USING THE
CALGARY-CAMBRIDGE FRAMEWORK IN THE
CLINICAL ENVIRONMENT:
HISTORY TAKING
Year 3
Introduction to Clinical Learning (ICL)
Communication Session 1
September 2012
TUTOR NOTES
Original authors: Dr Chris Harrison & Dr Jo Hart
Changes for 2012
The Intended Learning Objectives have been streamlined. Instructions for role playing have been
clarified. Please ensure that if printing the C_C model you always use the adapted model that brings
together the words used in placements(PC/HPC etc) and the model. Tutor general notes have been
removed and point re use Communication Tutor Resource Pack inserted below. No change to roles.
Revised June 2012
By
Dr Rosie Illingworth
Any comments to
Rosie.illingworth@manchester.ac.uk
If as a tutor you are feeling rusty regarding facilitating an experiential group, working with Simulated Patients, feedback rules etc then
please refer to the Communication Tutor Resource Pack – if you do not have this then ask the Site Administrator for Communication, who
booked you to email you a copy.
1
Contents
page
Introduction, context, outline, staff requirements,
other requirements
Intended learning outcomes
Session outline
SP role & model history 1 - Wilson
SP role & model history 2 - Dixon
SP role & model history 3 - Ahmed
The Calgary-Cambridge framework
Traditional history and Calgary-Cambridge framework
integrated
Information for SPs
3
4
5-7
8-11
12 – 14
15 – 17
18
19
20
Note for administrators 2012
There are three SP roles for this session – each group gets the same roles,
not in the same order! The role name has been changed for one of the
female roles – this is to allow for inter-cultural marriages and can be played
by any female SP
Thanks
2
ICL Communication session 1
CONTEXT
This is a half day course which is designed to be run as the first communication skill session in the
Introduction to Clinical Learning for 3rd Year Medical Students.
The medical students have taken part in ‘early experience’. They have had 8 hospital visits, 8
community visits, portfolio sessions and basic clinical skills. They have also had 8 communication
sessions. They have had basic history taking experience, and have spent a lot of time practising their
communication skills in session with simulated patients, as well as having self, peer and GP assessment
on their communication skills in practice.
Some students have not done their first 2 years training at Manchester; they are direct entry students
(mainly from St Andrews or a Malaysian medical school). They will have had a review session, but
please be aware that they might not have had the same experiences/style of training as those who
have been at Manchester.
OUTLINE OF SESSION
The session [3hrs including 15min break] is divided into 4 main parts, which all take place in a small
group of no more than 10
 An introductory/review part in small groups [5 min]
 A brainstorm and general discussion about the content and process of Medical Interviewing
[35 min]
 3 role plays [the first 30 min for medical interviewing skills and the second and third 40 min to
practice medical interviewing and taking notes]
 Debriefing in small groups [15min]
The small group sessions provide the students with opportunities to develop, practice and reflect on
their medical interviewing skills prior to joining their clinical firms.
The students will be divided into groups with a tutor in each. 3 simulated patients will visit the groups.
Groups will undertake the tasks in varying sequences - there is no problem with this as the 3 tasks
stand alone and do not interrelate.
There are 3 SP roles in the pack, please check with site administrators which order they will be in for
your group. Also included in the pack are model histories for the tutor to refer to during the discussion
of recording a history for each role, and student instructions.
STAFF REQUIREMENTS
One tutor for each group, each in an appropriate room
3 simulated patients for each 3 groups (admin: when sending out roles and student instructions to SPs,
please send session information sheet on p 22)
OTHER REQUIREMENTS
- Tutor notes
- Stickers for name badges and flip chart/pens for each group room
- CC guides (1 per student plus 1 per tutor)
- Pendleton’s Feedback Rules (A3 – one to display each room)
- Intended Learning Outcomes (A3 – one to display in each room)
- Yellow individual student feedback forms for role playing students (one per student)
3
-
Session Evaluation forms, one per tutor, for the comm team to keep
Student feedback forms, for the tutor to keep (one per student)
INTENDED LEARNING OUTCOMES:
By the end of the session students will have:





Taken a full medical history using the adapted Calgary-Cambridge Framework
Understood that the patient’s perspective is an important part of information to be gathered
Used effective communication skills in order to gather information
Started to record the content of a history effectively during the interview, appreciating the
importance of chronology
Appreciated that there are four stages of information processing:
1. Gathering information;
2. Recording information
3. Synthesising the information to arrive at a differential diagnosis
4. Presenting it (to be taught in another session)
Setting: small groups, preferably 8, max 10 (PBL groups if possible)



Student interviewer
Group and Tutor
Simulated Patient (in role)
 Student
 Group and Tutor
 Simulated Patient (in role)
Simulated Patient (out of role) on both areas
Learner’s take away points?
4
Time
SESSION OUTLINE
Start 0
Introduction – introduce yourself and use an ICEBREAKER to get the students to introduce themselves: you
could ask pairs of students to talk to each other for 1 min and then to introduce each other to the group – it
could be something specific you set like hobbies, favourite holiday or their choice.
What do you do?
Takes
Introduce the intended learning outcomes (ILOs) – see page 4
5 min
Give students an outline of how the session will run.
 A brainstorm and general discussion about the content and process of Medical
Interviewing [25 min]
 3 role plays [the first for medical interviewing skills and the second and third to
practice medical interviewing and taking notes] all 40 min each
 Debriefing & wrap up [15min]
Start 5
Takes
25 min
Brainstorm:
Why do we take a history? [The aim is to obtain information, which is useful in
formulating a diagnosis and providing medical care to the patient, while working
with the patient to also address their needs. Endorse that this is the start point of
medical work – not the be all and end all!]
Ask:
o How do good communication skills help in this process?
o What have you learnt so far about how to communicate well with patients?
(FAO TUTORS: use a flipchart/get a scribe to list: e.g. introduction, rapport building, open/closed
questions, room arrangement, body language, eye contact, summarising, reflecting, pausing, clarifying
information chunking and checking, forward planning, appropriate closure)
o What problems may you encounter when trying to elicit a history?
(FAO TUTORS: scribe to write up on flipchart e.g. patient’s beliefs/concerns – ideas, concerns,
expectations, , issues like hidden agendas, the difference between a focused and a full history)
Discussion
1. What needs to be covered in a medical interview including a systems review:
(FAO TUTORS: use flipchart + use the CCF pocket guide to help you but please note we cannot cover all
the different systems reviews in this session – today is just an introduction – students will learn
systems reviews on their firms over the coming year)
o Remind them to use the Calgary-Cambridge Framework (CCF) (see p).
(FAO TUTORS: could use flipchart to briefly revise the sections: initiating the session / gathering
information / physical exam (not today) / explanation and planning (not today – a separate session
later in the year) / closing the session)
o Discuss the differences between the approach of traditional medical history taking and the CalgaryCambridge Framework. The CCF integrates the medical information gathering with the patient’s
perspective, while providing structure and attending to building a relationship using. (FAO TUTORS:
you need to be clear about the differences yourself! – handout p18 - 19)
2. Discuss note taking during the interview and recording of the history in the notes:
o Explain the difference between writing up the history in the traditional way (presenting complaint,
history presenting complaint etc) in contrast to recording it in the notes following the CalgaryCambridge model
(FAO TUTORS: use flipchart with 2 columns–demonstrate the difference)
3. Discuss the need for the next steps after taking and recording the history (not practiced in
this session):
Making sense of the information, synthesising it to come to a diagnosis, considering the differential
diagnoses and presenting the information to someone else.
This is what they need to practice throughout their clinical years.
5
Prepare the group for the next part: interviewing
1
practising taking a full history [if time including making a start on a systems review]
2 + 3 practising taking a history and taking notes at the time
o
You need 5 volunteers (three for the first role and one for each of the other roles – see SP grid for
details of rotation). The observers will also be given tasks (see below).
Explain the student doing the interview can use the pause button at any time to ask for suggestions
from the group; encourage focus on both content and process
FAO TUTOR – you could also ask individual students to focus on specific areas, like body
language/non verbal behaviour, involving the patient by asking about and responding to Ideas
Concerns & Expectations, style of questioning, attending to flow/having a structure, chronology, use
of summarising, making organisation overt/signposting, non verbal behaviour, rapport building,...
and/or ask the role playing student what they would like specific feedback on.
o
o
Start at
30
Takes 40
min
Role play 1
New for 2012!!!!
Since students feedback to us that more would like to have a go at interviewing, for the 1st role only have 3
volunteers, who each have 3 minutes to take a ‘rolling’ history i.e. each starts from where the previous one
left off. You will need to debrief (do not use Pendleton’s fb rules here) between each 3min role. Feedback on
what has been achieved and what missed so far. Questions that will be helpful for this might be:
 What do we know now? What was done effectively? Where do we go from here?
o
SP visits group for 30 min (FAO TUTOR – keep to time!) – to practice a complete medical interview
including some systems review without recording the interview
- the SP will wait outside until the student comes to call them in
(FAO TUTORS: remind the student to use the pause/rewind button)
Start at
70
15 min
Start at
85
Takes
40 min
o
Break
Role play 2
Explain the feedback arrangements:
o
There is a student feedback form about the tutor, which the tutor keeps for their own
portfolio.
o There is a yellow feedback form for each student interviewer, which a colleague will use to
record a summary of the main points of individual feedback from the session. This is then
o
One tutor and one student from each group are also being asked to provide a detailed
evaluation after the session – email after the session. This is used by the student for their
portfolio and by lead tutors when all sessions are reviewed at the end of the academic year.
given to the student to keep for their portfolio.
o
The aim of this role to practise taking the medical interview and writing up the history at the same
time
o Student interviews SP for a maximum of 7/8 min and tries to take notes at the same time
o Arrange for up to 4 additional people to take notes (as if they were conducting the interview),
others to be active observers
o Active observers – to give feedback on content/process /flow e.g. chronology, open & closed
questions
o Note takers – write notes as interview progresses for discussion afterwards – alternatively, one
student could write up the emerging history on the flipchart
After role
o Debrief the student and group using the Pendleton Rules of Feedback
o Use the interviewer, the other students and tutor and the SP in and out of role feedback for what
appears to have worked well and what they would do differently
o Discuss note taking whilst interviewing!
6
o
o
o
Start 125
Takes 40
min
Role play 3
o
o
o
Start 165
Takes
15 min
End
180
mins
Ensure yellow student feedback sheet is filled in for each student interviewer
Ask note-taking students about the notes they have taken and how they have ordered them
Discussion of taking and recording notes – effect on interview, how to do without breaking eye
contact, maybe explaining to patient why taking notes, writing notes up after each mini-summary,
what to record, how to record ICE, how to develop a structure, etc
Follow the same format from role 2, but try to implement some of the learning points that came out
of this, especially in terms of note-taking whilst interviewing
You may also pause the interview and move it on to focus on a different section (e.g. past medical
history) if the students haven’t covered these issues so far.
Discuss what would be recorded – needs discussion on purpose of patient notes. Then discuss
student notes – as learners with confidentiality, anonymising, (purpose is for the learner).
Group Debrief – Closure
End the session by asking each student to state one point they have learnt from today.
Hand out student feedback forms to be filled in and handed back.
Remind the student who has been asked to fill in a detailed evaluation to do this within 2 weeks and send it
back to the administrator.
After the students have left, fill in the tutor evaluation form, including comments on each individual student,
and hand to the administrator.
Tutor debrief with site leads after the session please
7
Simulated patient role
Patient’s
Mr/Mrs. Wilson
name
Setting
Surgical ward
Course/Session
ICL 1
role
Age
Sex
Other info
1
35 - 65
M or F
Post op
Background
Married, with three children (pick suitable ages to fit in with your age). You work for a bank on the counter.
You don’t smoke, and you share a bottle of wine with your spouse approximately three times per week.
Recent Past
For a few months you had recurrent attacks of tummy pain. It was high up, just below your ribs (pointing
below ribs on right side). The pain often went through to your back, and would last an hour or two. You
had wondered whether it was a stomach ulcer, but hadn’t got round to seeing your GP. About 6 weeks
ago, you had a much more severe version of the pain. It was constant, and any movement was very
uncomfortable. You were vomiting, had a high fever and felt very unwell. You were sent into hospital by
your GP, where they diagnosed an inflamed gallbladder, caused by gallstones. They put you on a drip, and
painkilling injections for a few days. The surgeon said that they would remove the gallbladder a few weeks
later.
Other Medical Problems (if asked)
You’ve usually been fit and well, apart from an under active thyroid, for which you take thyroxine (100
micrograms per day). This has never bothered you, as this seems to run in your family. You have blood
tests each year to make sure you are on the right dose.
About three years ago you were depressed, and took Prozac for about 8 months. This happened after your
mother died of breast cancer. You were close to her. Since then, you have felt mentally fine, although your
family keep you busy.
Now
You were admitted to hospital 3 days ago to have your gallbladder taken out by keyhole surgery.
Unfortunately, the surgeon was unable to remove it through the keyhole, so instead they had to make a
much bigger scar underneath your right ribcage. It is painful and you have a drain coming out of the scar.
You feel bloated and your bowels haven’t properly worked after the operation- you have only been once
and passed a very small amount. You feel constipated. You are on oral painkillers that the nurses give to
you – you do not know what they are called.
Current Concerns and Emotions
You feel very disappointed that you have had to have the bigger scar, as the surgeon implied this was very
unlikely. He also said you’d be up and about in no time, and would barely realise you’d had an operation.
Now you are worried about when you will be able to get back to work. With these concerns and your
discomfort, you feel quite low and, at times, even tearful. You are not angry with the surgeon, just sad and
frustrated.
Task OBJECTIVES:
•
•
Students should practise how to gather information while maintaining good communication skills,
please ensure that you give them feedback on both of these.
In some parts of the session, they are learning how to record the content of a history effectively, so
if they are taking notes please comment on how their taking notes affected the interview.
8
Instructions For Medical Student
Role 1
You are a third year medical student.
You are based on a surgical ward.
Your consultant has asked you to take a history from Mr/Mrs Wilson.
You have been told that he/she has had an operation recently but you have not been given
any other information.
Please take a full history including systems review if appropriate from Mr/Mrs Wilson, to
find out why he/she has had an operation, as well as discovering what has happened since
coming in to hospital.
If you have been asked to take notes during the interview, please do that also.
Remember you can pause at any time to ask for suggestions from the group.
The tutor may need to stop you if time is short.
9
Model History – Information For Tutor
Mr /Mrs Wilson
Age: YY
Date of birth: A/B/C
[today’s date] Seen on Ward QQ
Presenting complaint(s):
Post-op open cholecystectomy
History of Presenting Complaint:
Recurrent episodes of epigastric pain for several months
- each episode lasts 1-2 hours
- radiates through to back
6/52 ago, much more severe episode of pain
- same location
- constant, made much worse by any movement
- associated with vomiting and high fever
- admitted by GP to hospital
- put on drip and parenteral analgesia
- advised by surgeon it was due to inflamed gallbladder/gallstones, listed for admission to remove
gallbladder
Admitted here 3 days ago for planned laparoscopic cholecystectomy
Laparoscopic approach unsuccessful so converted to open cholecystectomy
Now recovering, drain still in place. Still in significant discomfort.
Currently constipated – bowels have opened once since op, but small amount only. Passing flatus. Not
vomiting. Eating small amounts only.
Patient’s Perspective (Beliefs and Concerns0
Initially thought recurrent episodes were due to ulcer
Disappointed by larger scar – had expected laparoscopic approach would have been successful
Concerned about level of pain and when can return to work
Low and tearful at times, not angry or clinically depressed
Past Medical and Surgical History
Hypothyroidism, on replacement Rx.
(Has annual thyroid function tests to monitor this)
Episode of depression 3 years ago
- took prozac (fluoxetine) for 8 months
- associated with life events (death of mother)
- been fine since, but busy with family
Drug History
Levothyroxine 100mcg daily (takes regularly, no side effects)
Currently on oral analgesics while in hospital – unsure of name
No herbal or over-the-counter remedies
Allergies
None known
10
Family History
Mother died of breast cancer 3 years ago (?age)
Thyroid problems run in family (unsure of details)
Nil else relevant
Personal and Social History
Married, 3 children
Counter Assistant at local bank
Non-smoker (lifelong)
9-12 units alcohol/week (3-4 units, 3 times per week – wine)
Systems Review
NS* current low mood, tearful
Nil of note in other systems
Examination Findings
Not examined
* NS = Neuro System
11
Simulated Patient Role
Patient’s
name
Setting
Mrs. Dixon
Dermatology OutPatient Department
1st outpatient
appointment
Course
ICL 1
Role
2
Age
Sex
20-50
Female
Other info Wear a hat, skirt that covers knees, long sleeved top
You are married – your husband says he understands your feelings about having psoriasis but you are not
sure that anyone does really. You work in a factory, which is fine because you have to wear a cap to cover
your head – it is a sweet factory. You worry that someone will say that you cannot work if they find out.
You have no children – your husband cannot have them so when the doctor told you that you both agreed
not to do any other tests. You have always been happy with that, as you would not want to pass psoriasis
on to any children. You think it is hereditary as an aunt and a cousin have it but they do not seem
bothered by it. There is no family or previous personal history of anything else.
Current Problem and how it affects you
You have psoriasis – a scaly, thickened skin disorder on your elbows, knees and scalp. It comes as red thick
patches with a silver scale. The patches are itchy and the scales come off causing you great
embarrassment because it looks like you have very bad dandruff most the time. You feel you have to cover
up your arms and legs always even in very hot weather and you have not been swimming for years even
though you enjoyed it. You cannot wear dark clothes because of your scalp and you find it very awkward
going to the hairdresser even though you know it is not contagious at all but just looks awful. In the past
one hairdresser insisted on wearing gloves to cut your hair. No-one knows that you have psoriasis until
you feel you can trust them and you feel it is because of the psoriasis that your social life is very limited
even though you feel you would naturally like to go out to the pub, for meals with friends etc more. So you
don’t drink at all, and have never smoked.
You do not know what caused it and you have had it since you were late teenage which was awful at the
time because you felt everyone was looking at you. You are sometimes better than at other times but you
do not know why – when you are particularly stressed in life it is possibly worse, but even this is not clear
cut.
Now Your psoriasis is very bad right now. You have come to the dermatology clinic as your GP has referred
you. You suspect because she doesn’t know what else to do. You have seen various GPs in the past - but
feel they have always been interested in the skin as a condition, rather than in you and the effect if has on
your life. Consequently you have never really listened much to what they have said especially as the
creams and shampoos they have prescribed have always smelt so much and have not helped much anyway
and you have given up using them. There is an element in you that would love there to be a magic cure
but expect that you’ll get the usual brush off from the doctors.
OBJECTIVES:
•
•
Students should practise how to gather information while maintaining good communication skills,
please ensure that you give them feedback on both of these.
In some parts of the session, they are learning how to record the content of a history effectively, so
if they are taking notes please comment on how their taking notes affected the interview.
12
Instructions for Medical Student
Role 2
You are a third year medical student.
You are based in a dermatology out-patient clinic.
Your consultant has asked you to take a history from Mrs Dixon, who has been newly
referred. The consultant will see her afterwards.
You have been told that she has been referred to the clinic by her GP for psoriasis but you
have not been given any other information.
Please take a full history from Mrs Dixon including an appropriate systems review, to find
out why she been referred.
If you have been asked to take notes during the interview, please do that also.
Remember you can pause at any time to ask for suggestions from the group.
The tutor may need to stop you if time is short.
13
Model History- Information For Tutor
Mrs X Dixon
Age: YY
Date of birth: A/B/C
[today’s date] Seen in Dermatology Outpatients
Presenting complaint(s):
Psoriasis
History of Presenting Complaint:
Extensive psoriasis for many years
Affects extensor surfaces of knees and elbows, also scalp
Patches are red and scaly - can be itchy
Has tried numerous creams and shampoos in past (unsure of details, some had strong odour), but none
have helped. Unsure whether has she been compliant with treatment. Remains sceptical that any doctor
will be able to help
Has had very significant impact on her life
- embarrassed by scales coming off (manifesting as ‘severe dandruff’)
- feels has to keep covered up, even in hot weather
- avoids swimming, wearing dark clothes
- some hairdressers have stigmatised her in past (implied it was contagious)
GP has referred her here to Dermatology Outpatients for second opinion
Patient’s Perspective (Beliefs and Concerns)
Knows she has psoriasis
Hopes for ‘magic cure’ but recognises this is unlikely
Not felt doctors have previously taken her seriously – treated her skin rather than her as whole
person
Past Medical and Surgical History
Nil of note
Drug History
Nil at present. Has tried numerous creams in past for psoriasis, unsure of details
No herbal or over the counter remedies
Allergies
Nil known
Family History
Aunt and cousin both have psoriasis (are less severely affected)
No other relevant family history
Personal and Social History
Married, no children (infertility in husband)
Assistant in sweet factory
Limited social life – tends only to tell very close friends about psoriasis
Non-smoker
No alcohol intake currently
Systems Review
M Skel: No joint symptoms
Nil relevant
Examination Findings Not examined
14
Simulated Patient Script
Patient’s
name
Setting
Lisa Ahmed
Course
ICL 1
A&E
Role
Age
Sex
Other info
3
20 - 40
Female
Background
Teacher/ nursery nurse. Just got married [previous name – Ball] and arrived back from 2 week honeymoon
in Australia a few days ago. Travelling out you were upgraded to business class as you were
honeymooners, but coming back you were stuck in economy. You had a fair amount of wine on the way
back and slept for a large part of the journey. (NB This may not seem relevant to the case but it does fit in
well with the subsequent diagnosis.) Smoke 20 per day – know you should give up really. Normally rarely
drink, but shared a bottle of wine with your husband most nights during your honeymoon.
Current situation
You have come to A&E after you coughed up blood several times in the last 24 hours– darkish red, small
amounts, and have been feeling a bit short of breath. Also had a sharp pain in the back of your chest. Felt
like a knife in your back, especially when you take a deep breath in. If asked your left leg is slightly swollen,
at the calf, and feels uncomfortable – this has only come on since the flight home.
Concerns
When initially noticed blood, wondered if you had contracted TB during plane journey. Or whether this is
lung cancer (recognises she is at risk as a smoker). You are very frightened.
Expects to be examined and uncertain what might be the outcome
When you first coughed up blood, you thought it might have been TB, as you’d heard that there’s more
about these days – maybe you picked it up from the air conditioning on the plane. At the back of your mind
you wondered about lung cancer as you smoke.
Previous Medical Problems
Had grommets in your ears when you were young, because of recurrent ear infections. Hearing fine now.
Gets headaches and neck ache at the end of the day. GP said it was it was tension which you can believe as
your job is very hectic. Swimming helps the headaches. Hay fever in summer.
Medication
Femodene – contraceptive pill (take 21 out of 28 days). Been on this for about 4 months. You took a
different type of pill before that (microgynon) but you thought it was making your headaches worse. Take
Zirtek antihistamines in the summer for your hayfever.
OBJECTIVES:
•

Students should practise how to gather information while maintaining good communication skills,
please ensure that you give them feedback on both of these.
In some parts of the session, they are learning how to record the content of a history effectively, so
if they are taking notes please comment on how their taking notes affected the interview.
15
Instructions for Medical Student
Role 3
You are a third year medical student.
You are based on A & E.
Your consultant has asked you to take a history from Ms Lisa Ahmed
She has presented to A&E complaining that she is coughing up blood.
Please take a history from Ms Ahmed to find out the symptoms and take a full history
including a systems review.
If you have been asked to take notes during the interview, please do that also.
Remember you can pause at any time to ask for suggestions from the group.
The tutor may need to stop you if time is short.
16
Model History – Information for Tutor
Mrs Lisa Ahmed
Age: YY
[today’s date] Seen in A +E
Presenting complaint(s):
Date of birth: A/B/C
haemoptysis
History of Presenting complaint:
- 24 hr history of several episodes of haemoptysis
- small amounts of dark red blood
- no fever or purulent sputum
- associated with sharp, stabbing pain in back (interscapular region)
- pain aggravated by deep inspiration, and causing some shortness of breath
- this occurred within 2 days of returning from long-haul flight from Australia (had slept most of time,
drank large quantity of alcohol)
- also left leg swollen and uncomfortable
Patient’s perspective (beliefs and concerns0: patient initially thought it might be TB following plane
journey
Past Medical and Surgical History
Recurrent ear infections as child – treated surgically by grommet insertion. Hearing now fine
Recurrent tension-type headaches
Hay fever
Drug History
Femodene for last 4/12 – now been told to stop
Cetirizine once daily as required (for hay fever)
No herbal or over the counter remedies
Allergies
No drug allergies known
Family History
Nil relevant
Personal and Social History
Nursery nurse
Married (2/52 ago)
Smokes 20 per day for x years, aware needs to stop ‘at some stage’
Patient concerned about long- term risk of lung cancer, aware is at risk
Alcohol normally only on rare occasions, but drank 3-4 units per night for last 2/52 (honeymoon) – ie ½
bottle wine
Drank on plane journey, long haul, stationary for several hours in economy class
Systems Review
Examination Findings
Nil relevant
Not examined
17
18
THE TRADITIONAL HISTORY
AND CALGARY-CAMBRIDGE FRAMEWORK
INTEGRATED
STRUCTURE FOR TAKING, RECORDING AND PRESENTING A HISTORY
PRESENTING COMPLAINT(PC)
HISTORY OF PC(HPC)
Add Patient’s Perspective
PREVIOUS MEDICAL HISTORY(PMH)
PREVIOUS SURGICAL HISTORY
Drug History (DH)
Allergies
SYSTEMS REVIEW (SR)
PATIENT’S PRESENTING COMPLAINT(S):
1.
2.
3.
4.
BIOMEDICAL PERSPECTIVE
(DISEASE)
sequence of events
symptom analysis
relevant systems review
PATIENT’S PERSPECTIVE & experience
(ILLNESS)
ideas
concerns
expectations
effects on life
feelings
SOCIAL HISTORY
BACKGROUND INFORMATION/CONTEXT
FAMILY HISTORY
DIFFERENTIAL DIAGNOSIS
MANAGEMENT PLAN
DIFFERENTIAL DIAGNOSIS
MANAGEMENT PLAN
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Information for SPs
CONTEXT
This is a half day course which is designed to be run as the first communication skills session in the
Introduction to Clinical Learning (ICL) for 3rd Year Medical Students. Introduction to Clinical Learning is the
3 week block at the beginning of 3rd year.
The medical students have taken part in ‘early experience’. They have had 8 hospital visits, 8 community
visits, portfolio sessions and basic clinical skills. They have also had 8 communication sessions. They have
had basic history taking experience, and have spent a lot of time practising basic communication skills in
sessions with simulated patients, as well as having self, peer and GP assessment on their communication
skills in practice.
Some students have not done their first 2 years training at Manchester; they are direct entry students
(mainly from St Andrews or a Malaysian medical school). They will have been offered a revision session,
but please be aware that they might not have had the same experiences/style of training as those who
have been at Manchester.
OUTLINE OF SESSION
The session [3hrs including 15min break] is divided into 4 main parts, which all take place in a small group
of no more than 10
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An introductory/review part in small groups [5 min]
A brainstorm and general discussion about communication issues [35 min]
3 role plays [first @ 30 min – medical interviewing, then twice @ 40 min, the 2nd and 3rd covering
the skill of note taking as well as medical interviewing]
Debriefing in small groups [15min].
The small group sessions provide the students with opportunities to reflect on and practice and develop
the interviewing skills they have learnt in the last semester of early experience, in order to prepare them
for medical history taking in their clinical placements.
The students will be divided into groups with a tutor in each. 3 simulated patients will visit the groups.
Groups will undertake the tasks in varying sequences.
OBJECTIVES:
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Students should practise how to gather information while maintaining good communication skills,
please ensure that you give them feedback on both of these
In some parts of the session, they are learning how to record the content of a history effectively, so
if they are taking notes please comment on how their taking notes affected the interview
Note for Simulated Patients:
All scripts have been streamlined so students can gather information and integrate
content (symptoms etc) and process (how they ask/ listen).
For the first role play of the session [you do your role three times in total], please try to
keep things straightforward as students get the hang of taking a history [ eg omit Past
Medical History for Mr/Mrs Wilson & Lisa Ahmed; don’t over-emphasise psycho-social
aspects of Mr/Mrs Dixon].
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