1. History Taking for OSCEs
Clarissa Gurbani
Year 3 Medical Student
University of Manchester
2. General tips
Follow the Calgary-Cambridge Framework!
Score points with a solid introduction
Begin by asking open questions
Show that you’re interested
◦ Posture – lean forward
◦ Good eye contact
Remember ICE:
◦ Ideas
◦ Concerns
◦ Expectations
Summarize at regular intervals
Don’t miss crucial signposts!
3. Introduce yourself!
‘Good afternoon, my name is Joe Bloggs
and I’m a 3rd year medical student. I’ve
just been asked to take a history from
you today, is that alright?’
‘Before I continue, can I just confirm your
name and date of birth?’
‘I just want to let you know that this
interview will be kept confidential
between me and the medical team
involved in your care.’
4. Your introduction
If there is hand gel – use it!
State who you are and your year of
study
Consent and confidentiality
Check the patient’s name and DOB
against their wristband – older patients
may be confused. Do it subtly so as to
not offend the patient!
5. Calgary-Cambridge
Framework
1. Presenting complaint (PC)
2. History of presenting complaint
(HPC)
3. Past medical history (PMH)
4. Drug history (DH)
5. Family history (FH)
6. Social history (SH)
7. Systems review
6. PC
1 sentence in the pt’s own words
Don’t interrupt pt’s opening statement!
Build rapport from the very beginning
7. PC
Start with either:
‘How are you feeling today?’
‘What has brought you into the GP
practice?’
‘Could you tell me what brought you
into the hospital?’
8. HPC
Respond to what the patient has told
you!
Obtain a timeline of events
◦ When it began (i.e. acute vs chronic)
◦ When pt first sought medical advice
◦ ‘Is this the first time this has happened?’
◦ ‘Does it get better?’ (i.e. remittance)
9. HPC
If there is pain, remember
SOCRATES:
◦ S – site
◦ O – onset
◦ C – character
◦ R – radiation
◦ A – associated features (e.g. nausea,
vomiting)
◦ T – timing
◦ E – exacerbating/relieving factors
◦ S – severity (compare with worst pain
ever felt)
10. HPC
Differentiate pain according to
symptoms
E.g. chest pain:
◦ Cardiac – central, crushing, radiating to
jaw, neck and left shoulder (angina, MI);
tearing, interscapular pain radiating to the
back (aortic dissection) etc.
◦ Pleuritic – worse on inspiration/coughing
◦ Musculoskeletal – worse on certain
movements (e.g. turning to the side) and
can usually be localized to a specific area
11. HPC
Full list of signs and symptoms (S+S)
E.g. in the respiratory system
◦ SOB (exertional/at rest)
◦ Pleuritic chest pain
◦ Weight loss
◦ Cough (dry/productive)
◦ Sputum (colour, quantity)
◦ Nocturnal cough (Asthma, ? cardiac
asthma in congestive heart failure)
◦ Reduced exercise tolerance
12. HPC
Also bear in mind:
◦ Disrupted sleep patterns (e.g. symptoms
worse at night? – asthma, peripheral
arterial disease etc.)
◦ Affecting activities of daily living (ADL)?
13. PMH
Ask about common medical
conditions:
•Hypertension
•High cholesterol
•Diabetes mellitus (type 1 or
2)
•Asthma (ask also about
chronic rhinitis and eczema
– triad of allergy)
•COPD
•IHD (angina, MI)
•CVS (TIAs, strokes)
•Arthritis
•Orthopaedic problems
•Liver disease
•Chronic kidney disease
•Bowel problems
(constipation, diarrhoea)
•Urinary problems (e.g.
benign prostatic
hyperplasia)
14. PMH
Previous surgeries
Previous hospitalizations
Try to obtain timeline, e.g. ‘When were
you diagnosed with asthma?’ – helps
when you are looking through the
patient’s drug history
16. FH
Don’t be afraid to ask!
Approach with tact – ‘Does anyone
else in your family have this
condition?’ or ‘Do you know of any
other health conditions that may run in
your family?’
Important as many conditions carry
genetic components
17. SH
Smoking
◦ ‘Have you ever smoked?’
◦ ‘When did you start?’
◦ ‘How many do you smoke a day, on
average?’
◦ ‘Have you ever tried to quit?’
◦ 1 pack year = 20 cigarettes/day for 1 year
18. SH
Alcohol
◦ ‘How much alcohol do you drink a week?’
◦ Maximum recommended no. of units – 21
for men, 14 for women
◦ If pt can identify a certain time he altered
his drinking habits, try and identify a
trigger
◦ 1 pint of beer = 2 units
19. SH
Employment status
Home situation
◦ ‘Who’s at home with you?’
◦ For elderly patients – ‘Do you get any help
at home?’
◦ Family support
Diet and exercise
Pets
◦ E.g. for atopic conditions like asthma
20. Systems review
Not an exhaustive list
Ask what you think is relevant to pt in
light of:
◦ Demographic (e.g. age, sex)
◦ PC and PMH
◦ Family history
You may uncover another PC that the
patient may not have mentioned!
27. Musculoskeletal systems
review
Arthritis
Pain while walking (differentiate from
claudication – comes on at a fixed
distance, worse when walking uphill,
does not radiate, usually localised to
back of calf but can affect gluteal
muscles and posterior thigh, settles
within 10 to 15 minutes of rest)
28. Conclusion
Summarise again
Make sure you have obtained ICE, if
not ask the patient explicitly – ‘What
did you hope to get out of this
interview?’, ‘What do you think these
symptoms might suggest?’
Ask the pt if he/she has any questions
29. Presenting your findings
Come up with 3 differential diagnoses
◦ 1 must be sinister e.g. malignancy
◦ Be able to explain why these are your
DDx
◦ Bear in mind further investigations you
may do to confirm a diagnosis if the
examiner asks
If you panic, go back to your surgical
sieves!
32. To finish your station
Thank the patient and the examiner
Wash your hands again
33. Final tips
Appear confident throughout
If your mind goes blank, summarize
and ask the pt to add on – ‘Is there
anything you feel you might want to
add on?’
Practice taking histories on wards and
time yourself
Clerk patients (if the FY or consultant
is willing to let you to – ask for
permission!)
