.g. hernia, tonsillectomy etc.
- use of drugs, sensitivities and allergies, previous blood transfusion, X-ray exposure, and Rh incompatibility.
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Candidate assesses family history:
- DM, HTN, multiple pregnancy, and congenital anomalies.
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Candidate asks about tetanus vaccination history:
- (doses)
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Candidate performs what is required in the station.
What is expected from the candidate in DM case?
- Establishes rapport properly and uses communication skills appropriately.
- Enquires about eating pattern, physical activity, smoking, and psychological stress (assesses risk factors).
- Enquires about medication compliance, intolerance, or side effects.
- Enquires about glucose monitoring.
- Assesses hypoglycemic episodes: timing, awareness, frequency, and causes.
- Enquires about target organ damage: severe headache, blurring of vision, chest pain, palpitations, history of stroke, anuria, cold extremities, intermittent claudication, pain-free walking distance, pain at rest, peripheral revascularization.
- Assesses past history of hypertension, CVD, stroke, renal disease, hospitalization, surgery, and history of drug allergy.
- Elicits the ICE of the patient and effect on daily life.
- Orders laboratory investigations: HbA1c, lipid profile, liver enzymes, albumin/creatinine ratio, GFR, and fundus examination if not ordered previously.
- Responds appropriately to candidate directions.
- Closure of the session, time management, and follow-up
Summary
- Check understanding.
- Health education:
- Do you have any idea about what you want? Explain the disease then give advice.
- Try to lose some weight, stop smoking.
- Follow DAAD site.
- If he has very high BMI > 35, give him metformin & GLP.
- Kidney disease SGLT.
- Any questions?
What is expected from the candidate in dyslipidemia case?
- Candidate establishes rapport and doctor-patient relationship and uses communication skills fluently with the patient.
- Candidate asks about atherosclerotic cardiovascular disease (ASCVD), e.g.,
- acute coronary syndrome (ACS)
- stable or unstable angina
- coronary or other arterial revascularization
- stroke
- transient ischemic attack (TIA)
- peripheral arterial disease (PAD).
- Candidate asks about the major risk factors for atherosclerotic cardiovascular diseases (ASCVD) as smoking, hypertension, DM, sedentary life, and family history of early CHD in first-degree relatives if male less than 55 years & if female less than 65 years.
- Candidate asks about any secondary causes for dyslipidemia as hypothyroidism, DM, chronic kidney or liver diseases.
- Candidate assesses drug history e.g., chronic drug use and drug allergy.
- Candidate explains and discusses the results of investigations with the patient.
- Candidate assesses psychosocial history ICE and effect of his condition and screening for depression.
- Candidate provides to the patient the suitable health education for his condition (lifestyle modification) including healthy diet, weight management, physical activity.
- Candidate prescribes the suitable drugs for the patient; Atorvastatin 40 -80 mg or Rosuvastatin 20-40 mg once / day after dinner.
- Candidate informs the patient about the date of follow-up (after 1 month).
Education
What is expected from candidate in education of patient about inhaler use?
- Establishes rapport properly and uses communication skills appropriately.
- Checks her/his understanding of the inhaler and explains to him that an inhaler device delivers aerosolized bronchodilator medication for inhalation.
- Demonstrates standing up straight.
- Demonstrates shaking the inhaler.
- Demonstrates removing the cap from the mouthpiece.
- Demonstrates holding the inhaler between index finger and thumb.
- Demonstrates placing inhaler upright about 3-5 cm in front of mouth.
- Demonstrates breathing out completely.
- Demonstrates putting the mouthpiece in your mouth, breathe in deeply /activate inhaler simultaneously.
- Demonstrates closing her/his mouth and holding her/his breath for 10 seconds and then breathe out.
- Demonstrates repeating the procedure after 1 minute if relief is insufficient.
- Demonstrates checking the patient understands by asking her/him to carry out the procedure in front of the candidate.
- Asks if she has any questions.
- Informs her of the date of the next visit.
- Follow up after 2 weeks.