Medical Council of Canada

Case 2: 14-minute station – Angela White

Case 2: 14-minute station - Angela White

Objectives

  • Expert: Suicidal Behaviour
  • Communicator: Tailor the interview to the clinical context
  • Professional: Know and demonstrate the professional behaviours to ensure patient safety
  • Communicator: Establish a common understanding and negotiate agreement concerning diagnosis, management, and follow‐up
Candidate instructions
Angela White, 19 years old, comes to the walk‐in clinic for re‐evaluation of a post‐appendectomy wound infection.

Her vital signs are as follows:
BP: 130/64 mmHg        HR: 72/min          RR :16/min           Temp.: 36.7⁰C

IN THE NEXT 14 MINUTES:

• ASSESS AND INITIATE MANAGEMENT OF THE PATIENT

GIVE ONE (1) LABEL TO THE EXAMINER.


Note:  The video is less than 14 minutes.

 

Examiner checklist

Attempted only Completed satisfactorily
 

 

1.0 Clarifies that infection has resolved (e.g., establishes that there is no pain or redness around the cuts and that patient has completed her medications)
[EXAMINER: If candidate insists on performing a physical exam after the patient refuses, intervene and REPORT: Exam noted, wounds are healing normally, please move on.]






2.0 Explores the possibility of a mental health disorder
2.1 Assesses for symptoms of depression (any 2 of low mood, dark thoughts, crying, disrupted sleep, low energy, decreased appetite, weight loss, decreased interest, decreased libido, guilt, difficulty concentrating)
2.2 Elicits psychosocial stressors
2.3 Discusses support system




3.0 Proceeds to suicidal risk assessment
3.1 Asks about current suicidal ideation
3.2 Asks about suicidal plan and intent
3.3 identifies risk factors, including drug AND alcohol use
[EXAMINER: To obtain “Completed satisfactorily’, candidates MUST ask about both drugs AND alcohol.]




4.0 Initiates management of safety risk
[EXAMINER: The patient only agrees if candidate persists and is non-judgmental.]
4.1 Suggests follow-up arrangements [e.g., specialist, family physician or mental health follow-up, crisis worker, Emergency Department today]
4.2 Refers to some form of social assistance [e.g., social worker, financial assistance, food bank]
4.3 Negotiates and seeks agreement with patient to contact help before self-harming [e.g., go to Emergency or makes alternative safety plan with her]

 

Interaction Rating Scale