ℹ️ This is the case information for the doctor.
Name
Ilyas Kassi
Age
39 years
Address
23 Rosebank Avenue, Leicester
Social history
Past history
Investigation results
None
Medication
None
Booking note
Saw the nurse last week for a new patient check, asked to come back to discuss smoking cessation.
ℹ️ This is the information for the person role playing the patient.
Name
Ilyas Kassi
Age
39 years
Address
23 Rosebank Avenue, Leicester
Social history
Past history
Medication
None
“I saw the nurse last week for a new patient check and she says I really must stop smoking.”
Information given in response to questions or when good rapport is established
a) Details about the presenting problem and its context:
b) Ideas, concerns, expectations, family history:
Ideas:
Concerns:
Expectations:
Family history:
Social details:
ℹ️ To mark data gathering & diagnosis select from the descriptors below.
Positive descriptors
Negative descriptors
Data gathering was systematic and targeted ensuring patient safety.
Data gathering was incomplete, lacking structure and focus.
Makes effective use of existing information and considers the wider context.
Fails to use the information provided or understand the wider context.
The presence or absence of relevant red flags was established.
Fails to assess key information necessary to determine risk.
Information gathered placed the problem in its psychosocial context.
The social and psychological impact of the problem was not adequately determined.
A working diagnosis was reached using a structured, evidence based approach.
The evidence collected was inadequate to support the conclusions reached.
Relevant information was collected to place the undifferentiated problem in context and an appropriate differential diagnosis generated.
Inadequate information was collected to determine the likely cause of symptoms.
ℹ️ To mark clinical management & medical complexity select from the descriptors below.
Positive descriptors
Negative descriptors
Offers management options that are safe and appropriate:
Fails to provide appropriate and/or safe management choices:
Continuity of care is prioritised:
Ongoing care is uncoordinated:
Empowers self care and independence:
Management fails to foster self care and patient involvement:
Prescribes safely considering local and national guidance:
Unsafe prescribing ignoring best practice:
Refers appropriately being mindful of resource:
Sends patients for specialist input unnecessarily:
Arranges appropriate follow-up:
Unclear or inadequate follow-up:
ℹ️ To mark relating to others select from the descriptors below.
Positive descriptors
Negative descriptors
Shows ability to communicate in a person-centred way:
• Actively acknowledges Ilyas’s desire to quit smoking and respects his request for practical help rather than a lecture.
• Adjusts tone and language to foster a non-judgmental, supportive atmosphere, validating his efforts and emotions throughout the conversation.
Communication is doctor-centred and lacks empathy:
• Focuses on delivering didactic advice about the dangers of smoking without considering Ilyas’s personal context.
• Ignores Ilyas’s need for practical assistance, fails to respond to his emotional cues, or becomes paternalistic or critical.
Treats patients fairly and with respect:
• Demonstrates respect for Ilyas’s autonomy and life choices, avoiding judgement about his past smoking or previous failed attempts.
• Adopts a collaborative approach, considering Ilyas’s preferences and circumstances (e.g., his work, home life, relationships).
Decisions fail to prioritise the patient’s rights and interests:
• Uses disapproving language or stereotypes smokers.
• Pressures Ilyas into treatments or programmes he clearly declines, disregarding his personal values and choices.
Shows understanding of medical-legal principles and regulatory standards:
• Ensures Ilyas receives clear information about stop-smoking treatments, their risks, side-effects, and alternative strategies, supporting informed choice.
• Maintains sensitiveity and respects Ilyas’s right to choose (or refuse) interventions.
Fails to give appropriate regard to key legal aspects of consulting:
• Omits information required for informed consent regarding nicotine replacement or fails to check understanding.
• Discusses Ilyas’s smoking in a way that does not respect patient choice.
Explores the patient’s agenda, health beliefs and preferences:
• Elicits Ilyas’s motivations, concerns, and previous experiences around quitting, including emotional and practical barriers.
• Asks about preferences for methods of support, coping strategies, and desired pace or timing for quitting.
Fails to recognise the patient's agenda and impact of the problem:
• Ignores Ilyas’s preferred method (e.g., patches over medication) or does not ask about previous difficulties/quitting attempts.
• Fails to explore the challenges posed by Ilyas’s social environment (friends/co-workers who smoke).
Recognises what matters to the patient and works collaboratively to enhance patient care:
• Works in partnership to agree on a plan that fits Ilyas’s goals (e.g., using patches, avoiding group support), scheduling appropriate follow-up.
• Responds adaptively to cues about Ilyas’s social life, relationships, and recent motivations (mother’s success, new girlfriend).
Fails to work with the patient to plan care:
• Recommends only group-based support or smoking clinics, disregarding Ilyas’s wishes.
• Pushes a rigid plan without negotiating or checking agreement.
Demonstrates flexibility of communication adapting to the patient and scenario:
• Adjusts explanations for stop-smoking aids to match Ilyas’s practical needs at work and home, checking understanding.
• Offers a range of options and adapts to Ilyas’s responses during the discussion.
Consults rigidly, providing generic explanations and management plans:
• Uses medical jargon or offers a fixed script not tailored to Ilyas’s work/life circumstances.
• Fails to clarify or adapt when Ilyas expresses uncertainty or asks for alternatives.
ℹ️ Insights from the examiner
Confirm the reason for attendance avoiding assumptions. As you will know from day to day practice the reason on the booking note is not always the true reason for the appointment.
"It says in your notes that you are interested in some help to stop smoking, is that what you wanted to talk about today?"
The above is is a good example of a two part introduction, useful for when you have information about the likely reason for attendance.
Part 1 - show interest.
Part 2 - establish the patient agenda
In the first part of the sentence you use the advance information to rapidly build rapport. How?. By showing you are interested in the patient as demonstrated by the fact you have made the effort to prepare for the consultation by reading their notes. In the second part of the statement you show that you want to prioritse the patients agenda checking what their priorities are and avoiding assuming you already understand them.
Use brief, open questions to allow Ilyas to share his story:
"Can you tell me what made you decide to give stopping smoking another try?"
This gives space for Ilyas to declare his motivation and expected agenda.
Use targeted questions to clear up any missing information relevant to the consultaion but don't get hung up on them. For example efficiently clarify what he’s already tried and what helped or hindered him, e.g., his mother and girlfriend’s influence. The bulk of the marks is in clinical management and you need to move onto this by 6-7 minutes in.
"How many do you smoke a day now?"
"In which situations do you find yourself reaching for a cigarette the most?"
"Have you tried to stop before—what happened then?"
Structure speeds along the history.
Communication should be supportive and match Ilyas’ understanding:
"Lots of people feel it helps them cope, but there are ways of getting through the cravings. I can explain these, if you like?"
Avoid jargon and frame support in concrete, familiar language:
"Nicotine patches can really cut down cravings and help your mood while you stop."
Ilyas’s anxiety about quitting, enjoyment of smoking, and anticipated irritability are central. Probe and validating these cues :
"You mentioned you get ratty when you try to stop. What worries you about not smoking."
Demonstrate you’ve heard his concerns about both the rewards and the challenges.
Explicitly share control:
"What are your thoughts about stopping?"
"Would working towards a quit date is more likelly to help you stick to quitting, how would you feel about that?"
Refer back to his agenda—support for quitting now.
Link each question to the last, and signpost your reasoning:
"So you smoke most around work, and friends smoke too. That must make it harder. Are there people at work or home that can support you?"
Focus is behaviour change/nicotine addiction. It is worth consider smoking realted disease as relevant (history of cough), but don't get distracted from the key agenda. There arevarious issues that may be contributing to his difficulty in quitting and expressing these thoughts will show you have considered their impact and help the patient to reflect on them whilst demonstrating your awareness to the examiner.
Explore personal and contextual effects:
Give simple, easily processed chunks of information so that you make it easy forthe patient to give ou:
"Stopping will help your cough settle and your lungs heal. It also halves your chances of heart disease within a year. You’ll taste food better, and your clothes and home will smell nicer—plus you'll save a lot of money."
Make your clinical reasoning explicit:
"You’ve tried to quit on your own before, but evidence shows using nicotine replacement and getting a bit of support makes it much more likely to work. We can do that here."
Demonstrate options in line with national guidance. For full details see CKS
Check how Ilyas feels about the plan and his confidence:
"Does this sound like it could work for you?"
"What questions do you have?"
Tailor the plan to his stage and context:
