OSCESup.com — Y1/Y2 Communication Stations

OSCESup.com

Year 1 & 2
Communication Stations

4 practice stations with full mark schemes and actor scripts. Cardio/Resp and MSK. History taking and shared decision making.

4 stations 7 minutes each History taking Shared decision making Cardio · Resp · MSK Y1 & Y2

SettingGP consultation room

Duration7 minutes

Your roleYear 1 medical student

PatientMr Alan Park, 58

TaskHistory of chest pain

Candidate Brief — Read outside the door

You are a Year 1 medical student on a GP placement. Mr Alan Park, 58, has booked an urgent appointment today complaining of chest pain that started this morning. He has no previous cardiac history on record.

Your task: Take a focused history of his chest pain. You should explore the presenting complaint in detail, ask about relevant associated symptoms and risk factors, and briefly cover his past medical history, drug history, family history and social history.

You are not expected to examine the patient or give a diagnosis. At the end, the examiner may ask you to summarise your findings and give two differential diagnoses.

Y1 Tip — SOCRATES

Use SOCRATES to structure your pain history: Site · Onset · Character · Radiation · Associated symptoms · Timing · Exacerbating/relieving factors · Severity. Don't forget ICE at the start.

Key areas to cover

Site, onset, character of pain (crushing/sharp/burning?)
Radiation — arm, jaw, back, epigastrium
Associated: SOB, nausea, vomiting, sweating, palpitations, syncope
Timing — when, how long, constant or episodic
Exacerbating/relieving — exertion, rest, GTN, food, posture
Severity — pain score /10
Cardiac risk factors: HTN, DM, hypercholesterolaemia, smoking
Family history of heart disease
Drug history — aspirin, statins, antihypertensives

What the patient has (don't read before the station)

Central, crushing chest pain — 8/10
Radiates to left arm and jaw
Started 2 hours ago at rest, watching TV
Associated with sweating and nausea
No relieving factors — GTN not tried
Hypertensive — on amlodipine
Smokes 10/day, ex-heavy smoker
Father had MI age 62
Worried it's "the big one"

Score

0 / 18

Opening & ICE 3 marks

Introduces themselves appropriately and confirms patient's name1

Asks an open question to begin — e.g. "What brings you in today?" — and listens without interrupting1

Elicits ICE at some point — Ideas ("What do you think it might be?"), Concerns ("Is there anything you're worried about?"), Expectations ("What were you hoping we might do today?")1

SOCRATES — Pain History 7 marks

Site — asks where the pain is located1

Onset and timing — when it started, how long it has lasted, whether it came on suddenly or gradually1

Character — asks what the pain feels like (crushing, sharp, burning, pressure)1

Radiation — asks if the pain spreads anywhere (arm, jaw, back, shoulder)1

Associated symptoms — specifically asks about shortness of breath, sweating, nausea/vomiting, palpitations, dizziness or collapse1

Exacerbating and relieving factors — what makes it better or worse (exertion, rest, GTN, posture, food)1

Severity — asks patient to rate severity, e.g. on a scale of 0–101

Cardiac Risk Factors & Systematic Enquiry 4 marks

Asks about smoking, hypertension, diabetes, and high cholesterol1

Family history — specifically asks about first-degree relatives with heart disease or early MI1

Drug history — current medications and any allergies1

Social history — occupation, alcohol, living situation1

Communication & Closing 4 marks

Uses a mix of open and closed questions — does not use a rigid checklist style1

Responds to patient's concern about it being serious — acknowledges ICE before continuing1

Summarises the history back to the patient and checks accuracy1

If asked by examiner: gives two sensible differentials, e.g. ACS / unstable angina / GORD / musculoskeletal1

Pass Thresholds — 18 marks total

Pass: ≥ 12/18 — full SOCRATES covered, ICE attempted, at least 2 risk factors explored, coherent summary

Borderline: 9–11/18 — pain history mostly complete but ICE or risk factors missing

Fail: < 9/18 — or fails to pick up on the severity of symptoms / misses radiation and associated features

Actor: Mr Alan Park, 58, retired bus driver. Stocky, quietly anxious but trying to seem calm. He's convinced this is serious but doesn't want to say it out loud. He will offer information freely but only if asked the right questions — don't volunteer the radiation to the jaw until specifically asked about spreading. Soften once the candidate acknowledges his concern.

Opening

Alan"Morning. Sorry to come in as an urgent — I just… I've had this chest pain since about 7 this morning and my wife made me ring up."

When asked to describe the pain

Alan"It's right here, in the middle. Heavy — like someone's sitting on my chest. I'd say… eight out of ten. Maybe more."

If asked about radiation / spreading

Alan"Actually yes — it's going down my left arm. And my jaw feels a bit tight too, now you mention it. I thought that was just me."

If asked about associated symptoms

Alan"I've been sweating, yeah. And felt a bit sick. Didn't vomit or anything. I wasn't doing anything when it started — just watching the morning news."

If asked about ICE / what he thinks it is

Alan[Pause. Lower voice slightly.]

Alan"My dad had a heart attack at 62. I've always been worried I'd go the same way. I'm 58. This feels… like it could be the big one."

Risk factor questions — answers

AlanSmoking: "Ten a day now. Used to be 30. Cut down five years ago."

AlanBlood pressure: "Yes — on amlodipine for it. 5mg."

AlanCholesterol: "They said it was high a couple of years ago. I was meant to start a statin but I never went back."

AlanDiabetes: "No, not as far as I know."

AlanAlcohol: "Few beers at the weekend. Nothing crazy."

If candidate is dismissive or doesn't acknowledge his anxiety

"Look — is this serious? Because it doesn't feel like indigestion to me."
"Should I have gone to A&E? My wife said I should have called an ambulance."

SettingGP consultation room

Duration7 minutes

Your roleYear 1 medical student (supervised)

PatientMiss Chloe Reeves, 19

TaskExplain inhalers + shared decision

Candidate Brief — Read outside the door

Miss Chloe Reeves, 19, is a first-year university student who was seen by the GP last week after presenting with episodic wheeze, cough (especially at night), and breathlessness on exercise. Spirometry confirmed mild asthma. The GP has asked you to explain the diagnosis and discuss starting inhaler therapy with her.

Chloe has heard of asthma but doesn't think it's that serious. She is a bit reluctant — she doesn't like the idea of being on medication and is worried about what her friends will think.

Your task: Explain the diagnosis of asthma in simple terms, introduce the concept of a reliever inhaler (salbutamol), and discuss whether she would like to start it. Use a shared decision-making approach — explore her concerns, give balanced information, and support her to decide. You do not need to demonstrate inhaler technique.

Y1 Tip — Shared Decision Making

SDM = Information + Preference + Decision together. Don't just give information — ask what matters to her, what her concerns are, and invite her to be part of the decision. Avoid being paternalistic ("you should take this").

Key facts to communicate

Asthma = airways that are sensitive and can narrow, causing wheeze, cough, breathlessness
Reliever inhaler (blue — salbutamol): opens airways quickly, used when symptoms occur, not every day
Preventer inhaler (brown — beclometasone): reduces inflammation, taken daily — not needed yet at mild stage
Triggers: exercise, cold air, dust, pets, infections, stress
Important to carry reliever at all times
Asthma is very common and manageable — most people lead normal lives
She can review again in 4–6 weeks

Her concerns (don't read before station)

Doesn't want to be seen as "ill"
Worried about using an inhaler in front of friends / on a night out
Asks: "Will I have this forever?"
Asks: "Is it safe? Are there side effects?"
Plays five-a-side football — worried about impact on sport
Will agree to try the inhaler if concerns are properly addressed

Score

0 / 18

Opening & Establishing Understanding 3 marks

Introduces themselves and puts the patient at ease — acknowledges she may have heard some information already1

Checks what Chloe already knows about asthma before explaining — "What do you know about asthma already?"1

Explores her concerns and what matters to her before launching into information — uses ICE1

Explaining Asthma & Inhalers 6 marks

Explains asthma clearly in lay terms — sensitive airways that narrow, causing the wheeze and breathlessness she has been experiencing1

Explains the reliever inhaler (salbutamol / blue inhaler) — what it does, when to use it (when symptoms occur), that it works quickly1

Explains that it is taken when needed rather than every day — and that if she needs it more than 3 times a week she should come back1

Mentions common triggers — exercise, cold air, infections, dust, pets, stress1

Addresses safety / side effects — mainly mild tremor and palpitations with high doses; generally very safe at recommended doses1

Specifically addresses exercise — many athletes have asthma, a reliever before exercise can prevent symptoms, she can still play football1

Addressing Concerns & Shared Decision Making 6 marks

Addresses the social stigma concern — normalises asthma, mentions it is very common in young people and athletes1

Addresses the "will I have it forever?" question honestly — asthma can improve or resolve, particularly in young people; it's not always lifelong1

Explicitly invites her preference — "How do you feel about trying the inhaler?" / "What would you like to do?"1

Does not pressure or dismiss her hesitation — respects her right to decide, offers time if needed1

Offers follow-up — suggests a review in 4–6 weeks to see how she is getting on1

Checks understanding before closing — "Is there anything you'd like me to go over again?"1

Global Communication 3 marks

Uses no jargon, or immediately explains any medical term used — language is pitched appropriately for a 19-year-old1

Conversation felt two-way — patient was invited to respond and contribute throughout, not just lectured1

Patient left with a clear plan and felt heard — not rushed or patronised1

Pass Thresholds — 18 marks total

Pass: ≥ 12/18 — reliever inhaler explained clearly, patient's concerns addressed, SDM approach used

Borderline: 9–11/18 — information given but one-directional; concerns not fully acknowledged

Fail: < 9/18 — or telling patient she must take the inhaler without exploring her views

Actor: Chloe Reeves, 19, first-year student. Friendly and chatty but a bit guarded about the diagnosis. She's embarrassed about the idea of having a medical condition. She's not aggressive — just reluctant. If the candidate is warm, normal and non-patronising, she opens up quickly and agrees to try the inhaler. She responds well to being told famous athletes have asthma.

Opening

Chloe"Hi. So… the doctor said I had to come back about this asthma thing. I looked it up online but I'm not really sure I actually have it? Like, is it definitely asthma?"

When inhaler is introduced

Chloe"An inhaler? Like, every day? That feels a bit… extreme for something I barely notice."

Chloe"Also I play five-a-side on Sundays. If I have asthma, can I still do that?"

Questions to raise (pick 2–3 based on time)

Chloe"Will I have asthma forever? Like, is this it now?"

Chloe"Are there side effects? I really don't want to put on weight or anything like that."

Chloe"It's just a bit embarrassing, you know? Like pulling out an inhaler at a party."

If candidate is warm and addresses concerns well

Chloe"Oh — I didn't know loads of athletes used them. That's actually kind of reassuring."

Chloe"Okay. I think I'd be willing to try it — if it's just for when I need it and not like, twice a day forever."

If candidate is preachy or doesn't address her concerns

"You keep saying I should take it but you're not really listening to why I don't want to."
"Is there any other option? Like, can I just manage it without medication?"

SettingGP consultation room

Duration7 minutes

Your roleYear 2 medical student

PatientMrs Janet Okafor, 48

TaskFull back pain history

Candidate Brief — Read outside the door

You are a Year 2 medical student in GP. Mrs Janet Okafor, 48, has come in with a 6-week history of low back pain. The GP has asked you to take a full history before they come to review her.

Your task: Take a thorough history of the back pain using SOCRATES, explore the important red flag symptoms, and cover relevant background history. You are expected, as a Year 2 student, to demonstrate awareness of red flags for serious spinal pathology. The examiner will ask you at the end: "What red flags did you screen for, and did this patient have any?"

Y2 Expectation — Red Flags for Back Pain

By Year 2 you are expected to screen for: age >50 or <20 · trauma · constant progressive pain not relieved by rest · thoracic pain · night pain waking from sleep · bilateral leg weakness or saddle anaesthesia · bladder/bowel dysfunction · unexplained weight loss · history of cancer · fever / systemically unwell · IV drug use. This patient has one concerning feature — screen carefully.

What to cover

Full SOCRATES of the back pain
Radiation — into buttock, thigh, below knee (sciatica pattern?)
Neurological symptoms — leg weakness, numbness, pins and needles
Red flag screening (see tip above)
Bladder and bowel function — any change?
PMHx — previous back problems, osteoporosis, cancer
DHx — NSAIDs, steroids (bone health)
Social history — occupation, manual work, impact on daily life

What the patient has (don't read before station)

6 weeks of central lower back pain, aching, 5/10
Radiates into left buttock and down back of left thigh — stops above knee
Worse in the morning, eases with movement and ibuprofen
No bladder or bowel change
No leg weakness or saddle anaesthesia
Night sweats — "yes, quite a lot actually" — and 5kg weight loss over 8 weeks
History of breast cancer 3 years ago — completed treatment, told she was in remission
Works as a school administrator — desk job

Score

0 / 20

Opening & ICE 2 marks

Introduces themselves appropriately, open question to begin1

Elicits ICE — what she thinks is causing it, what she is worried about, what she hopes will happen today1

SOCRATES of Back Pain 6 marks

Site — where exactly in the back1

Onset — when it started, sudden or gradual, any precipitating event1

Character — aching, sharp, stabbing, burning1

Radiation — into buttock, thigh, or below knee (sciatica); or bilateral; or thoracic region1

Exacerbating / relieving factors — movement, rest, analgesia, morning stiffness1

Severity and impact — pain score, impact on work and daily activities1

Neurological Symptoms 3 marks

Asks about leg weakness or difficulty walking1

Asks about numbness or tingling in legs or saddle area (inner thighs / genitals) — cauda equina screen1

Asks about change in bladder or bowel function — urinary retention / incontinence / bowel change1

Red Flag Screening 4 marks

Asks about unexplained weight loss1

Asks about night sweats or fever1

Asks about previous cancer history1

Asks about night pain — pain that wakes from sleep or is constant regardless of position1

Background History & Closing 3 marks

Drug history and allergies — asks specifically what analgesia she has tried and whether it helps1

Social history — occupation, impact on work and daily life1

Examiner question: correctly identifies red flags present (weight loss, night sweats, cancer history) and states urgency of further investigation1

Global Communication 2 marks

History flows naturally — candidate uses information from earlier in the consultation to guide later questions (not a rigid checklist)1

When patient mentions cancer history or weight loss, candidate follows up appropriately — does not pass over it1

Pass Thresholds — 20 marks total

Pass: ≥ 14/20 — full pain history, cauda equina screened, weight loss + cancer history identified as red flags

Borderline: 10–13/20 — pain history complete but red flags missed or not followed up

Fail: < 10/20 — or patient's cancer history mentioned but not identified as clinically significant

Actor: Mrs Janet Okafor, 48, polite and matter-of-fact. She's had back pain before and assumed this was the same. She does not volunteer the cancer history or weight loss unless specifically asked — she doesn't think they're related. When the candidate asks about weight loss or night sweats, answer honestly but say "I didn't think it was relevant." Don't mention the breast cancer unless directly asked about previous medical history or cancer.

Opening

Janet"Hi. I've had this back pain for about six weeks now. I've had back problems before but this one doesn't seem to be going. I've been taking ibuprofen and it helps a bit but it's not really going away."

About the pain — answer when asked

JanetSite: "Lower back, sort of in the middle and slightly to the left."

JanetCharacter: "It's a dull ache mostly. Sometimes a bit sharp if I twist."

JanetRadiation: "It goes into my left buttock and down the back of my thigh. Not below the knee though."

JanetMorning stiffness: "Yes, it's worse when I wake up. Eases off when I move around."

Neurological questions — answer when asked

JanetLeg weakness: "No, nothing like that."

JanetBladder/bowel: "No changes there — all normal."

JanetNumbness: "My thigh feels a bit tingly sometimes but nothing severe."

Red flag questions — answer when asked

JanetWeight loss: "Actually — yes. I've lost about five kilograms over the past couple of months. I just thought I was eating less because of the pain."

JanetNight sweats: "Yes, quite a lot actually. I put it down to menopause."

JanetCancer history: [Only if specifically asked about previous medical history or cancer] "I had breast cancer three years ago. I finished chemotherapy and they told me I was in remission. I didn't think that was relevant to my back."

JanetNight pain: "Sometimes I wake up in the night and it's uncomfortable. I just assumed it was the way I was lying."

ICE — if asked

Janet"I assumed it was just a trapped nerve or a disc. My sister had that. I was hoping for some stronger painkillers and maybe a physio referral."

If candidate does not ask about cancer history or red flags at all

Do not volunteer the information — the examiner will note it as a missed red flag.
If candidate wraps up without asking: "Is there anything else you need to know about me? I wasn't sure if my old health issues were relevant."

SettingOrthopaedic outpatient clinic

Duration7 minutes

Your roleYear 2 medical student (supervised)

PatientMr Tom Griffiths, 32

TaskDiscuss management options — SDM

Candidate Brief — Read outside the door

Mr Tom Griffiths, 32, is a PE teacher who injured his left knee playing rugby 10 weeks ago. MRI has confirmed an anterior cruciate ligament (ACL) tear. He has been seen by the consultant, who has explained the diagnosis. He has been referred back to discuss his management options.

He has been given a leaflet but found it confusing. There are two main options: physiotherapy-led rehabilitation (conservative) or ACL reconstruction surgery. Both are valid — the best choice depends on his lifestyle, goals, and preferences.

Your task: Explore what matters most to him, explain both options clearly, and support him to make a decision. You should not push him towards one option. At the end the examiner will ask: "Based on what he told you about his life and work, which option would you support and why?"

Y2 Expectation — SDM in MSK

By Year 2 you should demonstrate that you can tailor information to the individual patient's context. His job as a PE teacher and his desire to return to rugby are clinically relevant — they should influence the conversation, not just be noted and ignored.

Conservative management (physio)

Structured physiotherapy programme — 9–12 months
Strengthens muscles around the knee to compensate for the ACL
Works well for less active patients or those with less rotational demand
Avoids surgery risks — anaesthetic, infection, DVT, nerve damage
Some patients do very well and return to sport without surgery
Risk: knee may remain unstable for pivoting/cutting sports

ACL reconstruction surgery

Keyhole surgery — graft used to replace the torn ligament (often hamstring or patellar tendon)
Recovery: 9–12 months to full return to sport
Better outcomes for high-demand sport (pivoting, cutting)
Surgical risks: infection, DVT, anaesthetic risks, graft failure (~5%)
More likely to allow return to competitive rugby
Not urgent — can be planned electively

Score

0 / 20

Opening & Exploring What Matters 4 marks

Introduces themselves, establishes what Mr Griffiths already understands about his diagnosis and options1

Asks about his goals — what he wants to get back to, what matters most (return to rugby? get back to work? avoid surgery?)1

Explores his concerns about each option — e.g. fear of surgery, time off work, recovery1

Acknowledges the impact of the injury on his work as a PE teacher — connects this to the clinical decision1

Explaining Conservative Management 4 marks

Explains physiotherapy — what it involves, timescale (~9–12 months), what it aims to achieve (muscle compensation)1

Explains benefits — avoids surgery, no anaesthetic risk, many people return to sport1

Explains limitations — knee may remain unstable for high-demand pivoting sports such as rugby; may not be adequate for his activity level1

Does not dismiss this option — presents it as a genuine valid choice, not a consolation prize1

Explaining ACL Reconstruction 4 marks

Explains the surgery in lay terms — keyhole procedure, a tendon graft is used to rebuild the ligament1

States recovery timeline — still 9–12 months for return to sport, not an instant fix1

Mentions surgical risks in a balanced, non-alarming way — infection, DVT, graft failure, anaesthetic1

Explains benefit for his context — better outcomes for high-demand sports like rugby; more likely to allow full return to contact sport1

SDM Process & Closing 4 marks

Explicitly invites his preference after presenting both options — "Having heard all of that, do you have a leaning towards one option?"1

Does not push one option — respects his choice even if he leans towards physio only1

Offers time to think — doesn't pressure an immediate decision; suggests he could discuss with family and come back1

Examiner question: correctly identifies that given his active job and rugby goal, surgery is clinically reasonable — but acknowledges physio-only is a valid first step if he prefers1

Global Communication 4 marks

Uses the patient's own language and goals throughout — "you mentioned getting back to rugby — let me explain how each option affects that"1

Avoids jargon or explains any medical terms used (e.g. "graft," "reconstruction")1

Conversation was balanced — both options felt equally presented, not one favoured over the other implicitly1

Patient felt the decision was genuinely his to make — not just informed consent for a procedure someone else has already decided on1

Pass Thresholds — 20 marks total

Pass: ≥ 14/20 — both options explained with pros/cons, patient's context used to guide discussion, preference elicited

Borderline: 10–13/20 — options covered but SDM approach missing; or one option not explained

Fail: < 10/20 — or only one option presented / patient's work and sport context ignored entirely

Actor: Mr Tom Griffiths, 32, PE teacher. Fit, sporty, frustrated that his knee is stopping him from working and playing rugby. He is leaning towards surgery because he wants to return to rugby fully — but he's nervous about the recovery time and being off work. He is engaged and asks good questions. He will make a decision by the end if the candidate gives him balanced information and acknowledges his specific situation.

Opening

Tom"Hi. So I've read this leaflet three times and I'm still not sure what I should do. The consultant said both options are on the table but I need to decide. I play rugby — I'm not ready to give that up."

When physiotherapy is explained

Tom"So with just physio — could I actually go back to playing rugby? Like, proper rugby, not just a kick-around?"

Tom"And how long would it take before I can get back to work? I'm a PE teacher — I can't just sit on the sidelines indefinitely."

When surgery is explained

Tom"What are the chances something goes wrong with the surgery? Because my mate had knee surgery and ended up worse."

Tom"And it's still 9 to 12 months either way? So what's the actual advantage?"

Questions to ask mid-station (pick 1–2)

Tom"If I do the physio first and it doesn't work, can I still have the surgery later?"

Tom"What would you do if it was your knee?"

If candidate explains both options well and connects to his context

Tom"Okay. I think… if there's a better chance of getting back to rugby properly, I'd rather go for the surgery. But I want to talk to my wife first. Can I have a week to decide?"

If candidate doesn't acknowledge his rugby / work goals

"I feel like you're just telling me the options — you're not actually helping me decide what's right for me."
"Does it matter what I want to do? Or is there a right answer here?"