Medical Council of Canada

Case 1: 14-minute station – Ken Scott

Case 1: 14-minute station – Ken Scott

Objectives

  • Expert: Back Pain and Related Symptoms (e.g., Sciatica)
Candidate instructions
Ken Scott, 40 years old, presents to your office complaining of severe pain in his left leg. Ken works as a carpenter. Three weeks ago, he felt severe lower back pain while lifting a bag of cement out of the back of his truck. The attending physician at the Emergency Department recommended time off work and provided a note for his employer and told him to progressively increase his physical activities. The physician gave him your name for follow‐up.

IN THE NEXT 13 MINUTES:

• OBTAIN A FOCUSED AND RELEVANT HISTORY
• CONDUCT A FOCUSED AND RELEVANT PHYSICAL EXAMINATION

As you proceed with the physical examination, EXPLAIN what you are doing and DESCRIBE ANY FINDINGS.
After the 13‐minute warning signal, the examiner will ask you for A WORKING DIAGNOSIS.

GIVE ONE (1) LABEL TO THE EXAMINER.

Note: The video is less than 14 minutes.

Examiner checklist

Attempted only Completed satisfactorily




1.0 Elicits signs and symptoms of radiculopathy as a cause of leg pain
1.1 Asks about worsening with Valsalva (i.e., bowel movement, coughing, sneezing)
1.2 Examines bilaterally for sciatic irritation (e.g., straight leg raising / Lasègue sign)


2.0 Explores herniated disc as the most common cause of lumbar radiculopathy in young adult
2.1 Asks about a precipitating event such as a trauma or heavy lifting




3.0 Explores rare but dangerous causes of radiculopathy such as infection or cancer
3.1 Asks about fever or weight loss
3.2 Elicits patient’s past medical history


4.0 Assesses for severity of neurologic involvement
4.1 Asks about urinary or fecal incontinence
4.2 Indicates need to assess rectal tone or presence of perianal (saddle) anesthesia
[EXAMINER: REPORT, Normal tone, no perianal anesthesia, normal findings.]

 

Examiner oral questions:

What is your diagnosis?

[EXAMINER: If the candidate mentions either herniated disc or sciatic nerve involvement, please ask “At what level?”]
[Score as many items as applicable]

  • L‐5 nerve root involvement
  • Herniated disc

 

Interaction Rating Scale
Interviewing skills
(one bubble only)
Inadequate performance
Marginal performance
Adequate performance
Superior performance
  • Gathers relevant biomedical and psychosocial information
  • Establishes a timeline or sequence of events
  • Elicits pertinent positives and negatives as they relate to the differential diagnosis
  • Uses open and closed-ended questions
  • Avoids jargon and leading questions
  • Clarifies and summarizes what the patient has said
Approach to physical examination
(one bubble only)
Inadequate performance
Marginal performance
Adequate performance
Superior performance
  • Selects appropriate manoeuvres for the patient problem
  • Performs examination in a logical order
  • Demonstrates technical skill for eliciting findings
  • Executes the examination respectfully
  • Attentive to the patient’s physical comfort and dignity