How to Question A Simulated Patient During ILA Case Presentation

Disclaimer: this post is specific to MBBS UniKL pre-clinical students.

Greetings, readers. In this post, I wish to share with all of you on a proper questioning techniques to a simulated patient during Integrated Learning Activity (ILA) Case Presentation. Before that, let me quote an excerpt regarding description of ILA in UniKL RCMP.

"Integrated learning activity (ILA) has been introduced as a learning method to first and second year medical students at the Royal College of Medicine Perak (RCMP) since 2007. The ILA is introduced to draw together the teaching of basic sciences through lectures, practical, demonstration, problem solving sessions and integrate them within a clinical framework. There are eight ILAs (2 ILAs per module). Each ILA runs over a two or three week period. It contains the essential components of an introductory session followed by a small group discussion (SGD1), SGD2 and a closure and feedback session.During the introductory session, all the students (100-200) are introduced to a real or simulated patient by a clinician in a large group setting. The students are encouraged to ask questions pertaining to the case scenario for about 30-45 minutes. They are then divided into smaller groups (8-10 per group) and are guided by a tutor in small seminar rooms. During the SGD1, the assigned tutor will guide the students through a process of brain storming to establish the appropriate learning objectives (LOs). Two weeks later the students reassemble in their respective groups to discuss their findings on the LOs together with their tutor. The tutor's role is not as an expert but as a facilitator. At end of SGD2, a set of 10 extended matching questions (EMQs) are given to students as a formative assessment. The final Closure and Feedback session takes place in a large lecture theatre. Answers to EMQs are discussed, gross performance of EMQ is displayed and relevant feedbacks and response from students are highlighted by the ILA coordinator. The clinician concludes the session."

-Excerpt from Introduction to ILA by Dr. Muniandy-

Okay, now that we know what is an ILA, here are the proper techniques to question a simulated patient, given by Prof. Dr. Myo Than.

The order of questions to ask the patient is as follows:

1. Name, age, race, sex and occupation. (All these must be asked first before other questions.) 
2. Chief complaints. (The reason why the patient comes i.e. pain, fever, dizzy etc. Might be shown on screen before start of question. If so, it is advisable to ignore this section.)
3. History of present illness. (What happened that preceded the complaints, disease. Refer below if patient comes with pain.)
4. History of past illness. (Other major illnesses the patient had i.e. heart disease, diabetes, gout etc.)
5. Personal history. (Includes lifestyle, medications, smoke/alcohol consumption, places visited etc relevant.)
6. Family history. (Diseases contracted by any family member, hierarchy, background etc relevant.)
7. Menstrual history. (Asked only if the patient is a female and have lost blood i.e. leukemia.)

If the patient comes with pain, ask these:

1. Site of pain. (Where does the patient felt the pain?)
2. Nature of pain. (Mild, sharp, dull, blunt. Can ask to rate the pain between 1-10 like Baymax in Big Hero 6 movie.)
3. Frequency of pain. (How often the pain comes? The patient may tell it happen at certain time or when doing something specific and related to the pain.)
4. Duration of pain. (How long does the pain felt in each frequency?)
5. Severity. (Any signs or manifestations of the pain such as the cardinal signs, infection etc.)
6. Radiation. (Does the pain radiates? If so, to where does it radiates?)
7. Aggrevating factor. (What the patient did that will increase the pain i.e. doing certain works or exercises.)
8. Relieving factor. (What the patient did that will decrease the pain i.e. taking drugs, icing the pain area.)

I hope with this guideline, all of us can question the patient with professionalism. Or else the ILA lecturer/doctor-in-charge won't be pleased. Of course, if there are any questions, feel free to leave a comment below or ask the lecturers/doctors at the college for consultation on the matter.