Essay Tips
2500 +/_ 10% = 2750 words. (Anything over 2750 will not be read – new word count policy)
Use of CONCISE tables – bullet points.
How does a word count…count a word?? Or spaces?? (do not have additional spaces – for example: Strathdee(2022)
If using Ely et al (Framework for diagnostics) – suggests just looking at differentials after the history and physical exam – We suggest doing this after History, and Physical examination rather than after both…
LINK THEORY TO CASE – Not large chucks of theory please!!
First person
Write in FIRST person – I am a trainee Advanced…
I did this, I did that.
Do not write in first person when discussing literature: For Example: I think Strathdees (2022) study on DADM tutorials is rubbish… It should be: For example: It could be argued…
Introduction
Summary of essay
Job role – I am a… (ACCP can discuss FICM – BRIEFLY)
Discuss confidently – use of a pseudonym – mention latest code (NMC is 2018!!)
(We do not want a section on advanced practice – not enough words)
Case study
Paragraph on your patient – case study – Paint the picture
Handover
You start when you first get the information about the patient
Initial thoughts – early thinking
Link to underpinning theory – Your type 1 thinking – related to experience, related to your speciality. Bias: Pattern recognition – seen something like this before. Framing – did someone ‘frame’ the diagnosis for you?
Consider Red flags
History
Use of OLDCART – presented complaint. Or PQRST – Use a framework – table or summarise. Pain Score…
Relevant factors – past medical history
Differentials – enough information to come up with differentials (Differential is a diagnosis not a symptom) – how likely they are. In Order – likelihoods. The rationale for your differentials – Expose your reasoning….
Examples:
Differential Likelihood Rationale
PE
(Must not miss) Highly likely +Immobile
+Long stay in hospital
+History of central chest pain
+Cough
+Haemoptysis
Met lung cancer
(Must not miss) Likely +Known Bowel ca
+Haemoptysis
+Known cough
+Chest pain
-No loss of weight
-Recent scan showing remission
Mallory-Weiss tear Unlikely +Cough
Likelihood – pre-test probability – estimates – educated guess. There is data out there.
Physical assessment – this could be prior to history – (if critical and need to be seen first)
Justify what you are going to examine and WHY.
Look for ALL differentials not just one that is most likely
Present findings – table: do not need to tell us every ‘normal’ finding – just findings that prove or disprove your differentials
How have your differentials and your likelihood changes? Could use same table but change likelihoods and add additional rationales. You may add a differential as you have seen something new, you may rule out differentials, but you need to consider ALL the differentials
Don’t forget any underpinning theory – type 2, dual process, bias
Differential Likelihood Rationale
PE Highly likely +Immobile
+Long stay in hospital
+History of central chest pain
+Cough
+Haemoptysis
+Tachycardia
+Auscultation normal
+Right heart strain on ECG (What is the S and S of this?)
Met lung cancer Likely +Known lung ca
+Haemoptysis
+Known cough
+Chest pain
-Auscultation normal
Mallory-Weiss tear Unlikely +Cough
Focus on one Test – (minimal word count for lots of tests)
Clinical test accuracy
Debate what test you use – cost, radiation… Think about how many patients do not have a PE that have a CTScan?? But of course it is a do not miss, but may be worth looking at within your test…
Sensitivity and specifically, negative and positive predictive values
Consider what tests are good For example: – ?CXR ?Ultrasound ? CT Scan – What’s best? Why? What’s the Sensitivity and Specifically of these? What does it mean – thinking about what is the chance of a false negative or a false positive? – the bits that may tell you that you are wrong??
** critical appraise the test – the study is only as good as the research that was carried out is, does the study include your patient population… For example: your patient is a female, the study you look at includes 99 males and 1 female = how does this change things?
Put it all together
Do we know what is wrong with the patient? – brief
Safety net
Sometimes we don’t? but normally have a front runner
Treatment – No marks for treatment! (Unless you are discussing how the patient is getting on with the ‘treatment’ they are having!! – as medications could be the
‘test’)
Conclusion
Critical Reflection. From doing this course I have learnt
CASE STUDY
ad symptoms indicating hyperglycemia for 2 years before diagnosis. He had fasting blood glucose records indicating values of 118–127 mg/dl, which were described to him as indicative of “borderline diabetes.” He also remembered past episodes of nocturia associated with large pasta meals and Italian pastries. At the time of initial diagnosis, he was advised to lose weight (“at least 10 lb.”), but no further action was taken.Referred by his family physician to the diabetes specialty clinic, A.B. presents with recent weight gain, suboptimal diabetes control, and foot pain. He has been trying to lose weight and increase his exercise for the past 6 months without success. He had been started on glyburide (Diabeta), 2.5 mg every morning, but had stopped taking it because of dizziness, often accompanied by sweating and a feeling of mild agitation, in the late afternoon.A.B. also takes atorvastatin (Lipitor), 10 mg daily, for hypercholesterolemia (elevated LDL cholesterol, low HDL cholesterol, and elevated triglycerides). He has tolerated this medication and adheres to the daily schedule. During the past 6 months, he has also taken chromium picolinate, gymnema sylvestre, and a “pancreas elixir” in
AB is a retired 69-year-old man with a 5-year history of type 2 diabetes. Although he was diagnosed in 1997
attempt to improve his diabetes control. He stopped these supplements when he did not see any positive results.He does not test his blood glucose levels at home and expresses doubt that this procedure would help him improve his diabetes control. “What would knowing the numbers do for me?,” he asks. “The doctor already knows the sugars are high.”A.B. states that he has “never been sick a day in my life.” He recently sold his business and has become very active in a variety of volunteer organizations. He lives with his wife of 48 years and has two married children. Although both his mother and father had type 2 diabetes, A.B. has limited knowledge regarding diabetes self-care management and states that he does not understand why he has diabetes since he never eats sugar. In the past, his wife has encouraged him to treat his diabetes with herbal remedies and weight-loss supplements, and she frequently scans the Internet for the latest diabetes remedies.During the past year, A.B. has gained 22 lb. Since retiring, he has been more physically active, playing golf once a week and gardening, but he has been unable to lose more than 2–3 lb. He has never seen a dietitian and has not been instructed in self-monitoring of blood glucose (SMBG).A.B.’s diet history reveals excessive carbohydrate intake in the form of bread and pasta. His normal dinners consist of 2 cups of cooked pasta with homemade sauce and three to four slices of Italian bread. During the day, he often has “a slice or two” of bread with butter or olive oil. He also eats eight to ten pieces of fresh fruit per day at meals and as snacks. He prefers chicken and fish, but it is usually served with a tomato or cream sauce accompanied by pasta. His wife has offered to make him plain grilled meats, but he finds them “tasteless.” He drinks 8 oz. of red wine with dinner each evening. He stopped smoking more than 10 years ago, he reports, “when the cost of cigarettes topped a buck-fifty.”The medical documents that A.B. brings to this appointment indicate that his hemoglobin A1c(A1C) has never been <8%. His blood pressure has been measured at 150/70, 148/92, and 166/88 mmHg on separate occasions during the past year at the local senior center screening clinic. Although he was told that his blood pressure was “up a little,” he was not aware of the need to keep his blood pressure ≤130/80 mmHg for both cardiovascular and renal health.11A.B. has never had a foot exam as part of his primary care exams, nor has he been instructed in preventive foot care. However, his medical records also indicate that he has had no surgeries or hospitalizations, his immunizations are up to date, and, in general, he has been remarkably healthy for many years
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