History-taking couplet station example

What the candidate reads

Candidate’s Instructions

Luc Léger, 59 years old, presents to your office complaining of jaundice.
In the next 5 minutes, obtain a focused and relevant history.
At the next station, you will be asked to answer questions about this patient.

What the examiner completes

Examiner’s Checklist
Fill in the bubble for each item completed satisfactorily

1.		Elicits onset/duration
2.		Elicits progression
3.		Elicits associated symptoms
		- dark urine
		- pain
		- color of stool
		- fever
4.		Elicits risk factors
		- previous exposure to hepatitis
		- recent blood transfusion
		- intravenous drug use
		- foreign travel
5.		Elicits an alcohol use history
6.		Conducts a review of systems
		- skin
		- gastrointestinal
		- weight loss
		- change in appetite

If UNSATISFACTORY, please specify why:
	Inadequate medical knowledge and / or provided misinformation
	Could not focus in on this patient's problem
	Demonstrated poor communication and / or interpersonal skills
	Actions taken may harm this patient
	Actions taken may be imminently dangerous to this patient
	Other: ________________________________________________

Did this candidate demonstrate a lapse in professional behaviour? Yes No
	Disrespectful to others (e.g., to patient, nurse)
	Over-investigated / over-managed the patient
	Actions raised ethical and / or legal concern
Briefly describe the behaviour for any of the above reasons or any other observed lapse : _______________________________________________________________________

What the candidate receives

Encounter Probe

Q1. The abdominal examination of Luc Léger revealed no organ enlargement, no masses and no tenderness. What radiologic investigation would you first order to help discriminate the cause of the jaundice?
______________________________________________________

Q2. If the investigations revealed that this patient likely had a post-hepatic obstruction, what are the two principal diagnostic considerations?

____________________________________________________

____________________________________________________

Q3. What radiologic procedure would you consider to elucidate the level and nature of the obstruction?
______________________________________________________

Q4. If this patient were found to have a cancer localized to the ampulla of vater, what single treatment would you recommend?
_____________________________________________________

What the post-encounter probe marker receives

Answer Key
Q1.	The abdominal examination of Luc Léger revealed no organ enlargement, no masses and no tenderness. What radiologic investigation would you first order to help discriminate the cause of the jaundice?
		Score
A1.	Abdominal (liver) ultrasound	4
	Endoscopic retrograde cholangiopancreatography (ERCP)	2
	Maximum	4

Q2.	If the investigations revealed that this patient likely had a post-hepatic obstruction, what are the two principal diagnostic considerations?
		Score
A2.	Pancreatic (periampullary) cancer	2
	Choledocholithiasis	2
	Gallstones	1
	Maximum	4

Q3.	What radiologic procedure would you consider to elucidate the level and nature of the obstruction?
		Score
A3.	Endoscopic retrograde cholangiopancreatography (ERCP)	4
	Percutaneous trans-hepatic cholangiogram (PTC)	4
	Computed tomography (CT) scan	1
	Hida scan (biliary)	0
	Liver scan (Technetium 99M labeled sulphur colloid)	0
	Maximum	4

Q4.	If this patient were found to have a cancer localized to the ampulla of vater, what single treatment would you recommend?
		Score
A4.	Whipple procedure (pancreatic-duodenectomy)	4
	Biliary bypass	2
	Excision	1
	Chemotherapy	0
	Radiotherapy	0
	No treatment	0
	Maximum	4