Station-Specific Criteria

• Criterion: The name and role of the doctor is stated. The names of the parent and child are clarified.
  Option: Done Well
  Justification: The conversation clearly states the name and role of the doctor as Dr. Smith, a junior doctor in paediatrics. The names of the parent and child are also clarified, with the patient introducing himself as Mr. Connors, Jack’s father. This information is provided early on in the conversation and is consistently used throughout, demonstrating clear communication and adherence to the criterion.

• Criterion: The aim of the consultation is established.
  Option: Done Well
  Justification: The doctor in the conversation has done well in establishing the aim of the consultation. They introduce themselves, confirm the reason for the visit (Jack’s heart murmur), and consistently refer back to this aim throughout the conversation. The doctor asks relevant questions about Jack’s medical history and symptoms, provides information about innocent murmurs, and explains the need for further tests. They actively involve Mr. Connors in the decision-making process and ensure that he understands the next steps. Overall, the doctor’s approach is comprehensive and patient-centered, effectively establishing the aim of the consultation.

• Criterion: The doctor recognises the likely diagnosis is an innocent murmur of childhood.
  Option: Done Well
  Justification: The doctor in the conversation demonstrates a thorough understanding of the likely diagnosis of an innocent murmur of childhood. The doctor acknowledges the patient’s concerns, provides reassurance, and explains the nature of innocent murmurs. The doctor also discusses the need for further tests to confirm the diagnosis and suggests an appropriate test, an echocardiogram, to evaluate the heart’s structure and function. The doctor effectively communicates this information to the patient, addressing their concerns and ensuring they understand the next steps. Overall, the doctor’s handling of the criterion is exemplary, demonstrating a strong understanding of the diagnosis and effectively conveying this to the patient.

• Criterion: The doctor undertakes an appropriately focused paediatric history, covering family history of structural heart lesions, growth, development and signs of breathlessness or poor exercise tolerance.
  Option: Done Well
  Justification: The doctor has done well in satisfying the criterion of undertaking an appropriately focused paediatric history. They asked relevant questions and gathered information about the patient’s medical history, recent illnesses, and symptoms related to the heart. The doctor covered the family history of structural heart lesions, growth, development, and signs of breathlessness or poor exercise tolerance. The conversation demonstrates a thorough assessment of the patient’s history, addressing all aspects of the criterion.

• Criterion: The doctor explains the diagnosis to the parent: What a murmur is and provides reassurance that it is most likely an innocent murmur of childhood.
  Option: Done Well
  Justification: The doctor in the conversation effectively explains the diagnosis of an innocent murmur to the parent and provides reassurance throughout the conversation. The doctor acknowledges the parent’s concern, explains the nature of innocent murmurs, and emphasizes that they are common and often harmless. The doctor also involves the parent in the decision-making process regarding further tests, showing a comprehensive understanding of the criterion. Overall, the doctor’s explanation and reassurance are clear and thorough, satisfying the criterion.

• Criterion: The doctor explains management to the parent: Patient can be discharged back to GP care and if there are any worrying signs in the history (there aren’t any), a cardiac referral is appropriate.
  Option: Done Well
  Justification: The doctor in the conversation has done well in explaining the management to the parent. They acknowledge the parent’s concern, provide reassurance about the commonality of innocent murmurs in children, and explain the need for further tests to ensure there are no underlying issues. The doctor involves the parent in the decision-making process by asking for their opinion on proceeding with the echocardiogram. They also mention that a cardiac referral is appropriate if there were any concerning symptoms, but since there aren’t any, it is not necessary at this point. Overall, the doctor effectively communicates the management plan to the parent, addressing their concerns and involving them in the decision-making process.

• Criterion: The doctor explains the prognosis that a murmur is likely to be present if the child is unwell with a cough/cold etc or if they run around and is likely to disappear as the child grows up.
  Option: Not attempted or poor
  Justification: The doctor did not fully address the criterion of explaining the prognosis of a murmur. While they mentioned that heart murmurs are common in children and can be harmless, they did not specifically address the relationship between the murmur and the child’s health status or activity level. They did not explain that murmurs can be more likely to occur when a child is unwell with a cough/cold or fever, and that innocent murmurs often disappear as the child grows up. Therefore, the doctor’s explanation was incomplete and did not satisfy the criterion.

• Criterion: The doctor checks parental understanding and allows questions.
  Option: Satisfactory
  Justification: The doctor in the conversation does check parental understanding to some extent by providing explanations and reassurance. However, there are a few missed opportunities where the doctor could have been more thorough in checking understanding and encouraging questions. Therefore, while the criterion is partially satisfied, there is room for improvement in actively checking parental understanding and inviting questions throughout the conversation.

• Criterion: The doctor summarises or ends the consultation. Offers written advice or a follow-up.
  Option: Satisfactory
  Justification: The doctor satisfies the criterion of summarizing or ending the consultation and offering written advice or a follow-up in a satisfactory manner. The doctor effectively summarizes the consultation by explaining the examination findings and discussing the next steps, including the referral for an echocardiogram. While the doctor does not explicitly mention providing written advice, the question about proceeding with the echocardiogram can be seen as a form of follow-up. Overall, the doctor adequately concludes the consultation and provides a clear plan for further investigation.

Overall Grade

• Option: Borderline
  Justification: The doctor performed some of their tasks adequately, but there were areas where improvement is needed. They did not clearly state the aim of the consultation, address the likely diagnosis, provide a comprehensive history, explain the management plan and prognosis, check understanding and allow questions, or summarise or end the consultation. However, they did introduce themselves and confirm the parent’s name, ask about the child’s medical history, explain that heart murmurs can be common and harmless in children, and mention the need for further tests. There are concerns about their interpersonal and clinical skills, as they did not provide clear explanations and reassurance, and did not check the parent’s understanding or allow questions. Overall, their performance is borderline, with room for improvement in several areas.

Communication Skills

• Option: Good
  Justification: The doctor responds effectively to the patient’s needs and cues. They ask appropriate questions to gather information about Jack’s medical history and symptoms. The doctor also provides reassurance and explains the significance of the heart murmur in a clear and understandable manner. They involve the patient in the decision-making process by discussing the need for further tests and obtaining the patient’s consent. Overall, the doctor’s communication style is effective and puts the patient at ease. However, there is room for improvement in terms of expressing empathy and building a stronger rapport with the patient.

Organisational Skills

• Option: Good
  Justification: The doctor demonstrated a well-organized approach to the consultation. They introduced themselves and clarified the names of the parent and child. They established the aim of the consultation by asking about the heart murmur. The doctor then proceeded to undertake a focused paediatric history, covering relevant aspects such as family history, growth, development, and symptoms. They explained the diagnosis of an innocent murmur of childhood and provided reassurance to the parent. The doctor also explained the management plan, which involved discharging the patient back to GP care and only referring for further tests if there were any worrying signs in the history (which there weren’t). They checked the parent’s understanding and allowed questions. Finally, the doctor summarized the consultation and discussed the next steps.