Simulated Office Orals (SOOs)

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”

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

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? "

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".

Agree or disagree with patient's ideas (eg. reassurance vs. serious problem)
Diagnosis "could be/most likely _____."
- Differential
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?"

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

References:

Google Sites

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