MRCGP Practice Case 3
Examiner Sheet – Case 3
Instructions:
Give the candidate the relevant doctor’s sheet for this case. Inform them they have 3 minutes to read
the case notes. Once 3 minutes are up, start your timer and allow 12 minutes of consultation time.
Read through the specific mark scheme for this case, observe carefully throughout, and mark the
case using the observed behaviours as follows:
Clear Pass - Demonstrated above the standard of a newly qualified, independent GP
Pass - Demonstrated at the standard of a newly qualified, independent GP
Fail - Insufficient demonstration to meet the required standard
Clear Fail - Significantly below the required standard
A description of the required standard / passing level for each domain is given below as a guide:
Data gathering and Systematically gathers and organises relevant and targeted
diagnosis information.
Addresses the needs of the patient/colleague and their problem(s).
Adopts a structured and informed approach to problem-solving,
generating an appropriate differential diagnosis or relying on first
principles of investigation where the presentation is undifferentiated,
uncertain, or complex.
Clinical management Demonstrates the ability to formulate safe and appropriate
and medical management options which includes effective prioritisation, continuity,
complexity and time and self-management.
Demonstrates commitment to providing optimum care in the short and
long-term, whilst acknowledging the challenges.
Interpersonal skills / Demonstrates ethical awareness where appropriate.
relating to others
Shows the ability to communicate in a person-centred way.
Demonstrates initiative and flexibility, adjusting consultation approach
where appropriate to overcome any communication barriers.
Reaches a shared understanding with the patient.
© Emedica Ltd www.emedica.co.uk All rights reserved
MRCGP Practice Case 3
Examiner Sheet – Case 3 Mark Sheet
Domain Observed Behaviours Comments
Data • Takes a full history asking about polyuria, polydipsia and fatigue. Also asks
gathering and about eyesight, feet, family history of diabetes, diet, exercise and smoking
diagnosis • Explains she would need to attend the surgery to have blood pressure,
heart, BMI examined and urine checked for protein
Clear Pass • Screens for low mood and explores recent stress at home
Pass • Assesses sun exposure
• Diagnoses type 2 diabetes + vitamin D deficiency
Fail
Clear Fail
Clinical • Offers advice on diet which is tailored to patient e.g. increase fruit and veg
management (could add to curry), smaller portions of rice, whole grain not sugary cereal
and • Offers referral to retinal screening and structured education programme
complexity • Prescribes metformin and offers trial of diet modification & exercise
• If starting metformin prescribes 500mg once or twice daily initially,
Clear Pass • Explains the possible side effects of diarrhoea and abdominal pain with
Pass metformin
• Starts atorvastatin 20mg at night
Fail
• Advises the patient that if she develops muscle pains she should contact
Clear Fail her doctor
• Offers 6-12 weeks high dose vitamin D replacement – such as 800IU
capsules 5 per day for 10 weeks with blood test for corrected calcium 1
month after
• Arranges to see the patient again in 1-2 weeks to assess treatment if
medication is prescribed, or 3 months if attempting diet and exercise – to
be reviewed with repeat LFTs and HBA1c
Interpersonal • Recognises that the patient is struggling to follow and breaks up
skills / information, checks understanding frequently, keeps language simple and
relating to offers to slow down
others • Notices that patient loses interest in the discussion of diabetes and tried to
find out what the patient knows about it
Clear Pass • Demonstrates an awareness of the patient’s cultural background and
Pass language/social barriers and makes an effort to address these – e.g.
offering an interpreter, advising about local services
Fail • Politely but effectively pulls the patient back from tangents to keep control
Clear Fail of the consultation
• Addresses the patient’s misconception that diabetes is not serious, giving
clarity without causing panic
• When patient mentions a vague symptom makes the effort to clarify what is
meant
• Discusses management options with the patient to reach a shared plan
and optimise chance of compliance – e.g. involving patient in decision re:
drugs or diet initially for diabetes
© Emedica Ltd www.emedica.co.uk All rights reserved
MRCGP Practice Case 3
Case domains covered:
Health disadvantage and vulnerabilities
Ethnicity, culture, diversity, inclusivity
Investigation / Results
Key learning/points for further discussion:
For many candidates, this may feel like a heart-sink consultation, where there are many vague
symptoms and multiple issues that need addressing. Good candidates should be able to focus
the consultation and use the abnormal test results as a marker to direct it. Looking at the results
there are 2 abnormalities – the low vitamin D and also raised HBA1c. Candidates should be
able to quickly re-explore the patient’s symptoms and contextualise this with the results.
Confident candidates should be able to make a positive diagnosis of type 2 diabetes, as the
patient has symptoms, and offer advice about how to manage this. Vitamin D should also be
offered. There is clearly a lot to be covered and it is therefore important that candidates offer
some sort of follow up, to reinforce what was said in the consultation and to see how the patient
feels after treatment with Vitamin D / trial of lifestyle change (or treatment) with diabetes. As
always, we need to treat the patient as a person, rather than a set of test results, and being able
to explore the patient’s life and routine will also help contextualise her risks and even views
about diabetes.
Further reading:
• NICE CKS: Type 2 Diabetes
• Vitamin D deficiency
Scan or click the QR codes to access guidelines
© Emedica Ltd www.emedica.co.uk All rights reserved
