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 well as the names of the parent and child. The doctor introduces themselves as Dr. Smith, a junior doctor in paediatrics, and the parent clarifies his name as Danny Murphy, Sam’s dad. This information is provided early on in the conversation and is consistently used throughout. Therefore, the criterion is satisfied and done well.

• Criterion: The aim of the consultation is established.
  Option: Done Well
  Justification: The aim of the consultation is clearly established in this conversation. The doctor provides updates on the child’s condition, explains the test results, discusses the possible diagnosis, addresses the parent’s concerns, and provides information about the available vaccines, the treatment plan, the potential complications, and the support and treatment options. The doctor consistently maintains the aim of the consultation throughout the conversation and ensures that the parent is well-informed and understands the information provided. Although the conversation could have been more structured, the aim of the consultation is effectively achieved.

• Criterion: The doctor checks the parent’s current level of understanding about the tests done and current antibiotic treatment.
  Option: Done Well
  Justification: The doctor in the conversation consistently checks the parent’s current level of understanding about the tests done and current antibiotic treatment. The doctor ensures that the parent is informed about the test results, explains the significance of the findings, and addresses the parent’s concerns. The doctor also encourages the parent to seek further clarification from their son’s pediatrician or healthcare provider if needed. Overall, the doctor demonstrates a proactive and comprehensive approach to checking the parent’s understanding throughout the conversation.

• Criterion: The doctor explains CSF result is consistent with bacterial meningitis (Low CSF glucose compared to blood glucose, High CSF Protein, Presence of infection fighting white cells in CSF and Presence of bacteria in CSF on microscopy).
  Option: Done Well
  Justification: The doctor in the conversation satisfactorily explains the CSF result and its consistency with bacterial meningitis. The doctor accurately mentions the specific findings in the CSF test, such as the increased white blood cell count, low glucose level, high protein level, and the presence of gram-negative diplococci on the gram stain. The doctor also provides additional information about the different bacteria that can cause meningitis. Overall, the doctor demonstrates a good understanding of the criterion and effectively explains the CSF result to the patient.

• Criterion: The doctor explains baby has definitely got meningitis (most likely Neisseria Meningitidis) and needs to stay in hospital for treatment.
  Option: Done Well
  Justification: The doctor in the conversation satisfactorily explains the baby’s possible diagnosis of meningitis and the need for hospital treatment. The doctor mentions the test results indicating an infection, specifically highlighting the increased white blood cells in the cerebrospinal fluid and the presence of gram-negative diplococci on the gram stain. The doctor also provides information about the specific bacteria that could be causing the infection, mentioning Neisseria meningitidis as a common cause of bacterial meningitis in children. Additionally, the doctor addresses the parent’s concerns about long-term complications and provides information about available support and treatment options. Overall, the doctor effectively communicates the diagnosis and treatment plan to the parent.

• Criterion: The doctor explains that the baby is on a broad spectrum antibiotic and this will treat the bacterial meningitis infection. Explains they may know which bacteria is causing the meningitis in another day or two. Explains that the laboratory will test the sensitivities of the bacteria to antibiotics and that this means they can change antibiotic to another suitable and sometimes less frequent antibiotic at that time.
  Option: Not attempted or poor
  Justification: The doctor did not provide a comprehensive explanation regarding the criterion. They did mention that the baby is on antibiotics, but did not explicitly state that the antibiotic will treat the bacterial meningitis infection. The doctor also did not mention the timeline for identifying the specific bacteria causing the meningitis or the possibility of changing antibiotics based on sensitivities. Therefore, the doctor’s explanation was not sufficient to meet the criterion.

• Criterion: The doctor discusses that they may start steroids and would discuss this with their senior.
  Option: Not attempted or poor
  Justification: The criterion for discussing the possibility of starting steroids and consulting with a senior was not addressed at all in the conversation. There was no mention of steroids or consulting with a senior regarding this decision. Therefore, the criterion was not attempted or poorly addressed.

• Criterion: The doctor explains the need to inform public health about the meningitis and the need for the appropriate contacts to receive prophylactic antibiotics.
  Option: Not attempted or poor
  Justification: The criterion of explaining the need to inform public health about the meningitis and the need for appropriate contacts to receive prophylactic antibiotics was not addressed at all in the conversation. The doctor did not mention anything about notifying public health or the importance of treating close contacts. This aspect of the conversation was completely missing, indicating that it was not attempted or poorly addressed.

• Criterion: The doctor explains that sometimes babies with meningitis can go home on ‘ambulatory treatment’ coming back for antibiotics to the hospital daily to complete the course of treatment. Explains that some babies can have long term effects of meningitis (learning delay/difficulty, epilepsy etc.), but this depends on the course of the acute infection and that many babies are completely well after the infection. Explains that the baby will require a hearing test and follow up outpatient paediatric appointment on discharge home.
  Option: Not attempted or poor
  Justification: The conversation does not fully satisfy the given criterion. While the doctor provides some information related to the criterion, such as the possibility of long-term effects and the availability of interventions, there are specific details missing, such as the mention of ambulatory treatment, learning delay/difficulty, epilepsy, the requirement of a hearing test, and a follow-up outpatient pediatric appointment. Therefore, the conversation can be considered as not attempted or poor in addressing the criterion.

• Criterion: The doctor checks parental understanding and allows questions.
  Option: Done Well
  Justification: The doctor in the conversation consistently checks the parental understanding and allows questions. They actively engage with the parent, ensuring that they comprehend the information being provided and addressing any concerns or uncertainties. The doctor encourages the parent to ask questions throughout the conversation and provides comprehensive and informative responses. They also summarize key points and ask if the parent has any further questions, demonstrating a commitment to ensuring the parent’s understanding. Overall, the doctor’s approach to checking parental understanding and allowing questions is exemplary.

• Criterion: The doctor summarises or ends the consultation. Offers written advice or a follow-up.
  Option: Done Well
  Justification: The doctor in the conversation satisfactorily summarises and ends the consultation. They provide a clear summary of Sam’s condition, the test results, and the possible diagnosis of bacterial meningitis. They also address the parent’s concerns and provide appropriate advice and follow-up, including recommending the discussion of the meningococcal vaccine with the other son’s pediatrician and emphasizing the importance of creating a nurturing environment for Sam’s development at home. The doctor’s summary and advice effectively conclude the conversation, satisfying the criterion.

Overall Grade

• Option: Borderline
  Justification: The doctor performed most of their tasks well and provided clear explanations to the parent. However, there were some areas where the doctor could have improved their performance, such as providing a clearer explanation of the CSF results.

Communication Skills

• Option: Good
  Justification: The doctor responds effectively to the patient’s needs and cues. They provide clear and understandable explanations, address the patient’s concerns, and offer appropriate recommendations. The doctor also shows empathy and understanding towards the patient’s worries, putting the patient at ease. However, there are a few instances where the doctor could have been more proactive in addressing the patient’s concerns, such as discussing the possibility of continuing antibiotics at home or providing more information about potential complications and support options.

Organisational skills

• Option: Good
  Justification: The doctor demonstrates a well-organized approach throughout the conversation. They address each task in a clear and logical manner, providing the necessary information to the patient. They also show flexibility by addressing the patient’s concerns and answering their questions. However, there are a few areas where the doctor could have provided more specific information, such as discussing the need for public health notification and the potential long-term effects of meningitis. Overall, the doctor demonstrates good organizational skills but could have been more thorough in certain aspects.