The history station is at once both the most fundamental station in the entire exam and the most difficult to prepare for. Good history taking is utterly fundamental to the practise of medicine, and its place in the examination is to ensure that those progressing are able to do this at a high level. In terms of preparation, candidates would be advised to see a lot of families, to learn how to move beyond question based fact acquisition and to tailor the history to the child’s presenting problem. It can be invaluable to be observed by a colleague or even video your own history taking session.
Other station guides have taken the reader through what to do and how to behave in each station. Here the guidance will be more focussed on how the examiner might view a candidate’s performance in a number of domains.
The purpose of history taking
History taking is much more than a series of diagnostic questions. Its aims are to:
- Establish characteristic features leading to a diagnosis; explore alternate diagnoses and enquire about distinguishing features.
- Identify severity of the condition both medically and to the child/family.
- Screen for other medical items.
- Establish rapport with the family and confidence in their clinical team.
There are several areas or phases within a history taking encounter. These may not necessarily occur sequentially. These are:
- Introduction, and identification of roles and purpose.
- Identification of presenting problem(s)
- Exploration of presenting problems, with specifics, and impact on child.
- Enquiry around related symptoms.
- Background information where not already covered (Pregnancy, birth, development, past medical history)
- Screening for other symptoms
- Screening for medical items (immunisation, development if not already covered, schooling, family issues)
- Recapping of information
- Conclusions and delivery of provisional plan
- Offer for patient or parent to correct information or plan.
Good candidates will flow naturally around these areas, and will have ease in focussing on important ones. They will create space for the patient to talk and the history taking will have a conversational quality to it. There will be a feeling of joint ownership of the final plan. The family and child will warm to this candidate, and empathy shown will be recieved as real, not ‘glue-on”.
The pointers below have been adapted from a medical school examiner’s guidebook on how to mark a candidate.
- Candidates should introduce themselves appropriately, including name and role. They should check the patient’s name, the relationship of the patient to others in the room, and explain what they are doing. They should explain where relevant in understandable language to the child what they is going to happen. Some sort of consent should be obtained.
- Candidates should use an appropriate mix of open and closed questions and avoid asking leading questions and multiple questions. Questions should be clear and jargon avoided. Candidates should demonstrate active listening, picking up clues, responding appropriately to patient replies and not repeating questions.
- Candidates should attempt to obtain relevant information from the child where possible, and if not, explain to the child that they will be talking to the parent.
- Good students will be organised and systematic in their approach, demonstrating skills such as sign posting and summarising. They should demonstrate empathy.
- Candidates should show interest, respect and concern for the patient. Tone and level of voice and non-verbal communication will be appropriate. Good students will position themselves at an appropriate distance from their patient and maintain eye contact.
- In concluding, candidates will accurately summarise to the patient the key presenting features and, using appropriate language, what the cause(s) might be. They will then explain what the next steps are and the way forward.
The MRCPCH Clinical Revision website team hope these notes will help you not just pass the examination, but be a better paediatrician.