EXPLANATION 101

GENERIC RUBRICS

Introduction and consent - 1

Check patient's understanding -1
Give information in chunks - 0.5
Repetition by student and by patient -2
Avoid jargon, explain medical terms -1
Leaves time for patient and asks patient if there are any questions -0.5
Use of visual/diagram - 2
Communication skills - 1
Non-verbal communciation - 1.5
Total: 10.5 on non-content stuff

GENERIC RUBRICS FOR MOTIVATIONAL INTERVIEWING

Introduction and consent - 1

Check patient's understanding and determine stage of Prochaska Diclemente Cycle (DIAGRAM) 1
Use of open ended questions to establish patient's motivation -1
Correctly identifies elements of SMART goal - 1
Help patient create a relevant SMART goal - 1.5
Summarizes the next steps with the patient (Asks patient to repeat as well) - 1.5
Motivational interviewing techinique
o Develops rapport - 1
o Patient lead - 1
o Encourages patient - 1
o Responds well to patient's questions - 1
o Uses language that is easy to understand - 1
o Check patient's understanding - 1
o Eye contact -1
o Organization of interview - 1
Total 15 marks on non-content (Rest of marks will be on quality of counselling)

Dealing with emotion

1. Recognizing patient cues
a. "You seem upset, is there something you would like to talk about?"
b. "You seem sad, what is happening?"
c. "You seem worried, can I help?"
2. Dealing with emotion

a. Preparation
i. Privacy, comfort
b. Set the scene
i. Summarize what has happened to date and check with the patient
ii. What is the patient thinking/ feeling "How are you feeling?"
iii. Negotiate agenda
c. Sharing information
i. Information in small chunks, assess patient's understanding
d. Be sensitive to patient " I can't imagine what you are going through"
e. Planning and suppport
i. Prioritizing patient's concerns
ii. Discuss treatment options (All such questions should be referred to treating
doctor)
f. Follow up and closing
i. Summarize and check with patient
ii. Provide information on support services
iii. Offer assistance to tell others
MED 1011 Week 8: Giving explanations
Main key for explanation stations:
1. Assess the patient's knowledge "What do you know about diabetes already?"
2. Give information in small chunks
3. Check the patient's understanding/ Repeat and ask patient to repeat back to you
4. Use visual methods
Station 1: How to use a stethoscope

Stethoscope consists of 4 parts- bell, diaphragm, tubing and earpieces

o Bell used for low pitched sounds
o Diaphragm used for high pitch sounds
o Tubing is used to transmit the sound from the bell/diaphragm to the earpieces
o Earpieces should be angled forward and helps to prevent outside sounds from
interfering with your listening
Stethoscopes are used for hearing sounds generated within your body around the heart, lungs
and gastrointestinal tract. They are also used in measuring blood pressure
Heart sounds: Normal sounds of the heart "lubdub" represent one contraction of the heart and
the noises are made when the valves in your heart close (can move on into minor explaination
of the different valves in heart and draw a picture)
Some people may have other heart sounds (e.g. whoosh) - murmur. Murmurs are sounds of the
blood itself moving through the heart. Murmurs are noisy when the blood flow has turbulence.
This is because a valve doesn't open or close all the way. Many people have heart murmurs
without it affecting them at all.

Station 2: Gastroenteritis

Bowel infection which can cause diarrhea and sometimes vomitting. Diarrhea may last up to 10
days
Can be caused by many different germs although the most common cause is a viral or bacterial
infection.
In most causes, medicaiton is not required
Signs and symptoms:
o Gastro can cause your child to feel unwell and not want to eat/drink.
o Vomitting in first 24-48h and diarrhea lasting up to 10 days
o Stomach pains and fever
Treatment:
o Young babies and chidren get dehydrated very easily (appear drowsy, dry lips and
mouth, not passing urine, cold hands and feet)
o Need to have fluids by a tube through the nose to the stomach or directly into a vein (IV)
o For mild gastro, the main treatment is to keep your child drinking fluids. It is important
for the fluids to be taken even if the diarrhea seems to get worse.
o Do not give medicines to reduce vomiting and diarrhea - may cause more harm
o Infectious- keep your child away from other children and practise good hygeine yourself
o Can continue breastfeeding but feed more often. Can give gastrolyte as well.
Gastrolyte is an oral rehydration fluid that replaces fluids and body salts
o Refusing to eat is not a problem as long as clear fluids are taken. Generally, if child is
hungry, give them food they feel like eating
o Medical help if child is not drinking and still vomitting/diarrhea/ child is dehydrated
*Give pamphlet about gastro!!!

Station 3: Combined Oral Contraceptive pill

The pill is made from 2 synthetic hormones, oestrogen and progesterone, which are similar to
naturally occuring hormones (oestrogen and progesterone) made by a woman's ovaries
When you take the pill daily, your chances of becoming pregnant <1%
Allowing for mistakes, pill is 92% effective- Explain that this means out of 100 women taking the
pill for a year, a maximum of 8 will become pregnant
The pill works by stopping the body from releasing an ovum (Egg) each month. It changes the
lining of the uterus, preventing a fertilized egg from sticking and it thickens the mucus in the
entrance to the womb (cervix), preventing the sperm from getting through
-REFERRING TO THE PACKAGE- Pill packets contain 28 pills -21 active pills (pills w the 2
hormones) and 7 sugar pills. Sugar pills are included to keep you in the habit of taking a pil l
daily.
o Generally, you're advised to take your first pill on the first day of your period and to take
each pill around the same time every day
o Finish all your pills (even the sugar ones)

If any of the pills you took in the last 7 days before missing a pi ll were sugar pills, and
you had sex in the last 5 days => Emergency contraception. Seek advice from your GP/
family planning clinic
o If you miss more than 4 active pills at any time, you have STOPPED taking the pill. You
need to restart taking the pill (at least 7 days to work)
o If you have diarrhea/ vomitting within 2h of taking the pill, the pill may not have been
absorbed by the body.
o Medications and remedies such as St. John's Wort may interfere with the Pill
o "Late pill"- Pill taken <24h late. Take it as soon as you remember and continue taking pill
at usual time. -> Covered for contraception
o "Missed pill"- pill taken more than 24h late -> take Pill as soon as you remember and
continue taking the Pill daily at your usual time -> Need to use condoms until you have
taken 7 active pills in a row
Advantages: Regular bleeding (28 days), shorter, lighter and less painful. Skip periods. Acne
usually improves. Decreased risk of cancer of the uterus and ovaries.
Disadvantages: Remember to take Pill daily. Expensive. Pill does not protect against STI. (need
to use condoms)
Should not take pill:
o Breast cancer within last 5 years
o DVT
o Stroke/ Heart attack
o Heavy smokers and are aged 35 years or more
o Extremely overweight
Side effects: Bleeding, spotting, nausea, breast soreness, headaches, bloating. Symptoms
usually settle with time.
The Pill has no long-term effect on fertility and you can safely skip a period by skipping the sugar
pills and going straight to the first active pill of the next cycle.