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Tutorial for MRCP PACES Station 2 ( Last modified: 12 January 2007)
History Taking
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History taking is included in one of the five stations under new MRCP PACES examination. Candidates must remember that they must do a few things before entering the room. You are given some information about a patient ( could be an out-patient appointment or a history taken in casualty) and you are given 5-minute interval before entering the eamination room.
During these five minutes, you should plan your history taking systematically, you must include the following information: presenting complaints, past medical history, treatment/ drug history, social and occupational history, family history, system review, impact of the complaint towards patient's life, ' hidden agenda/ worries' and conclusion. Remember a few principles while taking your history,
Greet the patient, by name if possible,
Try to put the patient at ease by asking a few simple questions such as " How do you feel today?"
Always start using open-ended questions first in your exam. However, later you can use a mixture of open and closed questions.
Maintain good eye contact with patient and show gestures that you are interested in listening to their complaints and avoid staring at examiners or spend the whole time furiously writing notes.
Stay calm and relaxed. Speak loudly and clearly so that besides the patient, examiners can hear clearly as well.
Always finish your history taking by asking the patient if there are any questions that he/she might be interested to ask.
I think there are a few common mistakes candidates tend to do in their MRCP PACES exam, these mistakes are,
Poor eye contact with patient, spend the whole time writing or looking at examiners or watch.
Fail to get proper social history and establish the impact of disease towards patient's daily life.
Fail to include all possible differential diagnosis in history taking and miss some important diagnosis.
Fail to summarize the history and outline next plan of action for patient.
Remember that at the end of your history taking, try to ask patient is there anything else that he/she is worried about concerning the symptom. The patient may tell you that due to his/her diarrhea, he/she is worried about cancer. If from the history you gather, you do not think that it is cancer, try to calm the patient and give an impression to examiners that you are sensitive towards patient's problem. Always end your history taking by asking patient
" So...... Mr/ Madam...........Do you have anything else you would like to tell me or ask me?"
After this, summarize the history again and outline your plan such as below,
" Miss........., you just told me that you have been having this joint pain for the past one week with rash over your face, there are a few possibilities for your problem, it is still too early for me to tell you the diagnosis. However, since that you are having high-spiking fever as well, I would advise you to get admitted and we can have some blood tests and I would update you the results later in ward"
Always tell your patient what you would like to do after listening his/her complaints, explain to them about the tests if possible and advise for admission if necessary.
After the first part, you have one minute to collect your thoughts and you are supposed to present your history taking to examiners, usually, the examiners would ask you to summarize your history, you can present your history by listing down the patient's problems,
" Madam Lee is a 65 year old retired teacher presented with history of progressive forgetfulness for the past 5 months. She has short term memory loss currently and due to her problems, there were a few episodes that she actually was found wandering outside her home. I also notice that she has a very poor social support since that all her children are staying outstations and her husband passed away 4 years ago. She is currently very depressed because of her symptoms and her daughter is worried that she might be dependent in future. I think Madam Lee most probably is having Alzheimer's disease!"
After your summary, discuss with examiners that you want to consider other possibilities as well. Try to give reasons to support your diagnosis. The next thing the examiners would ask you is how would you manage your patient. Always divide your management to investigation and treatment. It depends greatly on your scenario how you answer this question!
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