ℹ️ This is the case information for the doctor.
Name
Peter Collins
Age
67 years old
Address
52 Bellefield Road, Warrington
Social history
Smoking status: Smokes 10-15 cigarettes a day, has tried to quit several times (using patches/vape, but relapsed).
Alcohol: Occasionally – about 2-3 pints/week.
Living situation: Lives with wife; grown children live nearby.
Previous occupation: Retired builder.
Past history
Diagnosed with COPD 7 years ago.
Hypertension (well controlled).
No known diabetes or cardiac disease.
No hospital admissions for COPD
Investigation results
Spirometry 6 months ago showed FEV1 48% predicted (moderate to severe obstruction).
O2 saturations at last check: 94% on air.
Routine bloods 6 months ago normal
Last CXR 1 year ago: No acute changes, hyperinflated lungs.
No recent sputum cultures or ECG.
Medication
Salamol as required
Ramipril for hypertension.
No history of allergy to medications.
Booking note
COPD review
ℹ️ This is the information for the person role playing the patient.
Name
Peter Collins
Age
67 years old
Address
52 Bellefield Road, Warrington
Social history
Smoking status: Smokes 10-15 cigarettes a day, has tried to quit several times (using patches/vape, but relapsed).
Alcohol: Occasionally – about 2-3 pints/week.
Living situation: Lives with wife; grown children live nearby.
Previous occupation: Retired builder.
Past history
Diagnosed with COPD 7 years ago.
Hypertension (well controlled).
No known diabetes or cardiac disease.
No hospital admissions for COPD
Medication
Salamol as required
Ramipril for hypertension.
No history of allergy to medications.
"I’m finding my breathing’s getting worse, doc. I just wanted to talk it through and see if there’s anything more I should be doing."
Breathlessness gradually worsening over the past few months.
Misses being active, feels a bit useless at times.
Coughs every day, occasionally brings up a bit of greyish phlegm.
More About Symptoms:
No chest pain, but on a couple of occasions, breathless even at rest (when had chest infections).
No leg swelling or palpitations.
Gets a bit wheezy when at rest, worse at night or in cold weather.
Appetite okay but lost about half a stone in last few months, mainly because less active.
Admits to feeling down, low mood some days, especially after bad nights.
Ideas:
Wonders if lungs are "packing up."
Thinks maybe something stronger medication-wise is needed.
Concerns:
Worried he’ll "end up on oxygen" or "in hospital permanently."
Afraid he’ll be a burden to his wife.
Embarrassed to cough in public.
Expectations:
Wants to know what more can be done – new inhalers, tablets, or other treatments.
Interested if there’s physio or something to help him "get fit again."
Would like more help with stopping smoking.
Would prefer to see same doctor for continuity.
Family History:
Father died of emphysema at 74 (smoker).
Mother had heart disease.
Appears mildly breathless but not in acute distress; pauses occasionally when talking.
Somewhat anxious and a bit low in mood, but engaged and keen for advice.
Shows gratitude if the doctor listens, explains things, and offers a plan.
Opens up more about mood, fears, and embarrassment if asked sensitively.
If the doctor mentions pulmonary rehab or support groups, becomes interested .
If doctor brushes off concerns or is dismissive, becomes frustrated and withdrawn.
If encouraged, receptive to discussing smoking cessation again; motivated but needs support.
Responds well to suggestions of continuity ("It would be good to see you regularly about this, doctor").
ℹ️ To mark data gathering & diagnosis select from the descriptors below.
Positive descriptors
Negative descriptors
Data gathering was systematic and targeted ensuring patient safety.
Begins with open questions to establish the progression of breathlessness and allow Mr. Collins to share his concerns and perspectives in his own words.
Progresses to closed, focused questions to clarify the nature, duration, severity, and impact of his breathlessness, cough, exacerbation history, and smoking status.
Data gathering was incomplete, lacking structure and focus.
Fails to clarify the extent of breathlessness, its progression, and associated symptoms.
Jumps between symptoms and omits key aspects such as frequency of exacerbations, medication adherence, or smoking history.
Makes effective use of existing information and considers the wider context.
Reviews and references Mr. Collins' documented COPD, past spirometry, medication regimen, and exacerbation record.
Enquires about daily activities, impact on social and family life, and his home circumstances to contextualise management.
Fails to use the information provided or understand the wider context.
Ignores previous spirometry, medication list, or exacerbation frequency noted in records.
Neglects to consider Mr. Collins' social setting, support network, and day-to-day challenges.
The presence or absence of relevant red flags was established.
Actively elicits symptoms that may suggest alternative or serious pathology—chest pain, orthopnoea, haemoptysis, leg swelling, fever, unintentional weight loss, or cardiovascular symptoms.
Assesses risk factors for acute deterioration, such as recent severe exacerbations or increasing frequency of infections.
Fails to assess key information necessary to determine risk.
Fails to enquire about symptoms that could point to cardiac failure, malignancy, infection, or pulmonary embolism.
Omits assessment of the severity and triggers of recent exacerbations.
Information gathered placed the problem in its psychosocial context.
Explores impact of COPD on mood, independence, relationships, and hobbies.
Addresses psychological wellbeing (e.g., screen for depression and anxiety), support from family, and fears about the future.
The social and psychological impact of the problem was not adequately determined.
Fails to ask about emotional wellbeing, isolation, or effect on lifestyle.
Overlooks family support, concerns about being a burden, or embarrassment due to symptoms.
A working diagnosis was reached using a structured, evidence based approach.
Uses a logical question sequence (onset, duration, triggers of breathlessness; frequency/severity of exacerbations) to narrow down COPD progression versus other pathology.
Reviews past investigations (spirometry, O2 saturations) and integrates findings into an updated assessment.
The evidence collected was inadequate to support the conclusions reached.
Reaches conclusions about COPD progression or treatment escalation without adequately exploring the symptom pattern or excluding cardiac/other causes.
Does not reference or build on existing test results or evidence.
Uses an understanding of probability based on prevalence, incidence, and natural history to aid decision-making.
Recognises ongoing smoking and frequent exacerbations as predictors of COPD progression and risk.
Appropriately weighs other causes of breathlessness based on Mr. Collins' age, smoking history and symptom evolution.
Choce of diagnosis and investigatiosn does not reflect disease severity or likelihood.
Overlooks common complications of COPD.
Suggests unnecessary investigations or management strategies without clear clinical indication.
ℹ️ To mark clinical management & medical complexity select from the descriptors below.
Positive descriptors
Negative descriptors
Offers management options that are safe and appropriate.
Reviews current inhaler use and escalates in line with NICE guidance (offers escalation to LABA/LAMA dual therapy or LABA/ICS if asthmatic features, given frequent exacerbations).
Fails to provide appropriate and/or safe management choices.
Omits escalation of inhaled treatment despite evidence of symptom progression and frequent exacerbations.
Does not discuss or monitor for potential side effects or complications of steroids or inhalers.
Continuity of care is prioritised.
Proposes regular planned follow-up with the same GP or integrated respiratory nurse.
Emphasises importance of ongoing review and monitoring for COPD and mood.
Ongoing care is uncoordinated.
No structured follow-up or signposting for ongoing review.
Creates uncertainty about who will provide future care or how patient progress will be monitored.
Empowers self-care and independence.
Encourages self-management by advising on inhaler technique, symptom monitoring, and avoiding triggers.
Supports and motivates smoking cessation with personalised advice and access to support services.
Management fails to foster self-care and patient involvement.
Makes all decisions without involving the patient or addressing his self-management capability.
Fails to address or offer support for smoking cessation.
Prescribes safely considering local and national guidance.
Upgrades inhaled therapy following NICE/Gold guidance, checks for inhaler technique, and considers vaccination status (flu, pneumococcal).
Reviews contraindications and checks for drug interactions (e.g., ICS with pneumonia risk, ensures steroid doses are appropriate).
Unsafe prescribing ignoring best practice.
Escalates treatment without considering existing therapy, inhaler technique, or potential risks.
Fails to review or document vaccinations, potentially missing preventable complications.
Refers appropriately being mindful of resource.
Offers pulmonary rehabilitation, explaining its benefits for functional status and quality of life.
Considers referral to smoking cessation service and/or to respiratory team if complicated features.
Does not consider appropriate referral options
Fails to consider appropriate community support options to improve well being and outlook.
Manages uncertainty, including that experienced by the patient.
Acknowledges the unpredictable nature of COPD progression and provides safety netting.
Validates patient concerns about future deterioration and dependency, offering reassurance and clear action plans.
Struggles with uncertainty, leading to inconsistent decisions.
Ignores the patient’s anxieties or gives vague advice without discussing uncertainties or what to do if symptoms change.
Leaves the patient feeling unsupported or unclear about prognosis and next steps.
ℹ️ To mark relating to others select from the descriptors below.
Positive descriptors
Negative descriptors
Shows ability to communicate in a person-centred way:
Listens carefully to Peter’s story and allows him time to describe how breathlessness affects his daily life and mood.
Adapts explanations of COPD, inhalers, and future plans to match Peter’s understanding and unique concerns.
Communication is doctor centred and lacks empathy:
Focuses the discussion solely on medication or guidelines, rather than Peter’s experiences and worries.
Provides information without engaging Peter or exploring how changes will affect him personally.
Treats patients fairly and with respect:
Affirms Peter’s efforts and challenges in smoking cessation and disease self-management, addressing him non-judgementally.
Shows respect for his wishes around continuity and involvement of his wife, and recognises the impact on his family.
Decisions fail to prioritise the patient’s rights and interests
Criticises Peter for ongoing smoking, or dismisses his feelings of guilt or dependency.
Ignores or overrides Peter’s request for consistent follow-up or involvement of his support network.
The patient’s agenda was understood:
Identifies Peter’s desire for better control over his condition, fear of deterioration, worries about his wife, and his wish for continuity.
Demonstrates active listening and responds clearly to Peter’s questions and concerns.
Fails to recognise the patient’s agenda and impact of the problem:
Does not explore what matters most to Peter or address his anxieties about being a burden or further decline.
Offers generic information on COPD without adapting to Peter’s agenda.
Recognises what matters to the patient and works collaboratively to enhance patient care:
Works with Peter to create a shared plan for inhalers, smoking cessation, rehabilitation, and follow-up, involving his preferences throughout.
Responds to emotional cues, such as anxiety or low mood, by validating and incorporating mental health into the care plan.
Fails to work with the patient to plan care:
Presents a management plan without inviting Peter’s input or considering what he wants from his care.
Misses emotional cues, leaving Peter unsupported in coping with the emotional burden of COPD.
Demonstrates flexibility of communication adapting to the patient and scenario:
Explains the rationale for treatment escalation and pulmonary rehabilitation in simple terms; pauses to check for understanding.
Adjusts language and tone if Peter seems anxious, overwhelmed, or low in mood.
Consults rigidly, providing generic explanations and management plans:
Repeats standard information without ensuring Peter follows, or uses technical terms without clarifying meaning.
Does not adjust communication style when Peter shows signs of distress or confusion.
Checks the patient’s understanding of the consultation including any agreed plans:
Summarises key points, confirms Peter understands changes to inhaler therapy and referral plans.
Clarifies steps for follow-up and safety netting,and encourages questions or clarification.
Does not seek to confirm understanding:
Ends the consultation with unresolved confusion about inhalers, pulmonary rehab, or warning signs.
Does not provide opportunities for Peter to ask questions or clarify his understanding.
ℹ️ Insights from the examiner
“Could you tell me about how your breathing has been day to day over the past few months?”
“When you’ve tried to stop smoking in the past, what helped? What got in the way?”
“COPD is a long-term lung condition that can gradually get worse, but there are some changes we can make now to help keep your lungs healthy.”
“It sounds like it’s been tough noticing those changes in how far you can walk.”
“It’s clear you’re trying your best with your inhalers and quitting; let’s figure out how to help you more.”
References:
Simulated consultations: a sociolinguistic perspective (BMC)
“It sounds like you’re worried about what’s coming next. Can you tell me more about your concerns?”
“You mentioned feeling a bit down—that’s important, and not uncommon with conditions like this.”
“A lot of people feel self-conscious about coughing, but you’re not alone.”
“What would you like to be able to do that’s been getting harder?”
“Let’s work out some steps—maybe getting further when walking, or building confidence with your inhaler, or finding some extra support for quitting smoking.”
References
