Lesson 1.2: The 8-Minute Structure and Reading Instructions
Eight minutes sounds like a long time until you are inside a station and the clock is moving. Structure is what keeps you calm under pressure — once it is automatic, you can focus entirely on the patient in front of you.
The Five Phases
| Phase | Time | What Happens | Key Focus |
|---|---|---|---|
| Opening | 0:00 – 0:30 | Introduce. Confirm name and GMC number. Open question. Listen. | Rapport, first impression |
| Data Gathering | 0:30 – 4:00 | Focused history. Examination if required. ICE woven throughout. | Structure, red flags, empathy |
| Transition | ~4:00 | Signal the shift: 'I'd like to share my thoughts on what might be going on — is that okay?' | Signposting, summarising |
| Management | 4:00 – 7:00 | Diagnosis in plain language. Management plan. Shared decision-making. | Plain language, patient involvement |
| Closing | 7:00 – 8:00 | Specific safety-net. Summary. Follow-up. Close warmly. | Safety-netting, completeness |
At 4 minutes, begin transitioning to management — no matter what. An incomplete history with a complete management discussion scores significantly better than a thorough history with no management. Never sacrifice the management phase.
Time Splits by Station Type
| Station Type | Typical Split |
|---|---|
| Combined (history + exam + management) | 3 min history → 2 min examination → 3 min management |
| Pure history taking | 5 min history with ICE → 3 min management discussion |
| Counselling / explanation | 1 min check what they know → 5 min explanation → 2 min ICE and safety-net |
| Breaking bad news (SPIKES) | Setting → Perception → Invitation → Knowledge → Emotion → Strategy. Do not rush to strategy. |
| Clinical examination | 30 sec consent and positioning → 6 min systematic examination → 90 sec present findings |
| Emergency / SimMan | ABCDE — complete each step before moving to the next. Escalate early. |
Reading Candidate Instructions — 90 Seconds
You have approximately 90 seconds between stations, which includes moving to the next room and reading the candidate instructions outside the door. Every second is planning time.
- Diagnose the station type — history, counselling, examination, emergency, ethics, colleague? Knowing the type determines your opening lines and mental flow.
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Decode the task verb:
Task Verb Station Type Primary Goal "Take a history" History taking Data gathering is the main event. Management follows but is lighter. "Counsel this patient about..." Counselling / explanation Patient already has information. Explain — do not start a full history. "Assess and manage" Combined History, diagnosis, and management all required. Time discipline critical. "Explain the results to..." Data interpretation Explore what they know, then interpret and explain. "This patient is refusing treatment" Ethics station Capacity assessment, autonomy, best interests — do not try to override. "Address their concerns" ICE-heavy station Finding and responding to the concern is the primary task. - Identify the setting — GP, A&E, ward, or telephone. Each shapes tone and likely presentation.
- Use demographics to narrow differentials: a 55-year-old male with sudden crushing chest pain is a very different picture from a 25-year-old female with pleuritic chest pain.
- Spot hidden tasks — "The patient is angry/anxious" signals ICE and empathy are the priority. Any occupational or contextual detail may carry ethical implications (e.g. a pilot with epilepsy; a teacher with a transmissible infection).
- Decide your opening line before the buzzer goes. Take a breath. Enter calm and confident.
The card outside the cubicle is also placed inside the room. You do not need to memorise it word for word — you can re-check it once you enter.