Medical Council of Canada

Ten-minute management station example

Ten-minute management station example

What the candidate reads

Candidate’s instructions

Raymond Reeves, 55 years old, has been brought to the Emergency Department by ambulance because of chest pain which has now resolved with oxygen in the ambulance. The INITIAL ECG was normal and the vital signs are as follows:

BP:   130/85 mmHg
Pulse:   70/minute, regular
RR:   20/minute

IN THE NEXT 9 MINUTES, ASSESS AND MANAGE THIS PATIENT. An Emergency Department nurse is present in the room. Direct the nurse to order any tests or perform any procedures you believe are appropriate for this patient.

As you proceed with the physical examination, EXPLAIN TO THE EXAMINER what you are doing and DESCRIBE ANY FINDINGS.

After the 9-minute warning buzzer, you will be asked a question about this patient.

What the nurse reads

Nurse’s chart and instructions
Candidate  Nurse’s Response
Candidate enters the room Give the ECG # 1 and say: “This patient just arrived and had an ECG. What would you like me to do?”
Orders aspirin Simulate giving aspirin.
Asks for vital signs Say: “Unchanged.”
BP 130/85
Pulse 70/minute, regular
RR 20/minute, regular
Orders second ECG Give ECG # 2
Orders cardiac monitor Apply three cardiac dots and report: “Sinus rhythm and pulse 70.”
Orders oxygen Apply nasal prongs, say: “O2 applied at 4L by nasal prongs.”
Requests O2 saturation level 100% if O2 on
OR 96% if O2 not on
Orders I.V. Ask to specify size, solution, flow and quantity.
Set up IV as requested
Orders blood work Ask to specify, and then simulate.
Report: “Done. It will take about 10-15 minutes for results.”
Orders analgesic Ask to specify, and then simulate.
Cue standardized patient to adapt his pain simulation.
Orders nitroglycerin Simulate.
Cue standardized patient to adapt his pain simulation.
Orders other medication Simulate.
Orders chest X-ray Report: “I will order stat.”
Any other orders: e.g., nasogastric tube, Foley catheter, heparin drip, etc. Report: “I will order.”  OR  “I will set up stat.”
Orders any other test Say: “I will order/call but it will take at least 10 minutes.”

What the Examiner reads

Examiner checklist

Fill in the bubble for each item completed satisfactorily

1. Orders initial management

1.
2.
3.

2. Elicits history of presenting problem

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5.
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7.

3. Conducts physical examination

1.
2.
3.
4.

4. Second ECG requested. Candidate interprets electrocardiogram

(Examiner: Ask for interpretation if candidate does not volunteer it)

1.
2.

5. Orders further appropriate initial investigations

1.
2.
3.

6. Management of patient’s pain

1.
2.
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5.
6.

7. Orders aspirin (ASA)

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 :