Direct Observation Prep and Learner Expectations

Palliative Care Clerkship

Clerkship Director: Dr. Laura Belland

You will have two separate cases with two separate standardized patients (SPs). Each are 10 minutes long.

Case 1 - Communication Skills

You will be asked to share a diagnosis of cancer with a patient who is presenting to the primary care clinic for follow up after being discharged from the hospital.

The student is expected to demonstrate the following behaviors:

• Setting the stage/preparation

  • Student reviews the presenting scenario and the patient information prior to the encounter.

• Greeting the patient/Establishing initial rapport

  • Student introduces self using first and last name.

  • Student states their current level of training as a medical student.

  • Student states their role in the encounter.

  • Student actively verifies the patient’s name and date of birth.

• Initiating information gathering

  • Student asks the presenting problem or reason for the patient to present to the care site, or can acknowledge that the patient was recently in the hospital.

• (S)PIKES protocol (S=setting already done)

  • Student obtains patient’s Perception about what they know regarding what was found during the hospitalization.

  • Student gives Invitation to give the news of what was found during the hospitalization.

  • Student delivers the news of what was found during the hospitalization (Knowledge)

  • Responding to Emotion

    • Student utilizes NURSE statements at appropriate junctures in response to patient’s emotion(s).

    • Student uses therapeutic pauses at appropriate junctures to allow patient time to process.

    • Student demonstrates respect towards patient through behaviors, words, and demeanor.

    • Student demonstrates empathy towards patient through behaviors, words, and demeanor.

• Closing the encounter

  • Student initiates invitation to Summarize and discuss next steps.

  • Student indicates next step includes oncology referral.

    • Student is not expected to know specifics of the oncologic plan.

Case 2 - History-Taking Skills

You will be asked to see a patient presenting to the outpatient palliative care clinic to establish care.

The student is expected to demonstrate the following behaviors:

• Setting the stage/preparation

  • Student reviews the presenting scenario and the patient information prior to the encounter.

• Greeting the patient/Establishing initial rapport

  • Student introduces self using first and last name.

  • Student states their current level of training as a medical student.

  • Student states their role in the encounter.

  • Student actively verifies the patient’s name and date of birth.

• Introducing the clinic and specialty

  • Student assesses patient’s awareness of what type of clinic this is

  • Student explains what palliative care is

  • Student explains what hospice care is

• Initiating information gathering

  • Student assesses patient’s awareness of the reason for referral to the clinic.

  • Student performs a thorough pain assessment related to the serious illness (note: no physical exam).

  • Student asks at least 5 pertinent symptom questions (e.g. insomnia, anxiety, constipation, nausea/vomiting, anorexia, depression, dyspnea, confusion).

  • Student assess patient’s palliative performance status (note: no physical exam).

  • Student confirms Health Care Proxy/Agent form information in the chart.

• Exploring patient’s perspective of the illness

  • Student demonstrates respect towards patient through behaviors, words and demeanor.

  • Student demonstrates empathy towards patient through behaviors, words and demeanor.

  • Student acknowledges feelings, concerns and anxieties of patient by verbally recognizing them and legitimizing them.

• Closing the encounter

  • Student directly asks for any additional questions or concerns the patient may have.

  • Student verbalizes to patient that a plan will be made for patient’s pain and symptoms after conferring with attending.