- Five 15 minute interviews, each with:
- 2 medical problems (diagnosis, investigation, management)
- 1 social problem
- 1 context integration statement
- Must address 50% of bullet points under each numbered point in the marking scheme
- Initial statement: Problem #1
- 10 minute remaining: If the candidate has not brought up the second issue, the following prompt must be said: "Doctor, Problem #2 has also been bothering me"
- 7 minutes remaining: If the candidate has not brought up the first issue (unlikely), the following prompt must be said: “What can you do about Problem #1”
- 3 minutes remaining “You have THREE minutes left” (both verbal and visual prompt)
- 0 minute remaining: “Your time is up”
IDENTIFICATION (Problem #1 and #2)
- Current Symptoms:
- Onset (__ years ago)
- Palliative/Provocative features
- Quality
- Radiation
- Severity (1-10)
- Temporal associations (e.g. worsening)
- "What have you tried? What has been investigated"
- Focused ROS
- History
- PMH/PSH
- Meds/OTC/Herbals
- Allergies
- Specialists/Previous Doctors
- Lifestyle
- Habits: Smoker, Alcohol, Drugs, Caffeine
- Risk Factors
- Diabetes
- Cholesterol
- Diet/Exercise
- Family history (eg. serious disease, cancer, diabetes, cardiac)
- Past Treatment
- DDX
- Red flags (fever, weight loss, etc...) and complications
- Problem #2 prompt at 5 minutes if not brought up yet
Illness Experience (FIFE)
- Feelings "What concerns you most? Do you have specific worries?"
- Ideas "What do you think is going on? What are you worried this might be?"
- Function "Has this affected you? Your daily activities? How have you been coping?"
- Expectation "What can I do to help you with this problem? Do you have any ideas of what would be most helpful to do now? "
SOCIAL AND DEVELOPMENTAL CONTEXT:
- Family (Children), Friends, Marital status, Support
- "Who do you live with?"
- How is your relationship? Recent losses/deaths?
- Have you discussed your (problem #1 and #2) with your partner, family, parents, children, etc...
- Interest/Hobbies/Activities
- Finance (dependent on someone, or someone dependent on the patient, financial abuse/theft)
- Employment/ Education
- Religion/Community
- Stress/Mood (r/o anxiety, depression)
- Don't forget: Sex (Sexual orientation, Dysfunction, STI, Pregnancy), Drugs (Gambling/Legal hx), Rock and Roll (abuse, suicide)
- Lifestyle Stage
- Pediatric: HEADS
- Retirement
- Elderly: Will, power of attorney, advanced directive
Context Integration statement (social to medical)
- Integrade illness experience with
- Family
- Social structure
- Personal development
- Reflects observation/insight in clear empathetic way
- Example: "So I see how it is difficult going through a new stage in your life ______ (Life cycle stage) while having Problem A and B all in the social context C. I want to help you through it".
MANAGEMENT (Problem #1 and #2)
- Agree or disagree with patient's ideas (eg. reassurance vs. serious problem)
- Diagnosis "could be/most likely _____."
- Investigations
- Physical exam/Chart review "I'd like to do a physical exam, and go over past medical records to see what has been done"
- Blood work
- Tests
- Referral to specialists or counsellors
- Treatment (even if pending investigations)
- Reassurance vs. SAFETY
- Driving (epilepsy, narcotic), suicidal/homicidal, minors
- Non-pharmacological (Lifestyle)
- Stop smoking, medication, driving, poor lifestyle
- Prevention (vaccines)
- Pharmacological
- Refer (specialist)
- Follow-up next visit (and results)
- Follow-up with family or partner / ask or discuss issue with family or partner
- Community resources (foundation)
- Support groups / Friends
- Red flags, when to go to ER, action plan
- Common ground "Does this sound okay to you? Do you have any questions?"
INTERVIEW PROCESS AND ORGANIZATION
- Good direction, sense of order/structure
- Conversational rather than interrogative tone
- Flexibility and good integration of all interview components (not choppy)
- Appropriate prioritization with efficiency allotment of time for various interview components
Extra tips
- Quantify/Numbers (dates, days, months, years, age, time, amount)
- Developmental milestones in children