Station 4

Station 4

Station 4 in MRCP PACES is an assessment of communication skills and ethics. Many, particularly Asians whom english is not their first medium find it difficult. However, I believe practice makes perfect. Like history taking station, this is a station that you will be able to practice at anytime, anywhere, all you need is a study partner and An Aid to the MRCP PACES vol. 2 by Ryder.

What I did with my study partners was each of us will take turn to become candidate and surrogate while the others will observe and give their comments after the session. Initially we practised with the senarios from the books. Later, we created our own senarios.

When reading the case senario, you should be able to relate your senario to the 4 ethical principals, this could help you in the discussion with the surrogate later.
The 4 ethical principals:

1. Patient's autonomy

2. Beneficence

3. Non-maleficence (do no harm)

4. Justice

There are few senarios that I think sometimes are difficult to discuss about, one of it is brain death.

Case Senario - Brain death

You are the SHO in medical ITU and you are about to see Mr L, the father of Miss L, a patient in ITU.

Miss L, 25 year-old Chinese lady who was admitted 3 days ago with massive intracranial bleed due to a ruptured cerebral aneurysm. She was intubated immediately in ED for poor GCS and subsequent CT brain showed massive ICB with midline shift. She was referred to neurosurgical team for intervention which was done before she was sent to ITU with 3 inotropes. Sedation was halted 36 hours ago and Miss L has shown no neurological response. Your neurology consultant and the ICU consultant has decided for a brainstem testing which was done earlier today and Miss L has been confirmed brain dead. Currently, Miss L is ventilated, her BP is 100/60 mmHg on 3 inotropes and ECG showed sinus rhythm. Your task to to explain to Mr L the diagnosis of brain death and explore the possibility of organ donation.

I shall leave this to you and your study partners to discuss about it.


Useful website:
Brain Death: A Simple Explanation for Donor Families
http://www.kidney.org/transplantation/donorFamilies/infoBooksBrain.cfm