Activity

Overview

Briefing

Before starting the XR simulation, the learner must consent to taking part via this online form.

The learner will then be briefed that they will be meeting Albert, a 76-year-old man with back pain. The student GP will be given access to the Medical History for the patient.

Classroom

5 mins

Consultation with Albert

In an optimal consultation, the patient will be prompted by the student GP to explain that the gnawing pain has been persistent in his lower back for a fortnight but in the last 12 hours it has progressed to shooting pains, which had prompted him to make the appointment. He requests pain medication from the student GP, noting that the backache was preventing him from moving about easily, completing daily tasks and sleeping soundly. On asking further questions, the student GP discovers that the patient has also had difficulty urinating and faecal incontinence in the last few days. The student GP should then suggest to Albert which tests and further physical examinations/assessments they wish to carry out.

XR Sim

GP Surgery

5 mins  

Examination Results

The instructor will select the relevant results if the student GP chose any of the following examinations:

• Walking exam

• Back exam

• Reflex Test

• Leg Strength

• Leg Sensation

• Rectal Examination

For anything not on the list the instructor will select

• All other examinations offered normal results

XR Sim

GP surgery

1 mins

Relay Results

The student GP then relays their findings back to the patient, explaining that they suspect malignant spinal cord compression as the cause of the back pain. The student GP clearly conveys what this means, what is required to treat it and what the risks to the patient are if they choose not to. The student GP also suggests making referrals to hospital for further tests, including blood tests and ‘imaging’ to eliminate cancerous causes. This is met with some resistance from the patient, who downplays their pain and suggests just taking painkillers and resting at home.

There are two conversation branches if cancer is mentioned:

1. Bad outcome: if cancer is mentioned either inappropriately or indelicately by the student GP, this initiates the patient asking numerous questions in a panicked manner.  If this occurs, the Instructor will end the simulation and a debrief session with the student GP will begin.

2. Good outcome: this is likely to be the student GP carefully asking about the treatment and testing of the patient’s cancer, whereby the patient will close the conversation by saying he cannot remember all the details.

XR Sim

GP surgery

3 mins

On Call Team

If the patient agrees to the student GP’s proposed treatment plan, the student GP makes a call first to the acute spinal team. At the Instructor’s discretion, the referral conversation can go one of three ways:

1. The student GP accurately and succinctly relays the information to the spinal clinician and an emergency appointment is made that day.

1. The call is forwarded to the oncology department, given the patient’s medical history. The oncology department refuses to see the patient until he has been reviewed by the spinal team.

If the student GP has either not carried out the appropriate physical examination on the patient or has not sufficiently relayed the results to the spinal clinician. The spinal clinician ends the call, saying they cannot accept the referral without the GP carrying out the appropriate examination first.

XR Sim

GP surgery

3 mins

Debrief

The student GP, instructor (and possibly other students) will watch a recording of the simulation and discuss in detail the student GP’s technique and clinical reasoning

Classroom

15 mins

Evaluation

At the end of the training simulation, the learner is invited to complete an evaluation form.