# OSCE History Taking - Case-Specific Evaluation Criteria
# Case: Cardiology History 001 - Chest Tightness

## Coverage of Required Topics (Content Completeness)

Core component: Did the student elicit all relevant information?

### 8 Questioning Dimensions with Case-Specific Weights:

#### 1. Chief Complaint (Weight: 40%)
**Definition:** Captures the patient's primary reason for the visit, expressed in their own words. The student should prompt the patient to articulate what brought them in, prioritizing their perspective and phrasing. Duration or context should be recorded when naturally offered.

**Evaluation Criteria:**
- Clearly asks for the main reason the patient is seeking care
- Records the symptom using the patient's own language
- Confirms duration, onset, or context when applicable
- Demonstrates non-directive, open questioning

#### 2. History of Present Illness (Weight: 15%)
**Definition:** Gather a detailed and structured account of the main symptom or issue. This includes onset, location, duration, character, aggravating/relieving factors, timing, and context. The student should explore progression over time and its functional impact on the patient.

**Evaluation Criteria:**
- Explores detailed features (onset, location, duration, intensity, progression, triggers, relieving factors)
- Applies structured approach (e.g., OPQRST/SOCRATES if feasible)
- Sequences questions logically and contextually
- Follows up unclear or vague responses

#### 3. Associated Symptoms (Weight: 10%)
**Definition:** Identifies other symptoms that co-occur with or may be linked to the chief complaint. The student should explore related organ systems or syndromes, including both positive findings (what is present) and negatives (what is notably absent), helping to narrow differential diagnoses.

**Evaluation Criteria:**
- Actively checks for symptoms related to the primary issue
- Includes pertinent positives and negatives
- Avoids excessive listing or unconnected questions
- Demonstrates clinical reasoning in selection of symptoms explored

#### 4. Past Medical History (Weight: 20%)
**Definition:** Reviews previous diagnoses, surgeries, hospitalizations, and long-term conditions. The student should explore chronic illnesses (e.g., diabetes, hypertension), infectious diseases, immunizations, and psychiatric history when relevant.

**Evaluation Criteria:**
- Asks about chronic diseases, surgeries, hospitalizations
- Identifies relevant conditions based on presenting complaint
- Includes psychiatric history if contextually appropriate
- Avoids unnecessary repetition or overgeneralization

#### 5. Medications / Allergies (Weight: 5%)
**Definition:** Elicits all current medications, including prescriptions, over-the-counter drugs, supplements, and herbal remedies. Also documents known drug or food allergies, with specific attention to the type of reaction (e.g., rash, anaphylaxis, intolerance).

**Evaluation Criteria:**
- Elicits all current medications (prescribed, over the counter, herbal)
- Asks explicitly about allergies and reactions
- Clarifies unclear medication names or purposes
- Notes adherence or recent changes if patient offers

#### 6. Family History (Weight: 5%)
**Definition:** Explores the health status of first-degree relatives (parents, siblings, children) and any familial or genetic diseases (e.g., heart disease, cancer, diabetes). The student should identify hereditary risk patterns or relevant health trends in the family.

**Evaluation Criteria:**
- Asks about health conditions in first-degree relatives
- Targets familial diseases (e.g., diabetes, cancer, heart disease)
- Explores hereditary risks based on presenting symptoms
- Approaches sensitively and with clinical relevance

#### 7. Social History (Weight: 3%)
**Definition:** Investigates the patient's social and lifestyle context, including smoking, alcohol, recreational drug use, occupation, housing situation, marital status, and social support systems. May also include travel, sexual history, and diet depending on case relevance.

**Evaluation Criteria:**
- Inquires about smoking, alcohol, and substance use
- Covers occupation, housing, support, and relationships
- Addresses relevant lifestyle factors (diet, physical activity)
- Adjusts depth and scope depending on context

#### 8. Systemic Review (Weight: 2%)
**Definition:** A structured inquiry into symptoms across major body systems (e.g., cardiovascular, respiratory, gastrointestinal, neurological, genitourinary, musculoskeletal). The goal is to uncover coexisting or unrelated health issues that may have diagnostic significance.

**Evaluation Criteria:**
- Screens major systems with focused questions
- Uses an efficient, structured format (head-to-toe or system-by-system)
- Avoids mechanical or overly long checklists
- Captures unexpected findings or symptoms missed earlier

## Communication & Interpersonal Skills

### 6 Dimensions (equal weight within this category):

#### 1. Rapport Building (Weight: 16.67%)
**Definition:** The student's ability to establish a trusting, respectful, and cooperative relationship with the patient early and throughout the interaction.

**Evaluation Criteria:**
- Initiates interaction with appropriate greeting and patient name
- Demonstrates warmth and attentiveness through tone and posture
- Builds trust through respectful, culturally sensitive interaction
- Maintains consistent patient-centered demeanor

#### 2. Active Listening (Weight: 16.67%)
**Definition:** Demonstrates attentiveness through verbal acknowledgments, appropriate follow-up questions, and non-verbal cues that reflect understanding of the patient's statements.

**Evaluation Criteria:**
- Encourages patient dialogue with minimal interruption
- Accurately paraphrases or summarizes key patient statements
- Responds meaningfully to verbal and non-verbal cues
- Adjusts follow-up questions based on patient input

#### 3. Empathy (Weight: 16.67%)
**Definition:** Recognizes and responds appropriately to the patient's emotional state, concerns, and experiences with supportive and compassionate language or tone.

**Evaluation Criteria:**
- Acknowledges and validates the patient's feelings or concerns
- Expresses understanding with supportive language or gestures
- Adjusts behavior and tone in emotionally sensitive moments
- Uses empathetic phrasing (e.g., "That sounds difficult," "I understand")

#### 4. Clarity of Questions (Weight: 16.67%)
**Definition:** Uses clear, concise, and appropriately structured questions that are easy for the patient to understand without medical jargon or ambiguity.

**Evaluation Criteria:**
- Asks clearly structured, understandable questions
- Avoids or explains technical terminology
- Adapts language to patient's educational and cultural background
- Clarifies ambiguous responses appropriately

#### 5. Professionalism (Weight: 16.67%)
**Definition:** Maintains respectful, courteous, and ethical behavior, including appropriate tone, demeanor, and adherence to patient confidentiality and consent principles.

**Evaluation Criteria:**
- Maintains respectful, neutral, and ethical communication
- Obtains consent before asking personal questions
- Uses appropriate language, demeanor, and boundaries
- Handles sensitive topics tactfully

#### 6. Logical Flow of Conversation (Weight: 16.66%)
**Definition:** Organize the interview in a coherent and progressive sequence, smoothly transitioning between topics while maintaining focus and relevance.

**Evaluation Criteria:**
- Follows a structured progression of history-taking topics
- Uses signposting and transitions effectively between sections
- Avoids erratic topic shifts or repetition
- Summarizes when appropriate to maintain clarity

## Evaluation System

### Content Completeness Scoring
- Evaluation based on coverage of 8 dimensions with case-specific weights as defined above
- Weights reflect the clinical importance of each dimension for this specific case
- Content completeness contributes 90% to overall score

### Communication & Interpersonal Skills Scoring
- Evaluation based on performance in 6 dimensions
- Each dimension weighted equally within this category
- Communication skills contribute 10% to overall score
- 5-point scale assessment:

**Score 5 - Excellent:** Demonstrates exemplary, natural, and consistent use of the skill across the interaction. Adaptively responds to patient cues with ease.

**Score 4 - Good:** Shows strong, consistent use of the skill with only minor lapses. Responds well to most patient cues.

**Score 3 - Satisfactory:** Uses the skill adequately but with noticeable inconsistencies. Occasional missed cues or mechanical delivery.

**Score 2 - Limited:** Demonstrates partial or forced use of the skill. Several missed opportunities or awkward applications.

**Score 1 - Deficient:** Fails to demonstrate the skill or uses it inappropriately. Misses clear cues or disrupts the interaction.

### Overall Scoring Model
**Final Score = (Content Completeness Score × 0.90) + (Communication Skills Score × 0.10)**

Where:
- Content Completeness Score = Weighted average of 8 dimensions using case-specific weights
- Communication Skills Score = Simple average of 6 communication dimensions

### Passing Score Thresholds
- **Less than 50%:** Clear Fail
- **50% - 59.4%:** Borderline Fail
- **60% - 69.4%:** Borderline Pass
- **More than 70%:** Clear Pass