Educational AffairsOffice of Clinical Simulation

Standardized Patient Center and Clinical Skills Center

Template for Standardized Patient Script

(Adult Patient)

The following pages outline information needed to fully develop a standardized patient script using the script format approved by the Standardized Patient Advisory committee in June 2001. 

If you are writing a new script: please fill in ALL historical information. If a physical examination is included please specify the portions of the physical examination that you anticipate the examinee will perform.

If you are reformatting an existing script: please attach the script and complete the areas of the template where the requested information is NOT present in the existing script.

While we recognize that a detailed description of the patient scenario is being requested, it is important to have this information to insure standardization of patients and accurate, reproducible portrayals. Please note: template modifications are available for the pediatric and geriatric patient. If you have any questions regarding a script, please contact:

Karen Szauter, MD
Medical Director, Standardized Patient Program
Ext: 26300
Email: kszauter@utmb.edu 


Thank you for your interest in the Standardized Patient Program.

TOOLS: Sample Door Sign

Sample door sign for history and physical examination

[First name Last name] is a [xx]-year-old girl who presents to the clinic for the evaluation of specific problem.

Vital signs:

Temperature: xx.xo F

Respirations: xx per minute

Pulse:  xx bpm

Blood pressure:  xxx/xx mmHg

Instructions to Students:
Perform a medical interview and physical examination focused to the patient's problem(s).

Time allotted: xx minutes


Sample door sign for history and counseling

[First name Last name] is a [xx]-year-old woman who presents to the clinic for [purpose of visit]

Vital signs:

Temperature: xx.xo F

Respirations: xx per minute

Pulse: xx bpm

Blood pressure: xxx/xx mmHg

Instructions to Students:
Perform a medical interview focused to the patient's problem. Discuss your findings with the patient and provide appropriate counseling.

Time allotted: xx minutes


Sample door sign for history and counseling when laboratory studies are included in the initial information

[First name Last name] is a [xx]-year-old man who presents to the clinic because [reason for coming in today.]

The patient came to the clinic yesterday for lab studies to be done in preparation for today's visit. The patient has not yet been informed of the results of the lab tests.

Vital Signs:

Temperature: xx.xo F

Respirations xx per min

Pulse: xx bpm

Blood Pressure: xxx/xx mmHg

Labs from yesterday:

Lab test #1: Results

Lab test #2: Results

X-ray/other study results

Instructions to Students:
Perform a medical interview focused to the patient's problem(s) and provide appropriate counseling.

Time allotted: xx minutes

TOOLS: Sample Script

Eugenia Frankel

Exam:

  • Presenting Complaint: painful knee
  • Actual Diagnosis: osteoarthritis
  • Patient demographics:
  • Age: 65
  • Sex: Female
  • Race: does not matter
  • Body habitus: does not matter

Case summary: Eugenia Frankel is a 65 year old woman who comes to the clinic because of knee pain. She has had progressively worsening pain in the right knee over the past five years. The pain is now almost daily and has begun to interfere with her ability to perform her daily activities.


SCRIPT TRACKING

  • Case Author: KS/MAA
  • Date of Development: May 2002
  • Most recent update: May 2003(case retired from assessment case pool Sept 2004)

CASE OBJECTIVES: (Samples)

  • (1) Evaluate chronic joint pain in a geriatric patient
  • (2) Address both the medical and lifestyle issues associated with decreased mobility in an active older person

STANDARDIZED PATIENT TRAINING MATERIAL

Eugenia Frankel

Case Summary

You are portraying Eugenia Frankel, a 65 year old woman who comes to the clinic because of knee pain. You have had progressively worsening pain in your right knee over the past five years. The pain is now almost daily and has begun to interfere with your ability to perform you daily activities.

Case Setting

  • You are in the physician's office

Case Challenge

  • The student must perform a focused medical interview and a focused physical examination

How You Appear During the Encounter

  • Physical Description
  • General appearance/grooming: You are clean and neatly groomed.
  • Dress: You will be dressed in a hospital gown. Please wear boxer shorts under your gown so that the student can easily examine your legs without compromising your modesty.

Description of Affect and Behavior

You are pleasant and cooperative with the interviewer. You are an easygoing person and generally enjoy interacting with other people. You are concerned about your knee and you are uncomfortable which will influence your behavior a little. You should maintain normal levels of eye contact with the student.

Why You Are Seeing Your the Doctor Today

  • Description of Current Problem

Timeline

  • You first noted discomfort in your knee about 5 years ago
  • The pain has slowly progressed to the point where it bothers you daily
  • The pain worsens throughout the day with increasing levels of activity

Opening statement

  • Your initial statement should be about your "knee"
  • The student may open the interview with something like "how can I help you?" or "what brings you to the clinic today?"
  • Your response should be "My knee is bothering me a lot"
  • If the student states your problem (e.g. "I understand that you are having problems with your knee")
  • You should respond "Yes, I wanted someone to take a look at my knee. It is bothering me a lot"
  • If the student asks you "tell me more about it" or "can you tell me what has been going on"
  • You should respond "It's getting harder and harder for me to do what I want because of the pain"

Current Medical History

History of your problem (Information relating to your primary complaint)

  • Onset: You first noticed the pain about five years ago.
  • Context: You retired from your job at American National 5 years ago. Shortly before you retired you noticed that your knee would bother you when you would walk up and down the steps at work. After you retired, you started doing more things with your church and around the house and began to notice that your knee would bother you after you had been active.
  • Location: The whole right knee hurts. (Note: the left knee hurts a little too, but not nearly as much) When the student asks you where the knee hurts you should put your hand on the front of your knee and rub it almost as a reflex to the question.
  • Radiation: The pain is localized to the knee joint. It dos not radiate anywhere. There is no numbness or tingling in your lower leg or foot.
  • Character: The pain is aching, at times is very sharp.
  • Severity: The pain is variable. Some days the pain is a 2-3. Other days it gets as bad as a 7-8. [ On a 1-10 scale (where 10 is the worst pain possible)].
  • Timing: You have a little bit of stiffness first thing in the morning â€" it takes you 15 minutes or so to "get going". The pain is not too bad first thing in the day, but it progressively worsens throughout the day with increased activity.
  • Aggravating Factor: Activity. Long distance walking (you like to walk your dog) bothers you. Activity that involves a lot of bending of your legs like walking up and down the stairs or if you have to do a lot of bending on days that you clean house is also a problem. Your pain also seems to be worse on damp, cool or rainy days.
  • Relief by: You have tried Aleve (you do not remember the strength). It gives you some, but not complete, relief. Sometimes when you are relaxing in the evening or at night, especially on days when you notice swelling in the knee, you use a heating pad. The warmth helps a little. Mostly you just have to get off of your feet and put your leg on a footstool to raise it in order to get relief.
  • Associated Symptoms: You have occasional swelling towards the end of the day. You feel like you can't bend your knee completely anymore (limited range of motion). You have not fallen because of weakness or instability in the knee.
  • NOTE: You do NOT have fever, weight loss or any other signs of a generalized illness.
  • Previous episodes: You have never injured your knee. The pain now is the same as it was when you first noticed it five years ago. It has slowly progressed to the point now where you have pain daily and at times the pain is unbearable.
  • What you think is going on: You have not seen a doctor about the pain but you wonder if you have arthritis.

Past Medical History

  • Overall Health: Your general health is very good.
  • Prior Hospitalizations: You were hospitalized for the birth of your daughter 35 years ago. You have had no other hospitalizations.
  • Medical Illnesses: You have diabetes (you were diagnosed about 5 years ago). You have been in very good control - you don't check you blood sugars regularly - occasionally you dip your urine but it is always negative for sugar. Your last Hemoglobin A1C was 5.
  • Surgery/Trauma: You have never had major surgery. You broke your left wrist when you were 41 (you fell while walking your dog.)
  • OB/Gyn History: You started having your period when you were 12. You had one full term pregnancy and uncomplicated vaginal delivery. You went through an uncomplicated menopause at age 56.
  • Medications: You take Glypizide (you think it's 10mg) one time daily. You use Aleve (2-3 times daily) for your knee as needed and Tylenol for an occasional headache. You are not using any herbs.
  • Immunizations: You are up-to-date on your immunizations. You do not get an annual flu shot.
  • Allergies: You are allergic to erythromycin - (you vomit)

Preventive Health Issues

Last visit to an MD: You visit your PCP every six months to check on your diabetes and refill your medications. (Quick visits - sometimes you see the nurse practitioner and the doctor just says hello.) At the last visit (4 mo ago) you were told that everything was fine. You have not had a recent well woman check (need to schedule this - you've been "so busy") and you have not seen another doctor or required any specialty medical care.

Your preventive health care checks are not up-to-date. You do not know your cholesterol level. The doctor wants you to have a screening colonoscopy but you simply have not gotten around to it.

Family History

  • Father: Deceased. Age 76. He had severe emphysema and developed pneumonia.
  • Mother: Deceased. Age 64. She has migraine headaches. She had a stroke.
  • Siblings: None.
  • Daughter: Age 35. She is very overweight and has diabetes.
  • Grandchildren: None.

You are not aware of any other major health problems in the family. Specifically no one in your family has had cancer of any kind. If specifically asked, you are not certain if your mother had arthritis.

Present Life

  • Age: 65
  • Date of Birth: June 1, 1943
  • Level of Education: You have a college degree in business
  • Occupation: Retired. You worked at American National Insurance Company in the marketing department for 30 years.
  • Sexual History: You are sexually active with your husband only. You have been married for 38 years.
  • Life Details: You live in a house on Tiki Island with your husband. Your daughter lives in Beaumont. She attended Lamar University and settled in the area after graduation. She is history teacher at Lamar University. Your parents lived in Texas City. Your father worked for the refineries. Your mother was a housewife.
  • Hobbies: You enjoy doing things around the house and walking your dog. You also like to crochet. (Note: If the student asks, your hands do not bother you when you do needlework.)
  • Religion: You are Methodist. You attend church regularly. You are involved in volunteer work through the church at a soup kitchen and at one of the local nursing homes. You enjoy your church work and are concerned that the pain in your knees may interfere with your ability to do everything that you want.
  • Financial Status: You are comfortable financially.
  • Health Insurance: You are covered by Blue Cross insurance. You recently became eligible for Medicare.
  • Life Stresses: You perceive very little overall stress in your life. You and your husband are quite happy and enjoying retirement together. Your limitations because of your knee pain are a bit of a stress - you don't like having limitations on your activities.

Personal Habits

  • Tobacco Use: None. Never used tobacco products.
  • Alcohol Use: You have an occasional martini when you go out to dinner (maybe once every two or three months). You never drink at home.
  • Illicit Drug Use: None.
  • Diet: You eat a healthy diet. You always eat fruit, vegetables and lots of whole grains. You and your husband eat together and mealtime is relaxing time that you spend together.
  • Caffeine intake: You have coffee in the morning and an occasional cola drink. In the summer months you drink a few glasses of iced tea daily.
  • Exercise: You are active. You keep up your home and enjoy being outside with your dog.
  • Sleep Pattern: You have no problems sleeping. Sometimes your knee pain interferes with your ability to fall asleep. Once you fall asleep you do well through the night.

Other Symptoms/Problems You Have Encountered

  • You have occasional "leakage" of urine with coughing or heavy lifting. This has been going on for the past 8 years. You have never talked to the doctor about it - It's a little embarrassing and you assume it is part of "getting older".
  • You have no other significant problems.
  • Any other symptoms that the student may ask about, you answer "No".

Questions That You Should Ask the Student During the Encounter

  • Do you think the herbs they have been advertising on TV for arthritis would help my knee pain. (Chondroitin)

Physical Exam

  • The student should limit the physical examination to your legs
  • The student should carefully (but gently) feel for swelling and tenderness in your knee. They should also flex and extend your knee. Flexing and extending the knee will cause pain. You should limit your motion of the right knee on bending and flexing to ~ 90o.
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