History taking

These stations assess your ability to ‘elicit a thorough, relevant and accurate medical history’ in a ‘focused and timely manner’, ‘while acknowledging the patient’s other expressed concerns’ (ACEM Curriculum Framework). May be combined with physical examination where you describe to the examiner the focused examination you would perform in response to the information you've obtained.

Typical tasks

  • Take a focused history from the patient (role player)

  • Assess the severity of the condition based on discussion with patient/parent

  • Counsel the patient as to the possible causes for his/her presentation

  • Formulate an appropriate diagnostic workup or management/disposition/follow-up plan and communicate this to the patient

  • Answer the examiner’s questions regarding the differential diagnosis and further patient assessment.

  • Outline to the examiner the focused history you would obtain in order to diagnose a condition e.g. clinically clear the cervical spine

  • Give your differential diagnosis and clinical examination approach to the examiner

Domains that have been tested in recent OSCEs

  • Medical expertise: History and/or Examination

- Elicits a focused relevant history

- Identifies important historical details (red flags) diagnostic of an important condition.

- Clarifies aspects in history to refine diagnosis generation

- Outlines a focused, structured and relevant physical examination

- Describes expected physical signs for high risk differential diagnoses.

  • Medical Expertise: Diagnosis and Investigation, or Management

- Generates a differential diagnosis, with an inherent focus on conditions requiring time critical management

- Creates a focused investigation plan that confirms or excludes time critical diagnoses

- Provides an investigation plan with reasoning

- Outlines an overall treatment plan

  • Health Advocacy

- Facilitates an adequate follow up plan

- Incorporates the patient’s chronic clinical state and their wishes when making decisions

- Implements strategies to prevent a patient ceasing their emergency care prematurely

- Provides understandable instructions for the patient on discharge, including likely progression of their clinical course, and reasons to return

- Explains to patients and/or their guardians the rationale for management decisions

- Integrates communication skills relevant to the patient’s culture to enhance delivery of health advice to patients

- Refugee Health - Identifies findings on assessment that increase the likelihood of a patient being vulnerable

- Tailors treatment and disposition decisions for a patient to account for the presence of vulnerability factors

  • Prioritisation and Decision Making

- Links clinical information and evidence-based practice to explain decisions made

- Highlights high-risk features identified during initial patient assessment

- Provides a rationale to explain decisions about ongoing assessment.

  • Communication

- Uses a balance of open and closed questioning to obtain a concise history

- Uses language appropriate to the patient’s level of understanding i.e. avoids jargon

- Displays the use of active listening to explore a patient’s concerns and expectations.

- Allows the patient to react emotionally to the situation and responds appropriately to non-verbal cues.

ACEM OSCE report feedback

Common themes for candidates who performed well:

  • took competent history, able to generate an adequate differential list

  • appropriate use of open questions with periods of silence

  • establish rapport and show genuine empathy

  • gave comprehensive work up plan with rationale

  • gave clear discharge advice

  • appropriately prioritised and well-reasoned differential diagnosis.

Common themes for candidates who did not perform well:

  • incomplete or poorly structured history

  • missed red flags

  • ignored cues from patient

  • missed major aspects of past medical or social history which impact on Mx

  • not exploring details of underlying cause of a crisis (e.g. mental health)

  • poor/inaccurate advice

  • poor understanding of management options

  • disregarding key information

  • unable to manage emotional aspects of an interaction

  • lack of empathy or reassurance


  • Remember you may have to take the history, explain your findings and explain your management plan all in 7 minutes. This means that you must take a focused history that:

- Is a detailed history of the presenting complaint

- Explores a differential diagnosis

- Explores relevant past medical history; medications; allergies; family history

- Drug and alcohol history

- Clarifies your likely diagnosis

- Clarifies the severity of the presentation

- Covers risk stratification of the presentation

- Social history - this is often where the money is! For example, their occupation may impact on discharge planning.

- Explores disposition (social Hx; additional issues; risks)

  • Make sure you address ALL the tasks of the station. E.g. provide DDx, or discuss investigation options. You may do an excellent job taking the history but if you do not address the other tasks you won’t do well in the station.

  • Pay careful attention to what the role player is saying. Everything they say is relevant and important and designed to keep you on the right track.

  • Look at the Presentations List in the Curriculum Framework for all the presentations you should practice. Some examples from the last few years:

Paed head injury Headache Leg swelling

PV bleeding Sexual assault Mental Health

Trauma/MVA Paed abdo pain Paed bloody stools

Acute vision loss Syncope

  • Asking "Is there anything else you want to tell me?" may not illicit a key aspect of the history. You must use direct questions.

  • What the examiners are looking for:

· Develop and maintain rapport

· Non-judgemental, empathetic approach

· Assure confidentiality where appropriate

· Listen actively

· Begin with open ended questions

· Respond to patients verbal and non-verbal cues

· Summarise

· Verbalise plan, and reasoning in LAY language

· Give the patient opportunity for questions – and address those.