Table 4 Feedback provided by medical leads

Personalised, encouraging

You have written up this case really well.

Your history and examination are nice and succinct and clear.

You have written up this long case thoughtfully and have covered all the required domains.

Again you have written up a good case and have thought about the issues in this man.

Congratulations on your first long case- you have written this up very well.

It is a shame you couldn't examine him, but you have identified what you would look for.

Your summary and issues list is great!

In the next 4 weeks of medicine, work on investigation and management issues- your histories are excellent; well organised and succinct.

Good luck!

Another good case- you really write the cases up well- succinct and organised.

I am very impressed with your progress

Well done on completing your second case!

You have improved in your write up from your first.

Authenticity

Only suggestion is think what tests you would do to try and work out cause of fevers.

Some cases are diagnostic issues and some are management issues- when the diagnosis is clear, then most of your attention should be on management.

Be careful with abbreviations

Your issues list is good- think about how you would manage her high urine output.

Remember complications of immunosuppression- bones, infections, malignancy.

You could divide issues into short term, medium term and long term

Short term- management peri-operatively of anti-coagulation etc.

Medium term- optimisation of CV risk factors, DM etc.

Long term- monitoring for complications of DM

With your issues list, you could probably condense them down to 3 main issues:

1. Rehabilitation following stroke to improve function

2. Manage risk factors including hypertension, hypercholesterolaemia and hyperglycaemia.

3. Poor compliance- importance of ensuring understanding to improve compliance, communication with GP.

…. writing it up as though you are writing up an admission, succinctly listing the issues, and management plan.

For writing the cases up, you should think you are doing an admission and writing it clearly in the notes

Granular and specific

RA history- if possible include the following, particularly if RA is central to the case

- When it started? polyarticular vs oligoarticular onset, if known RF, CCP positivity

-subsequent course (flares and remission with cumulative deformity for example)

-Treatment: prednisone: duration and average dose (if sig steroid side effects)

Disease modifying agents- salazopyrin is a weak disease modifying agent, has he ever been on methotrexate or any others?

surgical management- eg joint replcements, etc.

Current state: active vs inactive, duration of early morning stiffness

Issues list- just list the issues then move management below

1. Investigation and management of thrombophilia

2. Assess fitness for further surgery

3. Management of multiple co-morbidities- medium to long term

4. Social issues- managing at home and drug/alcohol issues

Investigations- Standard things, FBC, UEC, LFT, Calcium, cultures if febrile again, etc.

How do you monitor if MM in remission??

Issues list-

1. Control infection, monitor for complications of chemotherapy (infection, plts, anaemia)

2. Complete chemotherapy when well enough- fitness for this?

3. Psychosocial issues-

-anxiety (well placed)

-Insight into prognosis

-carer fatigue

Issues list-

1. Management of febrile neutropenia

2. Ongoing management of cancer- side effects vs benefits

3. Optimise BP control- particularly in view of aneurysm

4. Socials aspects- isolation/depression/ prognosis and planning for future palliation if required