Standardized Patient Program Newsletter SPread Sheet · Standardized Patient Program Newsletter TAKE OUR KIDS TO WORK DAY PROVIDE S EX POSURE Questions or comments? Call 480-1307

SPread Sheet Volume 2, Issue 9, December 2010

educating, informing, entertaining, inspiring

Standardized Patient Program Newsletter

TAKE OUR KIDS TO WORK DAY PROVIDES EXPOSURE

Questions or comments? Call 480-1307

The SPread Sheet is your newsletter; if you have any articles, photos, opinions, thoughts,

trivia, anecdotes, pictures, or jokes to contribute for the next issue, please do so by Febru-ary 28, 2011. Contact information is provided in the sidebar on page two. We reserve the

right to edit any and all submissions for length and content in collaboration with the contribu-tor. Submissions that are not included in one issue may be included in subsequent issues.

SUBMISSIONS, PLEASE

IN THIS ISSUE

FEATURES

DID YOU KNOW . . . 2

SESSIONS PENDING 3

SPIN AND AROUND 3

HUMEROUS PROSE 3

SYMPTOMS . . .

Collapsed Lung &

Hyperventilation 7

ARTICLES

PHYSICIAN ASSISTANTS PRO-

GRAM SETS PRECEDENT 4

SPOTLIGHT ON . . .

Manju Balachander 6

RESEARCH PIONEER INDUCTED

INTO HALL OF FAME 8

CASE NOTES POTENTIALLY 9

On November 3, 2010, thousands of

Grade 9 students from across Manitoba spent a day at work job-shadowing a par-

ent, relative, friend, or volunteer host for Take Our Kids to Work day. In 2010,

42 students participated in the Faculty of Medicine's TOKTW Day program on Ban-

natyne Campus.

This experience assisted students in

understanding the importance of staying in school, helped them gain an appreciation of the working world, and demonstrated the connec-

tion between education and the future. (continued on next page)

Dr. Rob Brown with Grade 9 students in the CLSF during 2010 TOKTW Day

DISCOVERY DAY PRIMES YOUTH FOR MEDICAL CAREER

What’s it like to resuscitate a “patient,” use cool, high-tech ultra-

sound equipment, or make pills? On November 5, 2010, more than 260 high school students from across Manitoba - including Churchill

- spent their day finding out by sampling career options at the TD Discovery Day in Health Sciences. The interactive event was hosted

by The University of Manitoba Faculty of Medicine and organized by The Canadian Medical Hall of Fame.

The day kicked off with greetings from Minister of Health Theresa Oswald, the introduction of 2011 Hall of Fame Inductee, Dr. Allan

Ronald and 2001 Hall of Fame Inductee, Dr. Henry Friesen and a keynote lecture “Disaster Victim Identification - Haiti 2010” by Sgt.

Paul Brisson. He provided a heart-wrenching slide show of the dev-astation in Haiti and the important role Canadian soldiers played in

identifying victims of the earthquake.

University of Manitoba Med IV student Angela Schellenberg spoke about med school and how it provides “rewarding opportunities at

home and abroad.” She volunteered in Bangladesh after Med I and experienced another culture while gaining

(continued on page 4)

SPread Sheet Volume 2, Issue 9, December 2010 Page 2

Contact the SPread Sheet:

Office B, Clinical Learning

& Simulation Facility

Level 000, Brodie Centre

727 McDermot Avenue

Winnipeg, MB, Canada

R3E 3P5

Phone:

(204) 480-1307

Fax:

(204) 977-5682

E-mail:

[email protected]

Home Page:

http://www.umanitoba.ca/

faculties/medicine/

education/ed_dev/

spp.html

NEWSLETTER EDITOR

Tim Webster

SP PROGRAM STAFF

Shaun Beach,

Operations Director

CLSF / SP Program

Lezlie Brooks,

SP Coordinator

Holly Harris,

SP Coordinator

Tim Webster,

SP Coordinator

Cathy MacDonald,

Office Assistant

Copyright © 2010 University of Manitoba

Permission to reproduce

and/or distribute any of the material contained

herein must be obtained

from the Standardized Patient Program.

ISSN 1715-5452


TOKTW DAY PROVIDES EXPOSURE (continued from previous page)

Dean of Medicine, Dr. Brian Postl welcomed the students to the

faculty first thing in the morning. “We hope you will gain an appre-ciation for your parents' professions and consider careers in the

health sciences and medicine after today,” he said.

As an active supporter of Take Our Kids to Work, the U of M Fac-

ulty of Medicine developed a day-long program for Grade 9 students including hands-on activities in both the Clinical Learning & Simula-

tion Facility as well as the School of Medical Rehabilitation. The day included exposure to a variety of occupations, fun activities, and

workshops highlighting the diverse work happening on our campus.

The University of Manitoba supports this program and believes it

is a great way to highlight the diversity of roles at our university while developing connections with future U of M students.

Acadia Junior High Grade 9 student Aliaa El Tobgy described the day as “awesome! I liked the simulation lab the best . . . it was cool

working on the sim man, trying the endoscopy and doing activities with the actors [Standardized Patients],” she said. “I definitely want

to go into medicine.” Aliaa was accompanying her mother Dr. Edti-hal Ali, a fellow in the HSC NICU, for Take Our Kids to Work Day.

A special “Thank you!” goes out to SPs Nancy Gajdosik and Robert Halstead who helped make the day so memorable for the

students.

Source: http://myuminfo.umanitoba.ca/index.asp?

sec=36&too=100&dat=12/7/2010&sta=3&wee=2&eve=8&npa=23860

DID YOU KNOW . . .

. . . the youngest person ever to qualify as a doctor was a young

man named Balamurali Ambati?

He was only 17 years old when he graduated in 1995 from the

Mount Sinai School of Medicine in New York, which means he must have started studying medicine at the age of 12.

He completed an ophthalmology residency at Harvard University and a fellowship in cornea & refractive surgery at Duke University in

2002, before joining the faculty of the Medical College of Georgia where he practices clinical opthamology and conducts research.

Sources:

1) Surreal to sublime medical trivia By Michelle Roberts, BBC

News health reporter, Sunday, July 10 , 2005 2) http://www.worldlingo.com/ma/enwiki/en/

Balamurali_Ambati

Page 3


SESSIONS PENDING

• “Welcome!” to new SPs:

Madeline Braun, Marsha Graham,

Lars Jansson, Jane MacDonald, and

Thyr Trubiak.

• Please be sure to provide our Office Assis-

tant, Cathy MacDonald, with any changes in your personal or contact infor-

mation as they occur. You can reach her at [email protected] or at

480-1308.

• The phone number for the Standardized

Patient Program Training Room, 203 Bro-

die Centre, is 272-3164. Please use this number if an SPC is expecting you for a

training session but for some reason you aren’t on time.

SPIN AND AROUND

• We are still compiling a catalogue of photos

of all the SPs and Applicants in the pro-gram. The Coordinators don’t know what

each and every SP and Applicant looks like, and the catalogue helps us assign roles

more easily. If you haven’t already, please forward an 8” x 10” picture of yourself –

preferably in black and white – to the SP office. You can send your pictures elec-

tronically to:

[email protected]

. . . or mail them by regular post:

Attn: Tim Webster, SPC

Office B, CLSF

Level 000, Brodie Centre 727 McDermot Avenue

Winnipeg, MB R3E 3P5

NB: This listing is for informational purposes only; some of the sessions listed are

already in progress. If you are required for a role, you will be contacted directly by an SP Coordinator. If there is a discrepancy between the information provided here

and a confirmation form you have received, please regard the information from your SPC as correct.


UGME / CPA January 7, 12, & 21

PAEP January 10 & 11

IMG / CTA January 11, 13, 18,

20, 25, & 27

Surgery / CTA January 12, 19, & 26

UGME / Neurology January 13 & 20 February 3, 10, 17, & 24

CME / CAPE January 15

WRHA / Ethics Services January 18

SMR / OT 6140 January 21

Pharmacy 1100 January 26

CME / RCA Exam January 29

IMG / MURTA February 1

Pharmacy 1100 February 16

NCEP / MURTA & CTA February 17

UGME / CS060 February 18 & 25

CME / CAPE February 19

Nursing 7300 / MURTA March 3

Pharmacy 3100 March 8

HUMERUS PROSE

Old doctors never die . . . but sometimes they lose their patience.

Source: http://www.punoftheday.com/cgi-bin/disppuns.pl?ord=S&cat=6&sub=0602&page=1

Page 4


clinical experience. “It was inspiring to see people work with very little,” she said, adding, “I

was challenged in way I never thought possible.”

Following this session, the students attended two workshops from a choice of 27, visiting

research labs and teaching/surgical rooms on the University of Manitoba campus and in other affiliated sites.

Some of the workshops included:

• A Day in the Life of a Family Doctor where students had a chance to experience

the varied activities of a family physician using simulations and models to receive basic training in performing a delivery, suturing a wound, performing a colonoscopy

and reading x-rays;

• Medical Support to Soldiers where students learned about medical care provided

to soldiers in remote and overseas locations. A Power Point presentation provided an overview and “field medical kits” were available;

• Code Blue! With use of a simulator students lived the most exciting part of health

care - saving a life and running a simulated Code Blue; and

• Why They Call It “Practice” in which the students learned the way medical stu-

dents do in highly realistic scenarios wherein THEY were the doctors!

A special “Thank you!” goes out to SPs Nancy Gajdosik, Reid Graham, Robert Hal-

stead, Eden Katz, Rachel Klassen, & Michelle Szeto who helped the SP Program work-shop remain among the highest rated of the day.

Source: http://myuminfo.umanitoba.ca/index.asp?sec=36&too=100&dat=12/7/2010&sta=3&wee=2&eve=8&npa=23895


DISCOVERY DAY PRIMES YOUTH FOR MEDICAL CAREER (continued from page 1)

PHYSICIAN ASSISTANTS PROGRAM SETS PRECEDENT

For the first time in Manitoba history, physician assistants participated in the University of

Manitoba Fall Convocation on Wednesday, October 20, 2010. The ten graduates completed the country’s first Master’s level education program for Physician Assistants (PAs).

The two-year Master of Physician Assistant Studies degree, administered by the University of Manitoba faculties of Medicine and Graduate Studies, launched in September 2008. Previ-

ously, the only Canadian Medical Association-accredited physician assistant training program has been through the Canadian Forces.

“The University of Manitoba is a national leader in Physician Assistant education, a field which improves patient care and satisfaction,” said Dr. Brian Postl, Dean of the Faculty of

Medicine. “PAs are an important part of an inter-professional team, working collaboratively with physicians, nurses and other practitioners in a variety of settings.”

Under the supervision of a physician, PAs can perform a spectrum of duties including con-ducting physical examinations, ordering diagnostic tests, providing therapeutic procedures,

prescribing medications, and providing patient education and counseling. Although educated

as generalists, PAs are considered “polyvalent” clinicians who receive (continued on next page )

Page 5 SPread Sheet Volume 2, Issue 9, December 2010

PHYSICIAN ASSISTANTS PROGRAM SETS PRECEDENT (continued from previous page)

additional education, training, and experience

on the job and may work in primary care or subspecialty areas.

“Adding PAs to health care teams can help reduce wait times, curtail rising health care

costs, and alleviate workload issues,” said Ian Jones, Acting Program Director, Physician As-

sistant Education Program. “They are an im-portant component to addressing our prov-

ince’s health care human resource needs.”

The ten PA graduates come from diverse

backgrounds including nursing, biomedical en-gineering, athletic therapy, physical therapy,

occupational therapy, basic science and com-

munity health science.

The first Physician Assistant class is

comprised of the following graduates:

Melanie Richard – MPAS, M.Sc., B.Sc.:

Holds a Master of Science in Physiology University of Manitoba, and 4 year BSc in

Applied Biology. Prior to acceptance in the PAEP, had been involved as author in 25

Scientific Papers and presentations. A mother and wife; on her application a re-

viewer noted “Wow” – which has been demonstrated and remarked upon by every

preceptor and instructor who has the pleasure to meet her.

Heidi Robinson - MPAS, B.Sc. Kinesiol-

ogy and Applied Health: Heidi is an Oakbank resident, athlete, Navy reservist,

and musician. Prior to the PAEP Heidi worked in Clinical Research and as an ath-

letic therapist for several soccer teams and maintains an ongoing interest in Orthope-

dic Surgery. Her Capstone project in-volved research on Arthroplasty versus In-

ternal Fixation for Femoral Neck Fractures.

Heather Sigvaldason – MPAS, BMR

(Medical Rehabilitation, Physiothera-pist): Prior to acceptance in the PAEP

Heather worked in the Post-acute Neuro-

surgical Unit at the Seven Oaks Hospi-

tal. She brings to the PA profession

strong experience in Physiotherapy includ-ing time spent in Australia, and at the Pan-

AM games. Her personality is quiet, confi-dent, and her work ethic reflects proudly

on her Icelandic heritage.

Nikki Lwiwski – MPAS, B.Sc. Honours

(Genetics): Nikki is the Winner of the University of Manitoba Graduate Fellowship

award for 2009/10. She demonstrated sig-nificant leadership skills working hard to

improve the quality of the program through her involvement on several pro-

gram committees. Nikki managed to con-tribute, lead, and participate while main-

taining exemplary scholarship.

Elisa Pitamber – MPAS, B.Sc. (HNS): Elisa has entered the Physician

Assistant Profession building on her clinical experience in Human Nutrition Sci-

ences. Prior to acceptance Elisa was very active in several Volunteer organizations

including Habitat for Humanity, the Siloam mission, and the Osteoporosis Soci-

ety. Her hard work continued as she strived to improve the program through

communications and positive feedback.

Kevin Thiele – MPAS, M.Sc.

(Community Health Sciences) B H

Ecol: From, Dauphin, Kevin is dedicated to providing quality health care to his com-

munity. Throughout the program, Kevin directed his projects and research into un-

derstanding the values PA could provide to his community and to all Manito-

bans. Post Graduating Kevin has already assisted in furthering Diabetic and Wound

Care education opportunities for PA-Students and his community.

Jennifer Wilson – MPAS, BA psychol-ogy, M. Occupational Therapy. Born in

Selkirk, Jennifer is an example for future PA and students through her demonstrated


(continued on next page )

Page 6



SPOTLIGHT ON . . .

PHYSICIAN ASSISTANTS PROGRAM SETS PRECEDENT (continued from previous page)

enthusiasm in her clinical rotations and dedication for self improvement through her career

paths.

Marina Edwards – MPAS, B.Sc., BN, RN: Marina brings to the PA profession high quality

competence, experience, and a motivation to excel. Her prior experience enhances her academic and clinical acumen and combined with all the caring she demonstrated for her

family while completing the course will ensure her patients benefit from a outstanding pro-fessional.

Katrina Bruckschwaiger – MPAS, B.Sc. Biomedical Engineering: Katrina is an out-standing long distance runner and Bison Athlete who has provided the same passion for

her PA Education that she has demonstrated as a high performance athlete. Katrina quali-fied for the National track and field competition 3000meter race while maintain excellence

in her Academic studies.

Trevor Anderson-Hill - MPAS, B.Sc., BN, RN: Trevor graduates as a PA with a strong

interest in Community Health . Building upon his nursing expertise, Trevor has demon-

strated the value of life-long learning, a passion to improve himself and the community he cares for. His clinical preceptors and academic advisors recognize in him a dependable,

calm professional who will provide consistently high quality care.

Source: U of M e-memo, October 20, 2010

http://myuminfo.umanitoba.ca/index.asp?sec=2&too=100&eve=8&dat=10/20/2010&npa=23681

The other technician assigned

to the CLSF is Manju Balachander, Simulation System Administrator.

Not only is she responsible for the setup, maintenance, and care of

the simulators, Audio/Visual equipment, computers, and server and help-

ing in some of the instruction sessions and training people how to use the equipment and

software, she is also responsible for generat-ing reports, website maintenance, and setting

up exams on the EMS software.

Manju has been with the CLSF since 2008.

Prior to that, she worked with Wellington West as an Application Developer and with MTS

briefly as a graduate trainee. She graduated

in India with her engineering degree in 2001, and earned her masters degree here at the U

of M in June 2009, completing her masters project with TRLabs in 2007.

The position with the CLSF attracted her

eye because she was fascinated by the con-cept of helping people even though she wasn’t

a medical professional. Now that she’s been in the position for more than a year, she

really appreciates “the freedom to try out new and different concepts” as CLSF users become

familiar with, and expect more from, all the various capacities of simulation technology.

The oldest of two children, Manju was born in Secunderabad in the Indian state of Andhra

Pradesh just north of Hyderabad. She says, however, that now “home” means “Winnipeg,”

where she and her husband, Bala, have lived since getting married eight years ago; they

are expecting their first child in April.

In her spare time – when she has any –

she likes to watch movies, read, and cook. Her favourite proverb, translated from Tamil,

is: “Forgiving insult is a good habit; forgetting insult is better than that.”

Page 7



SYMPTOMS . . . Collapsed Lung & Hyperventilation

Sitting comfortably and sufficiently dis-

robed for the trainer to see chest movements, the SP should breathe with mouth open.

Then, the SP should pull in more air on one side of the chest, to expand that side more

than the other.

How can this be done? It’s instinctive, and

not SPs will be able to do it, like wiggling the ears or rolling the tongue. Once the SP has

tried it, the trainer should place his or her hands on the SP’s ribs as the SP breathes to

demonstrate how the chest is expanding more on one side than the other.

In an effort to be helpful, some SPs may

elevate the shoulder on the side where there is supposed to be more air. This is not contra

-indicatory as long as it’s not exaggerated and doesn’t lead the chest movement.

The asymmetry of the chest expansion can

be enhanced if the SP holds an arm tightly against the side of the chest that is not sup-

posed to expand. This actually looks natural as there is usually considerable pain with

most causes of pneumothorax (collapsed lung), and patients naturally clamp an arm to

the side to restrict movement.

Once the SP has mastered breathing asym-

metrically, the next step is to make the same chest movements without breathing. This is

the key to the simulation— making the same asymmetrical breathing movements whether

air is going in or not. An observer should not be able to tell the difference. Practice is es-

sential, and the SP should practice in front of a mirror, breathing and not, while constantly

moving the chest as if breathing at a steady rate.

During the simulation, the SP breathes in and out (asymmetrically!) when the exam-

iner’s stethoscope is on the normal side. When the stethoscope is moved the side of

the chest with pneumothorax, the SP contin-

ues to move the chest, but does not actually

breathe. The examiner will hear breath sounds on the normal side, but not on the

side with pneumothorax, even though the pa-tient appears to be breathing.

As a final trick, if the examiner lingers too long with the stethoscope on the side of the

pneumothorax and the SP feels a need to breathe, he or she can cough. The examiner

will remove the stethoscope (coughs are LOUD!) and the SP can pull in some air—while

maintaining asymmetrical chest movements.

If the examiner first encounters the patient

sitting on an examination table, usually the

exam is carried out with the SP sitting. It would be prudent, however, for the SP to

practice asymmetrical breathing while lying down, as well.

Sometimes this simulation will call for rapid breathing, or hyperventilation. Although this

is easy to do, if done incorrectly, it can lead to dizziness and/or faintness, and the simulation

cannot be maintained.

A number of conditions call for rapid

breathing, and the key is to take a deep breath, and then breathe rapidly on top of

that reserve of air in the lungs. If that re-serve is not let out, it should prevent dizzi-

ness. If dizziness does occur, then not

enough air was taken in initially.

Hyperventilation will also seem more real-

istic if the SP stops to breathe in the middle of sentences during an interview or answering

questions. In fact, the simulation loses real-ism if the SP stops breathing rapidly while

speaking.

Adapted from Training Standardized Pa-tients to Have Physical Findings, by How-

ard S. Barrows, M.D., Southern Illinois University, School of Medicine, Spring-

field Illinois, 1999, pp. 18, 25, & 26

Page 8


RESEARCH PIONEER INDUCTED INTO HALL OF FAME


Dr. Brian Postl, Dean of the Faculty of Medicine, congratulates Dr. Allan

Ronald OC (B.Sc Med, MD/61), , a world renowned infectious disease re-searcher, who will be inducted into the Canadian Medical Hall of Fame.

Established in 1994, the Canadian Medical Hall of Fame is the world’s only national Hall of Fame dedicated to celebrating medical heroes. By

creating an enduring tribute to those men and women who through dis-covery and innovation have contributed to better health in Canada and the

world, the Canadian Medical Hall of Fame inspires the pursuit of careers in the health sciences fostering future innovators and leaders.

Dr. Ronald is one of this country’s foremost physicians and microbiologists, who helped es-tablish in Canada a clinical specialty in infectious diseases. Born in Portage la Prairie, Dr.

Ronald trained in Manitoba, Maryland, Washington and Pakistan before returning to the Uni-versity of Manitoba’s Faculty of Medicine in 1968 to head its infectious disease unit. A full pro-

fessor since 1976, he led the first Department of Medical Microbiology (1976-1985) and then

the Department of Internal Medicine (1985-1990) and served as the Faculty’s associate dean of research (1993-1999).

In 1980, he established one of the first clinical investigation units exploring sexually trans-mitted infections in Africa. The program started small but eventually would put the University

of Manitoba on the map as a leader in the field of HIV epidemiology and immunology, as well as improve disease prevention and care. Lessons learned have been used widely throughout

Kenya and around the world. The Manitoba/University of Nairobi group has made major dis-coveries, including recognizing the importance of breast milk in the transmission of HIV from

mothers to infants, the role of male circumcision in reducing the risk of HIV infection among men, and the role of the immune system in protecting some individuals from acquiring HIV

infection.

In 2002, Dr. Ronald retired from a distinguished 35-year career as a professor and medi-

cal researcher and since then has helped develop a comprehensive HIV/AIDS Care and Pre-vention Program in Uganda.

Dr. Ronald has received awards from, among others, the Royal College of Physicians and

Surgeons of Canada, the Canadian Association of Professors of Medicine, the American Vene-real Disease Association, and the Canadian Medical Association, which in 2003 presented him

with its highest honour, the F.N.G. Starr Award. In 2006 he received the Gairdner Founda-tion Wightman Award and was appointed as Scientific Director of the National Collaborating

Centre on Infectious Diseases. Dr. Ronald is a Fellow of the Royal Society of Canada and an Officer of the Order of Canada.

Dr. Ronald will be inducted in to the Canadian Medical Hall of Fame under the category of Builder (Innovative Leadership). The University of Manitoba is now home to three Canadian

Medical Hall of Fame laureates: Dr Ronald, Dr. Bruce Chown and Dr. Henry Friesen.

Source: MEDLines, E-Newsletter of the Office of the Dean,

Faculty of Medicine, October 14, 2010

Page 9


CASE NOTES POTENTIALLY


As the SP Program moves forward and grows, we’re finding ways to improve the services

we provide. One of those ways is with the Case Note Template, which not only makes it eas-ier for Course Instructors to create scenarios, but also for SPs to learn them.

What follows is an example of the kind of clarity we’d like to bring to even the most com-plex of cases, one that we’ve found particularly pertinent to exams scheduled during this holi-

day season. This is only a potential case, so no confidentiality was breached in sharing the following case notes.

Standardized Patient Program

Case Notes University of Manitoba

Case Name / Number: 101225XMAS

Author(s): Iman Elf, M.D.

edited by Tim Webster, December 2010

Type of session: X Teaching

Type of station: X Communication X Physical Exam

Focus of case: Aerial Sleigh-Borne Present-Deliverer's Syndrome

Allotted time for completion: 20 minutes

Task(s) to be completed: __ obtain a complete medical history

X obtain focused and relevant history __ deal with a communication issue

__ deal with an ethical issue __ perform a complete physical exam

X perform a focused physical exam

X provide patient education __ provide student education

__ counsel the patient X indicate management decisions to be made

__ discuss monitoring plan __ indicate how follow-up will occur

__ other:_____________________________ (continued on next page )

Page 10


CASE NOTES POTENTIALLY (continued from previous page)

(continued on next page)


Scenario

1. Type of encounter (e.g new patient, E.R., clinic): new patient

2. Location / Setting of encounter: physician’s office

3. Opening statement from SP: “Ho! Ho! Ho!”

Patient

1. Name: S. Claus

2. Age: must appear to be over 65

3. Gender: male

4. Ethnic background: Caucasian

5. Marital Status: married

6. Weight (if relevant): BMI of 30 or greater

7. Highest level of education: unknown

8. Occupation: delivering presents once a year, on December 25th, to many people worldwide. He flies in a sleigh pulled by eight tiny reindeer, and

gains access to homes via chimneys. He has performed this work for as long as he can remember.

9. Primary language: English

10. Family members (if relevant): wife, Mrs. Claus

Medical History

1. Chief complaint (today): 1) generalized aches and pains, 2) sore red eyes, 3) depression, and 4) shortness of breath

2. History of present illness:

Symptoms:

1) Patient Claus has extensive ecchymoses (bruises), abrasions, lacera-tions, and first-degree burns on his head, arms, legs, and back.

He has leukoderma (loss of pigmentation) and anesthesia on his nose, cheeks, groin, and fingers

He has headaches nearly every day, usually starting half way through the day.

He has experienced chronic back pain for several years.

Page 11





2) His conjunctivae (clear membranes of the eyes) are hyperalgesic

(sensitive to pain) and erythematous (reddened)

3) Patient Claus’ depression has been chronic for several years.

4) He has had shortness of breath for several years.

Improving/worsening factors:

1) His bruises, abrasions, lacerations, and first-degree burns were caused and are worsened by: repeated chimney descents, falls from

his sleigh, collisions with birds during his flights, gunshot wounds (while flying over the Los Angles area), and bites consistent with rein-

deer teeth.

The loss of pigment and sensation on his face and in his fingers and

groin are consistent with frostbite caused by periods of hypother-

mia during high-speed, high-altitude flights.

His headaches get worse with stress.

The back pain gets worse when carrying a heavy sack of toys, en-during bumpy sleigh rides, and falling feet-first to the bottom of

chimneys.

2) Patient Claus’ sore eyes are aggravated by the dust, debris, and other

particles which strike his eyes at high velocity during his flights.

3) Because he experiences total darkness lasting many months during

winter at the North Pole, Seasonal Affective Disorder (SAD) may con-tribute to his depression.

4) His shortness of breath worsens during exertion.

3. Past medical history:

Immunizations: All his immunizations are up-to-date, including all available

vaccines for tropical diseases.

Diet & Exercise: He does not exercise.

He eats large meals with high sugar and cholesterol levels, and a high percentage of calories derived from fat. He subsists all year on food he

collects on December 25, which consists mainly of eggnog, soft drinks, and cookies.

Alcohol & Tobacco: Patient Claus only admits to drinking once a year: “Only when someone spikes the eggnog. Ho! Ho! Ho!”

He has smoked pipe tobacco for many years, although workplace regula-tions at the North Pole have forced him to cut back to one or two pipes

per day for the last 5 years.

Page 12





Relevant social history: His travel history is extensive, as he visits nearly

every location in the world annually.

Patient Affect

Initial posture: seated on side of examination table

Appearance: rosy cheeks, nose, & eyes; full, white beard with nicotine stains;

rapid, shallow breathing

Dress: fur-trimmed red suit with matching cap, black boots, glasses

Attitude / agenda: Although his demeanor is jolly, Patient Claus is concerned about his symptoms and thought he should have them checked out: “I’m

not as young as I used to be! Ho! Ho! Ho!"

Mannerisms / non-verbal gestures: When he laughs, Patient Claus’ belly will jiggle

like a bowlful of jelly.

Physical symptoms or findings:

Patient Claus is in mild respiratory distress.

A neurological examination will reveal a mild herniation of his L4-L5 or L5-S1 disk, and loss of sensation in the tip of the nose, cheeks, and fin-

gers.

If the interviewer initiates an eye exam, Patient Claus will say “The re-

sults of that test over there. Ho! Ho! Ho!” (The sheet will reveal numer-ous randomly occurring corneal abrasions and 20/80 vision).

Psychological symptoms or findings:

Patient Claus has a number of unresolved issues in his personal and pro-

fessional life which cause him distress.

He exhibits long-term amnesia, and cannot recall any events more than 5

years ago. This may be due to a repressed psychological trauma he ex-perienced, head trauma, or, more likely, the mythical nature of his exis-

tence.

Although he has a jolly demeanor, he expresses profound unhappiness.

He reports anger at not receiving royalties for the widespread commer-cial use of his likeness and name.

The patient feels annoyed and worried when he is told many people do not believe he exists.

He reports great stress over having to choose which gifts to give to chil-dren, and a feeling of guilt and inadequacy over the decisions he makes

as to which children are “naughty” and “nice”.

Page 13





Defining statements: “Ho! Ho! Ho!”

Any specific questions or statements the patient MAY make?

“Have you been a good boy / girl this year?” (dependent on the inter-

viewer’s gender)

“What do you want for Christmas?”

Any specific questions or statements the patient MUST make?

If the interviewer refers Patient Claus to a physiotherapist regarding his

back pain, he will agree.

If the interviewer refers Patient Claus to a psychiatrist (or other mental

health professional), he will agree.

If the interviewer suggests that Patient Claus consider switching to a

closed-canopy, heated, pressurized sleigh, he is reluctant: “I’ll have to

think about it.”

If the interviewer suggests that Patient Claus switch to a high-fibre, low

cholesterol diet, he may agree, depending on the rapport the interviewer has built. If he does not trust the interviewer sufficiently (“I’m not sure

–after all, you’re on the naughty list!”), he will refuse.

If the interviewer suggests that Patient Claus reduce his smoking and

drinking, he may agree, depending on the rapport the interviewer has built. If he does not trust the interviewer sufficiently (“I’m not sure –

after all, you’re on the naughty list!”), he will refuse.

If the interviewer suggests that Patient Claus add a helmet and protec-

tive accessories to his uniform, he will refuse.

If the interviewer indicates that s/he wishes to perform a rectal exam, Patient Claus will say “The results of that test are over there. Ho! Ho!

Ho!”

Props

corn cob pipe a sheet indicating vital signs

a sheet indicating results of Fluorescein staining (eye exam) a sheet indicating the results of a rectal exam

Additional Information

Reward a “good interviewing performance.”

If you, as the SP, perceive the interviewer asking open-ended questions and seeking to be helpful in an appropriate manner, Patient Claus should provide information

more readily and at least agree to consider some of the options/suggestions they

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suggest. If the interviewer has gained his trust, he will share his concerns and

thoughts about the situation.

The SP does not need to memorize the following information; it is provided

only to clarify questions about Patient Claus’ medical history and symptoms:

Patient Claus has no evidence of acute cardiac or pulmonary failure, but he is

quite unfit due to his mainly sedentary lifestyle and poor eating habits which, along with his stress, smoking, and male gender, place him at high risk for coro-

nary heart disease, myocardial infarction, emphysema and other problems.

Subsequently blood tests (revealed in the PEP) show higher-than-normal CO lev-

els, caused by smoke inhalation during chimney descent into non-extinguished fireplaces.

Instructions to candidate:

You are about to meet Mr. S. Claus, of indeterminate age, who presented to your family practice office with complaints of generalized aches and pains,

sore red eyes, depression, and general malaise.

His blood pressure is 150/95, heart rate 90 beats/minute, and respiratory rate

is 40.

The patient wears corrective lenses, and has 20/80 vision.

You are to: 1) conduct a focused medical history;

2) perform a focused physical examination; 3) advise the patient.

You have twenty (20) minutes.

Source: http://www.humormatters.com/holidays/Christmas/santasmed.htm

Happy Holidays! Best wishes to you and yours

from all of the staff at the Standardized Patient Program and the

Clinical Learning & Simulation Facility!

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