History station (Medical students)
In the History Station, you are not role-playing as the doctor speaking directly to the parent. Instead, you should describe your approach by saying something like, “I would ask the parents…” rather than speaking as if you are in the clinical interaction.
The examiner will present a brief clinical scenario, such as: “A 6-month-old infant is brought to the pediatric casualty with fever. What questions would you ask his parents?”
Avoid launching into a random list of questions. Instead, begin by outlining your approach in a structured manner. "I would begin by introducing myself to the parents and confirming the child’s name and age. I would then start by asking them to describe their concerns – in this case a 6 month old child with fever – followed by focused questions about the fever and associated symptoms, and continue to take full history"
Once you have outlined your overall plan, proceed to take the history of the presenting complaint: “When did you first notice that the child had a fever? Did you measure the temperature? How did you measure it? Did the child appear unwell, or were they still active and playing? Are they feeding normally? Have there been any other symptoms? Did you give the child any medications?”
After obtaining the history of the presenting complaint, you should state that you will continue by taking a full medical history, including:
(1) the pregnancy, birth, and neonatal period
(2) nutrition and development
(3) past medical and surgical history
(4) vaccinations, medications, and allergies
(5) social and family history.
“In this case, I would be particularly interested in knowing if the child has received their primary vaccinations and whether any family members were ill.”
At this point, the examiner may ask about your differential diagnosis or management plan.
"I would complete my assessment with a physical examination, followed by appropriate investigations if necessary."
It is unlikely that you will be asked for specific drug dosages, but if you are unsure, it’s better to admit it. For example: “I’m not certain about the exact dose of paracetamol for a 6-month-old infant. In practice, I would refer to the British National Formulary (BNF) for guidance. It’s crucial to administer the correct dose, as paracetamol can be hepatotoxic in overdose.” Do not make an assumption or guess the dose. It’s important to demonstrate that you will practice SAFE medicine.
If you realize that you made a mistake, admit it clearly and correct it. For instance: “I misspoke when I referred to the condition as an ‘asthmatic attack.’ That is incorrect. Asthma can only be diagnosed later in childhood. In infants, we would refer to conditions such as ‘bronchiolitis’ or ‘wheezy bronchitis.’”
Finally, and most importantly, be confident! Show that you have the necessary knowledge of the subject and that you can be trusted to practice as a competent and safe doctor.
- Febrile infant and older child
- Vomiting and/or diarrhoea (GE and differential diagnosis, including meningitis, intestinal obstruction, DKA)
- Cough and/or shortness of breath (croup, wheezy bronchitis, asthma, foreign body inhalation, anaphylaxis)
- Febrile convulsions
- Skin rash (septicaemia, HSP, etc)
- Headache
- Prolonged jaundice
- Limping child (transient synovitis, septic arthritis, osteomyelitis, trauma, malignancy)
- Abdominal pain in a child (DDx: appendicitis, mesenteric adenitis, constipation, UTI, intussusception)
- Excessive thirst and weight loss (new-onset diabetes mellitus, chronic renal disease, hyperthyroidism)
- Bruising (ITP, leukaemia, coagulopathies, non-accidental injury, normal bruising)