A PACES station on MedMock, start to finish
This is a real MedMock session, shown in full: the brief, everything that was said, and the scorecard produced at the end. The patient’s replies and the scorecard are exactly what MedMock generated. The candidate’s side was played by one of our own automated test accounts, not by a real user, and it is here to show what the product does — not as a model answer.
The brief
Mrs Margaret Lewis, aged 68, is recovering from her third admission with breathlessness this year and asks whether she is dying. Explain her lung condition, explore her priorities and agree a plan to reduce future crises.
The consultation
Hello Mrs Lewis, I am Dr Shah, one of the medical registrars. Is it alright if we talk for a few minutes about how things have been and what might happen next? Is anyone with you, or would you like anyone here?
That is fine. It is just me. I have been in and out of here three times this year and I am frightened. Am I dying?
That is a really important question, and I can hear how frightening this has been. Before I answer, could you tell me what you understand about your lungs and what the doctors have told you so far?
They said it is COPD and it is getting worse. I get so breathless I cannot get up the stairs.
Thank you. You are right that the COPD has become more severe; three admissions in a year tells us that. I am afraid I cannot give you an exact timescale, but it is a condition that shortens life and people can become more unwell during flare-ups. Many people still have months to years with good support. How does it feel to hear that?
I thought as much. I just do not want to end up on a machine in intensive care.
I am glad you told me that. What matters most to you if you become very unwell again? Some people want every treatment including a breathing mask or intensive care, others prefer to focus on comfort and staying at home. There is no right answer and we can plan it together.
I want to stay at home with my cat if I can. I do not want tubes.
That is really helpful. Here is what I would suggest: first, making sure your inhalers and technique are right, a rescue pack of steroids and antibiotics with a written action plan, pulmonary rehabilitation, and checking whether you need home oxygen. Second, I would like to write down your wishes in an advance care plan, talk about a DNACPR decision and whether you would want non-invasive ventilation, and involve your GP and the community respiratory and palliative care teams. Does that sound OK?
Yes, that sounds sensible. Will someone tell my daughter?
Only if you would like us to; with your permission we can arrange a meeting with her. Can I check what you will take away from today, so I know I have explained it clearly? And I will give you the leaflet and the respiratory nurse number, and we will review you in clinic in two weeks.
That I am quite poorly, I can make a plan so I stay at home, and you will see me in two weeks.
The scorecard
92 / 100
Appropriately recognised the prognostic significance of 'three admissions in a year' to frame this as severe, life-limiting COPD.
Proposed a highly appropriate, guideline-concordant plan spanning medical optimisation (rescue packs, PR) and advance care planning (DNACPR, palliative care).
Sensitively and honestly addressed the direct 'Am I dying?' question and explicitly explored her priority to avoid intensive care.
Checked if the patient wanted family present and strongly validated her wish to remain at home with her cat.
Skilfully executed the SPIKES framework, checking baseline understanding ('what you understand') and confirming comprehension via 'teach-back' at the end.
What went well
- Excellent execution of the SPIKES framework, specifically assessing perception ('could you tell me what you understand') before delivering sensitive prognostic information.
- Formulated a comprehensive management plan that beautifully integrated medical optimisation (rescue pack of steroids and antibiotics) with proactive advance care planning (DNACPR, non-invasive ventilation wishes).
- Effective and safe closure using the teach-back method ('Can I check what you will take away from today') to ensure the patient understood the agreed plan.
What to improve
- While the home oxygen assessment was appropriately mentioned, you could have demonstrated further clinical depth by explicitly stating the need to check an arterial blood gas for hypercapnia.
- Although the focus was on advance care planning, briefly assessing her current functional baseline (e.g., MRC dyspnoea score) would have further tailored the pulmonary rehabilitation discussion.
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