Transcript Simulated Patient Evaluation

Simulated Patient
Evaluation
44 Points
Perform 2 Simulations
 10
minute time limit for each scenario
 1 scenario on the Upper Extremity

1

Possible 22 pts
scenario on the Lower Extremity
Possible 22 pts
Rest of Trimester
– Monday – bring
stethoscopes!
 TMJ
Rest of Trimester
 Simulated
Patient Lab - Friday
 October 6th -13th Simulated patient
practical (Tuesday to Tuesday)
Rest of Trimester
2 on Wednesday – review for
Final Written
 Jeopardy
 Final
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
Written – Wednesday October 21st
9:05 am in P204
35 points – 35 multiple choice questions
Purpose of Simulated Patient
Evaluation
 Assess
student’s ability to utilize the
information learned in class to:
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Demonstrate an extremity evaluation
Verbalize information related to the scenario
Organize an evaluation proceeding in a least
to most invasive manner
Purpose of Simulated Patient
Evaluation
 Assess
student’s ability to utilize the
information learned in class to:


Reasonable evaluation relating to the
scenario
Examination as taught in class
Simulated Patient Evaluation Grading Form - Sample
Name:
Matric:
Scenario (Dr records which card student pulled):
Points:
0 12
0 12
(circle the amount the student gets credit for)
Case History
0 = no questions asked , 1 = asks questions regarding the scenario
on the card 2 = asks questions regarding other daily activities (Examiner provides
answers to student’s questions)
Differential Diagnoses
0 = none given
1 = diff dx 1 subluxation from another subluxation
2 = diff dx subluxation(s) from soft tissue, visceral, or other
0 1 2 3 4
Visual ROM Ortho-Neuro findings
0 1
Pain Point
0 1 2
Fluid Motion
0 1
Least to Most Invasive
0 1 2 3 4
Traction Move (graded like on practical)
0 1 2 3 4
Thrust Move (graded like on practical)
0 12
1 = for each area covered (visualization, ROM,
Ortho, Neuro)
1 = for FM for actual subluxation 2 = if did FM for any differential dx
Post Checks/Patient Instructions FM (if appropriate, pain point, ROM,
neuro, other)
Total Points
Patient instructions (if appropriate)
Bring your own patient Tues
Oct 6: Conn, Day, Meehan, Salinas,
Stoiber
 Wed Oct 7: Arguello, Fall, Rabideaux, Sallee
 Thurs Oct 8: Cichosz, Fletcher, Micka, Scott
 Fri Oct 9: Carr, Gardner, Justice, Stempky
 Mon Oct 12: Groves, Leipold, Schwarting,
Sneyd
 Tues Oct 13: Dague, Gleason, Samson, Sweley
Evaluation Day
 Place
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book bags along north wall by HyLo
Keep a pen/cil
Take 1 grading sheet from table by northeast
classroom door
Put name, matric & date on the sheets
 Students
will wait out in the hall
Evaluation Day

Students will be called in, in pairs (doctorpatient)
 1 pair to Dr. Gindl
 1 pair to Dr. Lipes
 Once the pair has been tested by their 1st Dr
they switch and move to another Dr
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Will perform 2 extremity exams – 1 upper & 1 lower
Ie start with Dr. Gindl for 1st scenario, then move on to
Dr. Lipes for 2nd scenario.
Evaluation Guidelines
 Examine
region as indicated on card
 Case History (2 pts)

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
Ask questions that are pertinent to the
scenario on the card
The questions should help you get an idea of
direction of trauma, any soft tissue damage,
areas that should be examined, items in the
history that would help guide your examination
The examiner will furnish data in response to
the student’s questions
Evaluation Guidelines
 Examine
region as indicated on card
 Differential Diagnosis (2 pts)
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give us some that are appropriate for the
scenario
1 subluxation from another subluxation
Subluxation from soft tissue, visceral, other
Evaluation Guidelines
 Visual

ROM - Orthos – Neuros (4pts)
Visual (1pt) – the student should relate what
they might see and/or should look for with this
scenario
• Then your grader will let you know what you saw

ROM (1 pt) – student should relate which
ROM(s) might be affected with this scenario
• Then your grader will let you know what ROM(s)
have been affected
Evaluation Guidelines

Orthos (1pt) – which Orthos would help you
differentiate the Diff Dx you gave us
• Perform some of those Orthos (stick with the ones we
went over in class)
• Then your grader will let you know what Orthos are
positive

Neuros (1pt) – which Neuros would help you
differentiate b: the Diff Dx you gave us
• Perform some of those Neuros (stick with ones we went
over in class)
• Then your grader will let you know the results of your
neuro tests
Evaluation Guidelines
 Pain
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Point (1 pt)
Relate where will you look and what would it
tell you (while you’re doing it)
Then your grader will let you know where the
pain point is
Evaluation Guidelines
 Fluid

Motion (2 pts)
Perform FM for the area(s) in question
• FM for joint restriction
• FM for any differential dx

Then your grader will let you know what FM is
restricted
Evaluation Guidelines
 Demonstrate:
 Your
examiner will indicate which of the
following to perform given your findings

Traction Move (4 pts)
• of grader’s choice

Thrust Move (4 pts)
• of grader’s choice
Evaluation Guidelines
 Post
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Checks & Patient Instructions (2 pts)
Perform post checks as they relate to your
adjustments
Relate patient instructions (if any) as they
would pertain to the scenario
Exam an extremity region
 Students
will pull 1 card
 Region to be examined will be determined
by reading a card with a short patient
complaint/history on it.
 # of Lower Extremity Scenarios - 11
 # of Upper Extremity Scenarios - 12
Right Shoulder Complaint
 Differential
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Dx
Rotator Cuff Tear
Subluxation – G-H, A-C, S-T, St-Cl, St-Co,
spinal subluxation
Bicipetal Tendonitis
Other shoulder muscle strain
Visual inspection - G-H
 What
you would look for on visualization
 Be specific as to what you see and what it
relates to:
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If visualize a sulcus sign that would correlate
with a G-H I
If visualize a squared off shoulder – possible
dislocation
Examiner will indicate what you saw
ROM
 G-H
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P
 Internal Rotation
 Appley’s Scratch on Int Rot
 G-H
I
 External Rotation
  Appley’s Scratch on Ext Rot
 Scapulo-humeral ratio  1:1
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Ortho-Neuro G-H Evaluation
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Yergason’s (mild click, maybe G-H I)
Dawburn’s
Drop Arm
Dugas
Apprehension
Muscle Tests
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Anterior Deltoid (weak G-H I)
Teres major (weak G-H P)
 Examiner
will indicate if there was any pain or
muscle weakness
Pain Point G-H
 Location
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of pain for the possible
G-H I anterior joint capsule
G-H P posterior joint capsule
Along a muscle (ie supraspinatus)
Fluid Motion G-H
 Decreased
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I-S glide (could be either G-H I or G-H P)
A-P glide (G-H I)
P-A glide (G-H P)
Examiner indicates which FM is 
Demonstrate Traction Move
 Examiner
prompts student as to which
move to perform
 For G-H joint traction either
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Supine
Seated
Demonstrate Thrust Move
 Examiner
prompts student as to which
move to perform
 For thrusting move for G-H joint
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G-H I
G-H P Prone
G-H P Seated
Post Checks/Patient Instructions
 Post
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Checks:
 Fluid motion - show
 ROM – which one?
 pain – where?
Visualizes normal – looks like?
 Patient
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Instructions
Anything that patient can do to help their
situation relating to the history of their
problem?
Update on Grading Scale
 Grading
Standard:
 215.26 - 229 (94%) ............................A
 199.23 - 215.259 (87%) …..................B
 183.20 - 199.229 (80%) …..................C
 Less than 183.20 (below 80%) ….......F