Communication and Rapport – This covers how candidates go about obtaining a patient’s history, explaining the problem and management, and negotiating agreement on the management plan. Candidates should be patient-centred, empathic and show  that they understand the patient’s concerns, ideas and expectations. The way the candidates ask questions makes a difference.

History taking – This is not random information gathering, but should be relevant and organised. It reveals clinical thinking. Candidates should learn to apply Murtagh’s safe diagnostic strategy: probability diagnosis, serious disorders, pitfalls, masquerades, and look for the hidden agenda.

Physical Examination – Candidates should be systematic and logical, and should also consider the patient’s comfort, and explain what they are doing, and communicate findings (positive and significant negative findings) to the examiner as they examine.

Investigations – These should be appropriate to the stage of presentation. Candidates should remember to consider office/surgery tests, and select relevant, cost-effective investigations in an appropriate sequence, displaying consideration for the safety and comfort of the patient. More is not better: consider what is most useful to discriminate between differential diagnoses. Will the result of this investigation change your management?

Diagnosis – Candidates may be asked to give a diagnosis, list differential diagnosis, or for a problem definition list. Remember the probability diagnosis and learn to prioritise any list.

Management – Candidates should determine whether they are being asked only for the initial management. If not, they should consider short-term and long-term management and patient support. Explaining the problem is more than using simple language and it is important to organise and prioritise information in order to avoid overwhelming the patient. Check the patient’s understanding and response to a proposed management plan and remember to safety-net.