Ten-minute history taking station example

What the candidate reads

Candidate’s Instructions

Julia Russo, 65 years old, has come alone to your office with the following complaint: "I just can't cope. Everything seems to be going wrong." She brought with her a note from her son which she gave to your receptionist (see below).

In the next 10 minutes, complete a focused history and mental status examination.

Dear Doctor,
My mother is no longer able to manage herself and her affairs. She makes frequent financial mistakes such as not paying her bills, getting overdrawn at the bank, and hoarding money in her home. The bank manager is very concerned and so are we. She is not herself. She seems sad and irritable. She does not remember much of what we, or others tell her. We are afraid that she is not safe at home and should not be living on her own.
Thank you for your help.
Oliver Russo
Office: 222-9999

What the examiner completes

Examiner’s Checklist
Fill in the bubble for each item completed satisfactorily

1.	Elicits
	- onset/duration
	- memory
2.	Elicits
	- mood
	- anxiety
3.	Asks about changes in daily activities
4.	Asks about
	- drug use
	- alcohol use
5.	Elicits dangerousness/risk factors
	- suicide potential
	- getting lost
	- financial management
6.	Elicits constitutional signs and symptoms
	- energy
	- sleep
	- appetite
	- weight gain/loss
7.	Conducts mental status testing
	- orientation:
		- time
		- person
		- place
	- memory:
		- immediate
		- recent
		- long term
		- concentration
8.	Elicits family history of senility
9.	Elicits past medical history

Did the candidate respond satisfactorily to the needs/problem(s) presented by this patient?

If unsatisfactory, please specify why:
(For items 4-6, please explain below)

Satisfactory

Borderline

Good

Excellent

Unsatisfactory

Borderline

Poor

Inferior

Inadequate medical knowledge and/or provided misinformation
Could not focus in on this patient's problem
Demonstrated poor communication and/or interpersonal skills
Actions taken may harm this patient
Actions taken may be imminently dangerous to this patient
Other

Do you have concerns regarding this candidate's ethical and/or professional behavior?

Yes (please specify) No