SIMMAN STRUCTURE
Introduction (Memorize)
• Hello examiner! I am Dr. ______ and my GMC number is _______. May I proceed?
• Examiner! Assume that I have taken all the universal precautions.
Build Rapport (Memorize)
• Hello! I am Dr. _______, one of the doctors here.
Conscious Patient
• Are you _______?
• Can you please confirm your age?
Short History (90 seconds) (Memorize)
I can see that you are in pain/struggling with breathing.
• Can you tell me what happened?
I am so sorry to hear about it. Don’t worry, we are here to help you. OK?
• When did it happen?
• What were you doing when it happened?
RED FLAG QUESTIONS
• Do you feel any heart racing?
• Do you feel that you are about to faint? (HF, PE, AF, HYPOVOLEMIA)
• Do you feel drowsy or confused? (Dizziness)
• Do you feel any shortness of breath? (Acute Limb Ischemia)
• Do you have chest pain or leg pain? (Pulmonary Embolism)
• Is there any tube down there? Did you receive any antibiotics?
(Anaphylaxis)
• Do you have any fever? (COPD)
• M = Do you have any medical condition?
• A = Do you have any known allergies?
• M = Are you using any medications?
• Do you have smoker’s cough?
Recovery Position
I would like to put my patient in the semi-sitting position.
Consent (Memorize)
_______! I am going to look, feel, tap and listen to different parts of your body. One of the medical
team members is present beside me and is acting as a chaperone to maintain your privacy.
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Monitor (Memorize)
I can see that the patient is attached to the monitor so I would like to start the ABCDE approach.
Airway:
• As the patient is talking to me, I assume that the airway is patent.
• As the oxygen saturation is low, I would like to give 100% oxygen via ________________.
• How are you feeling now?
• Don’t worry, I am trying my best to help you. Please bear with me.
Check monitor
Breathing:
• _______! I am going to unbutton your shirt to look, feel, tap and listen to your lungs and
heart. (Memorize) (Verbalize findings)
• Give treatment accordingly (salbutamol for wheeze etc.)
• I would like to order a chest x-ray, ECG and ABGs for my patient. (Memorize)
• How are you feeling now?
• Don’t worry, I am trying my best to help you. Please bear with me.
Check monitor
Circulation:
• _______! I am going to pinch your finger (capillary refill time) and check your blood pressure
and assess your pulse manually. (Memorize) (Verbalize findings)
• I can see that the blood pressure is _______ and the pulse is _______.
• I am going to insert an orange cannula into your arm. (orange = 14G = large bore)
• I am going to take some blood for investigations like ___________________________.
• Give treatment (I am going to give you 1L normal saline over 30 mins, furosemide etc.)
• How are you feeling now?
• Don’t worry, I am trying my best to help you. Please bear with me.
Check monitor
Disability: (Memorize)
• _______! I am going to check your blood sugar levels and assess your body temperature.
• _______! Can you move your right leg for me?
• _______! Can you move your left leg for me?
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• Repeat or add any medication if necessary.
• How are you feeling now?
• Don’t worry, I am trying my best to help you. Please bear with me.
Check monitor
Exposure: (Memorize)
• _______! I am going to examine your tummy, private part and legs. (Memorize) (Verbalize
findings)
• I am going to insert a plastic tube into your private part to measure the urine output (if fluid
is given) and send it for culture and sensitivity test (if sepsis).
• How are you feeling now?
• Don’t worry, I am trying my best to help you. Please bear with me.
Check monitor
Management:
• Reveal the Diagnosis (______! You presented to us with _______ (shortness of breath). Upon
my assessment, I suspected that you were having a condition called ________ (heart failure).
Let me explain what it is. (two-line definition in simple words and do not use medical
terms) (Memorize)
• Explain your management in two lines (we give you a water tablet to make you pee, so that
the excess water is removed from your body to make your heart pump more efficiently and
help with your symptoms)
• Here’s what we are going to do now: (Memorize)
1. Admit: We are going to admit you.
2. Involve Seniors: We are going to involve our seniors, including a cardiologist.
3. Further tests: They may do further tests or give you further treatments like they may
do a gel scan of your heart (echocardiogram).
4. Further treatment: They may give you further treatment like ACEIs or digoxin etc.
5. Safety Netting: During your stay at the hospital, if you become lightheaded or feel
heart racing, please ring the buzzer one of the medical staff will attend you.
6. Advices
You should be able to complete your simman in 6 minutes during practice.
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