Patients with suspected ED will primarily complain of difficulties initiating or sustaining an erection. Further details surrounding these issues should be explored: Okay, so we’ve discussed your medication which included [two inhalers, your medication for anxiety, pain, diabetes, epilepsy and the vitamins you buy over the counter]. The plan is to reduce your diazepam by one tablet each day and I’m going to call you in two weeks to see how you feel that is going and then review everything else again at your usual review appointment with the GP surgery.” Ask if the patient has any drug allergies and clarify what happens when the patient takes the medication

Once necessity has been identified, you should consider how much of the medication is needed for a therapeutic effect. This decision should be evidence-based but person-centred. For example, some randomised controlled trials will identify a therapeutic dose, however, the participants in the trial may be very different to the patient in front of you. If a man presents with priapism after use of a PDE-5 inhibitor, defined as an erection lasting greater than 4 hours, urgent hospitalisation is required for further investigation and management. Neurological: Parkinson’s disease, multiple sclerosis, stroke, spinal cord injury, peripheral neuropathy Objective Structured Video Examinations (OSVE). The variation consists of videotaped recordings of patient-doctor encounters are shown to students simultaneously and questions related to the video clip are asked. Written answers are marked in a standardised manner.The name of the drug must be included for schedule 2 and 3 controlled drug prescriptions. Formulation Harden, R M; Stevenson, M; Downie, W W; Wilson, G M (1975). "Assessment of clinical competence using objective structured examination". BMJ. 1 (5955): 447–451. doi: 10.1136/bmj.1.5955.447. PMC 1672423. PMID 1115966. Information about the prescriber that is required by the person signing the prescription is discussed below. Name Kurtz S, Silverman J, Benson J, Draper J. Marrying Content and Process in Clinical Method Teaching: Enhancing the Calgary–Cambridge Guides. Academic Medicine. 2003;78:802-809.

The penis is supplied by the dorsal penile artery, the deep penile artery and the bulbourethral artery, all which are derived from the internal pudendal artery. Venous drainage is via the superficial and deep dorsal veins to the superficial external pudendal vein and prostatic venous plexus, respectively. All penile innervation comes from S2-S4 spinal cord segments. Sympathetic penile innervation is provided by the pudendal nerve, which gives off the dorsal nerve of the penis, whereas parasympathetic innervation is from the prostatic nerve plexus which gives rise to the cavernous nerves. a b c Khan, Kamran Z.; Ramachandran, Sankaranarayanan; Gaunt, Kathryn; Pushkar, Piyush (2013). "The Objective Structured Clinical Examination (OSCE): AMEE Guide No. 81. Part I: An historical and theoretical perspective". Medical Teacher. 35 (9): e1437–e1446. doi: 10.3109/0142159X.2013.818634. ISSN 0142-159X. PMID 23968323. S2CID 28150274. The assessment of pharmacy students’ readiness to begin APPE education in clinical pharmacy settings continues to gain increasing attention [ 4, 5]. The Accreditation Council for Pharmacy Education (ACPE) in the United States (US) has emphasized the importance of competency assessment with comprehensive, formative, and summative testing [ 6, 7]. Since pharmacy practice training was first implemented eighth years ago in South Korea, preceptors and students have raised concerns related to experiential education, such as differences in IPPE educational content and quality among 37 colleges of pharmacy and differences in students’ competence in translating knowledge levels into practice [ 8, 9]. Despite the apparent need for a competency assessment program to assess students’ readiness for experiential learning, there are no established standardized examinations or evaluation criteria to assess students’ clinical performance consistently and accurately. a b c Amin, Zubair; Eng, Khoo Hoon (2009). Basics in Medical Education (2ed.). WORLD SCIENTIFIC. doi: 10.1142/7044. ISBN 978-981-283-538-3. Record the patient’s current and past smoking history, including the type and amount of tobacco used.Okay, so in the short– term, we would like to reduce your dose of diazepam as you feel like it is making you too drowsy.” A patient’s social history can provide useful information when reviewing their pharmaceutical care. For example, smoking tobacco induces enzymes that speed up the metabolism of theophylline and changes in vitamin K consumption can reduce the efficacy of warfarin. Asking about a patient’s social history also facilitates asking questions about any recreational drug use such as cannabis or ecstasy. Yeung, E (April 2, 2017). "Sharing of information in objective structured clinical examinations -- does no evidence of difference mean evidence of no difference?". BMJ Open. 6 (10): e012541. doi: 10.1136/bmjopen-2016-012541. PMC 5073653. PMID 27729351. Practicability: OSCE allows the use of simulated patients and clinical materials, thereby decreasing the need for real patients during the examination.

When you had erections with sexual stimulation, how often were your erections hard enough for penetration? This is the ‘form’ you would like the medication to be in and describes how the drug will get into the patient. For example, as tablets, capsules, solution, elixir, suppository, pessary, cream, powder, pressurised inhaler, dry powder inhaler, subcutaneous injection, intramuscular injection or infusion. Explore if the patient is experiencing any significant side effects with their current medications: Prescriptions represent a request from one healthcare professional to another to administer or supply medication to or for a patient. Some medications do not require a prescription as they are considered safe enough for patients to use without professional supervision and these are legally classified as general sale list medications (GSL). Medications that are considered less safe and require supervision by healthcare professionals are classified as prescription only medications, referred to as POMs and can only be used under the supervision of a prescribing healthcare professional. Anything that is not a GSL or POM is classified as a pharmacy medication or P medicine, which is only available under the supervision of a pharmacist.When closing the consultation it’s a good idea to summarise the key points, including the information on the currently prescribed medication, the non-prescribed and the extras to make sure nothing has been missed. You should also summarise the short term and long term plan so the patient understands it fully and give the patient a final opportunity to ask any questions about what has been covered.

Other important areas of the history to cover include past medical history, medication history, psychiatric history, social history and sexual history. Always be polite, empathetic and honest to your patient. Listen to them carefully and let them speak. Thank them and the examiner at the end of the station. After all, they’ve given up their free time to help you. A significant amount of marks are often awarded just for demonstrating these generic communication skills, so don’t neglect them! It is essential to counsel patients on the appropriate practice of PDE-5 inhibitors – take on an empty stomach 30 minutes prior to intercourse, avoid alcohol and fatty meals as it reduces drug absorption.Grover SA, Lowensteyn I, Kaouache M, Marchand S, Coupal L, DeCarolis E, et al. The Prevalence of Erectile Dysfunction in the Primary Care Setting. Arch Intern Med. 2006;166(2):213. Referral to a specialist pharmacist, medical consultant, GP or nurse if you have reached your level of competence and require additional input Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peñ BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999;11(6):319–26.