The best way to ace your history taking station is to listen tot your patient right from the start. Often examiners are bored and tired of seeing students walk through the door and reel off the same questions in the same methodological order. After all they are human. What they are really looking for is someone who stands out for the right reasons. This involves a few key things above the basic task of simply working through a checklist of questions.
1. Rule out the red flags
This means knowing why you are asking certain questions. For example in a young patient with a headache, where you may be concerned about Meningitis, you will want to ask about fever, photophobia and a rash. If you are ask about these three symptoms at different points in the history, it may seem you are simply going through a checklist in your head. However if you enquire about these symptoms in succession, it would better enable the examiner to follow your thought process and your line of questioning.
2. Listen to the patient
This means responding to certain cues and being flexible with your questioning. This will only come through practice. Not the type of practice you cram for two weeks before the exam with your friends but the kind of practice you get spending time with real patients on the ward and getting feedback from senior clinicians. The ability to listen to your patients and responding to their concerns (which are often non medical in nature), is a skill which differentiates the best candidates from the majority.
3. Observe the patient
Watch your patient carefully. Are they engaging with you? Do they seem distracted? What does their body language say? Picking up on non verbal cues can help guide your conversation in a patient centred manner and can unlock key information about your patient, which may be vital towards formulating an overall management plan. For example does your patient appear withdrawn, are they unkempt, do they appear to be in pain (perhaps it may be better to start the consultation by offering painkillers).
4. Know when to summarise
Often time the OSCE station won’t be as straightforward as you might hope it to be. The patient may ramble on and mention ten different symptoms along with a bunch of social issues and a complicated past medical history. The information can be overwhelming especially in an exam scenario. That where summarising comes into play. When you’re not sure where the consultation is going or where along the consultation you are, summarise everything the patient has told you in a few sentences. Get them to confirm what you said or add/remove anything you may have added by mistake. This gives you some mental breathing space and a chance to recollect your thoughts.
None of the skills mentioned above come overnight. They take constant practice and an active effort to address your specific weaknesses. However developing these skills will not only lead to better clinical outcomes but will also lead to a greater sense of fulfilment and satisfaction in your professional life.
