Confusion: collateral history
A relative gives a collateral history about a confused patient. Establish the baseline and the time course.
One of 8 stations in history taking. For how the whole circuit fits together, see medical OSCE practice.
The station brief
This is the sort of instruction you would read on the door before you go in. It is short, and every word in it is doing work.
Candidate instructions
A patient has been admitted with confusion. Please take a collateral history from their relative.
Read it twice. The task is what the mark scheme is built around, and it is easy to lose marks by running a perfectly good consultation that answers a different question from the one on the door.
Decide what you are being asked to do before you sit down, then hold to it when the conversation pulls you sideways. Wording varies between schools; the shape of the task rarely does.
- The role — who you are in this scenario and who you are speaking to; it sets the register for everything that follows
- The verb — take, explain, counsel, advise: the verb decides where the marks sit, and answering the wrong one is the most expensive mistake in the station
- The clock — plan the closing minute before you start, because the marks candidates run out of time for are the ones at the end
Timings vary between schools. Treat 8 minutes as the working assumption and practise to it.
What the examiner is marking
Stations like this reward process over recall. The examiner has a sheet in front of them and is watching whether you work through the consultation in a defensible order, then say what you have decided and why.
- Establishes the cognitive BASELINE before the current episode
- Pins down onset and whether it was sudden or gradual
- Asks about preceding illness and recent medication changes
- Covers function, mobility and care needs at home
- Explores the relative’s own concerns and expectations
The full mark scheme is in the app
What you see above is the shape of it. The itemised mark scheme for this station is shown against your own transcript once you have run it, so you can see exactly which points you picked up and which you walked past.
Where students lose marks
Almost none of these are knowledge failures. They are habits — a structure that slips, a question never asked, a plan the patient could not repeat back — and every one of them is drillable.
Failing to establish the baseline, which the whole station turns on
Talking about the patient as if the relative were the patient
Missing recent medication changes
How to practise this station
Reading a station is not practising it. You can recognise every point above and still dry up ninety seconds in, because the difficulty in an OSCE is running the structure out loud, to time, at somebody who is not helping you.
- 1
Commit to the task before you start
Say the task back to yourself in one sentence, and decide roughly where you want to be at the halfway mark. Two minutes of planning is worth more than another read of the lists on this page.
- 2
Run it cold with the AI patient
In the app this station runs as a live consultation. An AI patient plays the role and responds to what you actually ask, by voice or in text. Run it once without re-reading anything, so you find out what you do under pressure rather than what you know.
- 3
Read the marking against your own transcript
When the station ends your consultation is marked against the mark scheme, point by point. The gap worth closing is the one between “I knew that” and “I asked that”, and it only shows up in a transcript.
- 4
Put it in a timed circuit, then come back to it
Practise it inside a timed mock OSCE circuit alongside other stations rather than in isolation, then run it again a few days later. If the structure has become automatic by then, it will hold on exam day.
Related stations
Same category, same shape of consultation. Practising them as a group beats one-offs, because the structure carries across and the repetition is what makes it automatic.
Chest pain history
A patient presents with chest pain. Take a focused history, characterise the pain, and screen for the features that change urgency.
Headache history
A patient presents with headache. Establish the pattern and timeline, and screen carefully for features that need escalation.
Abdominal pain history
A patient presents with abdominal pain. Localise it, characterise it, and cover the systems review the site demands.
See every station in history taking, or browse the full station bank.
Run the station, don’t just read it
Practise with an AI patient, to time, and get marked against the mark scheme. The Free plan is enough to try it.