Download - SCHHS Emergency Department

History Taking - Syncope
Subject and Curriculum Reference
History Taking
Syncope
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Differential diagnosis
Identification of at-risk groups
Management and disposition
Communication
Clinical Scenario Stem
A 19 year old previously healthy man has been brought in by ambulance after a collapse. He
is now fully conscious.
Instructions
Candidate:
A 19 year old previously healthy man has been brought in by ambulance after a collapse. He
is now fully conscious. You are a consultant at a tertiary level emergency department. You
are required to take a history. After 5 minutes you will be asked to summarize the findings
and give a brief differential diagnosis, list a few investigations you would like to order and
decide on a disposition for this patient.
You will not be required to examine the patient. Vital signs are normal. The cardiovascular,
respiratory, neurological and gastrointestinal exams are all normal. There is a bruise on the
patient’s forehead from the collapse.
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Role player – patient:
You are a 19 year old man called Peter Caldwell. You were at university where you study
information technology when you collapsed. The last thing you can remember is standing
outside a lecture theatre talking to a friend and then you were on the floor with people
standing over you. You took a few minutes to work out where you were and bystanders told
you that you had collapsed. The ambulance then appeared and you were brought to
hospital. You have a bruised area on your forehead but otherwise feel back to normal. You
have not bitten your tongue and you were not incontinent. You felt no pain anywhere or
any other symptoms before you collapsed. You have recently felt well and felt fine today.
You have never collapsed before. You have only ever been to the doctor for your
immunisations. You have no other medical history. You take no medications. You do not
smoke. You drink 5-10 standard drinks when you go out about once a week. You do not take
any drugs. You have no allergies. You live with your mother and 2 sisters. Your mother and
sisters have no medical problems. Your father died suddenly at the age of 32. Your mother
said it was his heart that caused his death but that is all you know. Your uncle also died due
to a heart condition at the age of 23.
Examiner:
Observation only. After 5 minutes ask the candidate to give a brief differential diagnosis, list
some immediate investigations and decide on disposition.
NB:

The “Scenario” in the preceding page is ALL the information provided to the
candidate before s/he interacts with the actors.
 Candidates will only have 7 minutes to try to explain and complete the task.
Successive candidates will be interrupted by 3-minute breaks, during which the
examiners and actor discuss the preceding candidate.
 After a succession of 10 or less candidates, there is a longer break to permit rest and
refreshments
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Assessment Criteria
 Confirms the patient has been brought in after a collapse
 History presenting complaint should include:
o Symptoms/warnings prior to collapse specifically chest pain, headache,
o
o
o
o
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shortness of breath
Symptoms on day of collapse or in last few days
Patient’s recollection of collapse
Indications of seizure i.e. tongue biting, incontinence
Any area of pain or symptoms after the collapse
Past medical history
Medications
Drugs/alcohol/smoker
Allergies
Family history must be asked
Differential diagnosis must include arrhythmia/cardiac cause
Investigations must include ECG
Disposition for admission due to likely serious cardiac cause
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Examiner Scoring Sheet
Candidate Details
Candidate ID:
Exam Details
Date of OSCE:
Examiner Details
Name:
Signature:
Component Assessment
Select ONE option for each component
Worst
Mid
Best
History Taking
Communication
Medical
Expertise
Prioritisation
and Decision
Making
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Detailed Assessment Criteria
Please use the following criteria to inform your ratings
History Taking

Structured approach
 History presenting complaint:
o Symptoms/warnings prior to collapse specifically chest pain, headache,
shortness of breath
o Symptoms on day of collapse or in last few days
o Patient’s recollection of collapse
o Indications of seizure i.e. tongue biting, incontinence
o Any area of pain or symptoms after the collapse?
 Past medical history
 Medications
 Drugs/alcohol/smoker
 Allergies
Medical Expertise
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Differential diagnosis includes cardiac/arrhythmia
Other reasonable differentials given e.g. neurological (e.g. SAH), vasovagal,
hypoglycaemia
Investigations includes ECG
Prioritisation and Decision Making
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Disposition admit cardiology/telemetry
Communication
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Introduces self and clarifies purpose
Professional manner
Builds rapport with patient
Clear questions
Listens and clarifies
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Information
History Taking Station (Syncope): The participants are the candidate and the patient. The
candidate has received instructions, outside the room, that they are a consultant at a
tertiary level emergency department. A 19 year old previously healthy man has been
brought in by ambulance after a collapse. He is now fully conscious. They are required to
take a history. They are not required to examine the patient. They have been informed that
the patient’s vital signs are normal and that the cardiovascular, respiratory, neurological and
gastrointestinal exams are all normal. There is a mark on the patient’s forehead from the
collapse.
After 5 minutes you are to stop the candidate and ask them to summarise the findings and
give a brief differential diagnosis, list a few investigations they would like to order and
decide on a disposition for this patient.
Examiner Notes
Candidate performance notes: Please provide candidate feedback including any areas of
strength in their performance and suggestions for how they could improve.
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OSCE “incident reporting” notes: Pleas provide details if an issue occurs which may
influence this candidate’s exam outcome e.g. protocol breach, candidate illness etc.
Global Rating for Standard Setting:
This scale is used in the standard setting process for the OSCE. We would like you to make a
judgment that is independent of their scores on the adequacy of their performance. This
element MUST be completed for the standard of the examination to be set
Clear fail
Marginal fail
Borderline
Marginal
pass
Clear pass
Select the
ONE BEST
option that
reflects your
judgement of
how well the
trainee
performed in
this OSCE
station:
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