INFORMATION FOR SITE ORGANISERS Example stations 3 and 4

HISTORY TAKING

Resources needed Examiner Healthy volunteer 2 Chairs (for candidate and patient)

EXAMPLE STATIONS 3 AND 4 : 8 MINUTES HISTORY TAKING

Instructions to examiner:

The third year candidate has already been given the following information:
This is an 8 minute station You are based on a medical ward.

Your consultant has asked you to take a history from Ms Lisa Ball

She has been admitted recently but you have not been given any other information.

Please take a history from Ms Ball to find out why she has been admitted as well as discovering what has happened since coming in to hospital.

EXAMPLE STATIONS 3 AND 4: 8 MINUTES HISTORY TAKING Instructions to candidate:

This is an 8 minute station

You are based on a medical ward.

Your consultant has asked you to take a history from Ms Lisa Ball

She has been admitted recently but you have not been given any other information. Please take a history from Ms Ball to find out why she has been admitted as well as discovering what has happened since coming in to hospital.

History Taking: What skills are you looking for? Put a mark in the box for each section and a global mark (1-7) at the bottom Opening Interview Student introduces himself/herself (full name), uses the patients name and checks how they wish to be addressed Obtains permission for interview and explains purpose Demonstrates awareness of confidentiality Listens attentively to opening statement without interruption Obtaining a clear account of the symptoms Uses a range of open and closed questions appropriately Obtains a clear sequence of the events that have happened Clarifies vague aspects of story/symptoms Discovers what effect the symptoms have had on the patients life Obtaining concerns and responding appropriately Picks up cues or hints about the patients concerns Acknowledges concern by repeating, reflecting or summarising Acknowledges that concerns are legitimate Encourages patient to expand on concerns Avoids premature, false or inappropriate reassurance Obtaining information to aid diagnosis and management Discovers positive features pointing to diagnosis Considers other risk factors which would point to the diagnosis Discovers information to help to exclude other diagnoses Discovers relevant information about background which will aid appropriate management Building and maintaining relationship Displays interest and attention (eye contact, posture, not fidgeting) Encourages patient to speak (verbal prompts, nods, not interrupting) Responds to information given by patient, rather than appearing to follow set formula of questions Explores feelings with sensitivity and tact Appears at ease

YEAR 3 PRACTICE OSCE ROLE HISTORY TAKING Simulated patient script Patients name Setting Lisa Ball Medical Ward Course Role Age Sex Other info ICL 3 20 - 40 Female

Background Teacher/ nursery nurse. Just got married and arrived back from 2 week honeymoon in Australia a few days ago. Travelling out you were upgraded to business class as you were honeymooners, but coming back you were stuck in economy. You had a fair amount of wine on the way back and slept for a large part of the journey. (NB This may not seem relevant to the case but it does fit in well with the subsequent diagnosis.) Smoke 5-6 per day know you should give up really. Normally rarely drink, but shared a bottle of wine with your husband most nights during your honeymoon. Current situation Admitted to hospital four days ago after you coughed up blood a few times darkish red, small amounts. Also had a sharp pain in the back of your chest. Felt like a knife in your back, especially when you take a deep breath in. The doctors said it was probably a clot on the lung, and they also said you had a DVT (deep vein thrombosis) in the leg (one leg is slightly swollen and feels heavy and vaguely uncomfortable). They performed a scan on your legs on the day you were admitted and a V-Q scan on your chest yesterday (involves having dye injected into a vein then a number of pictures are taken bit like chest x-rays). These apparently confirmed the diagnosis. You were initially put on injections to thin the blood, and youre now on tablets to do the same (warfarin one of the doctors calls it rat poison!). They keep taking blood tests. Apparently youll be able to go home as soon as the blood is thin enough. Concerns When you first coughed up blood, you thought it might have been TB, as youd heard that theres more about these days maybe you picked it up from the air conditioning on the plane. At the back of your mind you wondered about lung cancer as you smoke. You were quite surprised when they told you it was a clot, and frightened when they said it was a DVT. Youd heard that people died from DVTs there had been something in the newspaper about this a few months ago. The nurse has said you wont be able to take the pill. This is going to be a problem, as your husband doesnt like condoms. Youre now very keen to get home as soon as possible feel as if youre doing nothing on the ward just waiting for the blood result each day.

Previous Medical Problems Had grommets in your ears when you were young, because of recurrent ear infections. Hearing fine now. Gets headaches and neck ache at the end of the day. GP said it was it was tension which you can believe as your job is very hectic. Swimming helps the headaches. Hay fever in summer. Medication Femodene contraceptive pill. Been on this for about 4 months. You took a different type of pill before that (microgynon) but you thought it was making your headaches worse. Take Zirtek antihistamines in the summer. Task The aims for this session are for students to practice their existing communication skills and integration of medical interviewing into the consultation and to practise taking notes without affecting the relationship,