A marked station, in full
This is what we hand back after ten minutes.
One real station, marked against the scheme written for chest pain. Thirty-eight criteria, each one red, amber or green, each with its reason written out. Read it before you decide whether we are worth paying for.
A worked example. The station, the patient's answers and all 38 criteria are live from the app. The student's half was written for this page, so the marking has something to mark.
- Specialty
- Cardiology
- Setting
- Emergency department
- Referral
- GP to ED
- Presenting
- Episodes of chest discomfort over two days
She does not volunteer it
Every line Caroline says is the case script, unedited. What decides the mark is behind questions nobody has asked her yet.
Hello, I'm Alex, one of the medical students. Would it be alright to ask you about what's brought you in today?
I was strolling in the local garden yesterday and had this funny feeling in the chest, and it happened again this morning as well, and I feel worried now.
That sounds unsettling. Can you tell me a bit more about that feeling?
I felt uneasy in the middle of my chest, more the left lower part, while I was walking, but it settled with rest. Then I had another feeling of tightness in the chest when I started to walk again.
Did that feeling go anywhere else, or stay in your chest?
It went down my left arm, and up into my jaw.
Radiation to the arm and jaw is in the script and she will not mention it unprompted. A student who never asks does not get told.
Do you smoke at all?
I gave up about eight years ago.
Twenty a day for twenty-five years is waiting behind one more question. The student moved on, and that is partial credit, below.
Excerpt. The station ran the full ten minutes.
The report
Section bands first, because the useful question is not what you scored but where you lost it.
38 criteria marked
9 sections
red, amber or green on each
You scored 72%, and your weakest section was Systemic review, at 17% of 3 criteria. You took a good cardiac history and never screened the systems around it.
Eight of the 38
Every criterion comes back with its reason attached. Green is full credit, amber partial, red none, each judged against an anchor written into the scheme beforehand rather than decided on the day.
You gave your name and your role in the first line. You never confirmed who you were speaking to. The anchor scores both together, so doing one of the two is partial credit.
All four. Site and character came out of your open question, which is the efficient way to get them. You then asked directly about radiation and she told you about the left arm and the jaw. Full credit needs all four, and you have them.
You asked for a number and she gave you six out of ten. Worth noting what this criterion will not accept: asking whether it was bad, and being told it was quite bad, earns nothing here. The scale is the criterion.
Nothing about palpitations or an irregular heartbeat anywhere in the ten minutes. This station does not expect a full palpitations workup, and the scheme says so: one screening question inside your associated symptoms would have taken the whole mark.
Cough, blood in the sputum and frothy sputum were not asked about. She would have said no to all three, and that negative is exactly what you needed for your presentation. This is most of why your systemic review came out at 17%.
You asked, and she told you she gave up eight years ago. You did not quantify it. Twenty a day for twenty-five years was one question away, and in a chest pain history the number is the point. Status asked but not quantified is partial credit.
She mentioned her mother and you followed it: what happened, and at what age. A cue raised and left alone is partial credit here. You also correctly did not treat a heart attack at 70 as a premature family history, which it is not.
Three differentials, which is a reasonable range, and stable angina was properly argued from the exertional onset and the relief with rest. Acute coronary syndrome and musculoskeletal pain were named and then left standing on their own. Thin justification across most of the list is partial credit, and this criterion is usually what separates a pass from a distinction.
30 more criteria were marked the same way were marked the same way, across systemic review, past medical history, medications, social and family history, and the presentation. All of them are in the report the student gets. The scheme behind them is written for chest pain, and every station in the library has its own.
Two stations are free.
This one is one of them. Marked in full, nothing held back, no card needed.
Caroline Smith, chest pain · Cardiology · 38 criteria