NAC OSCE History Taking & Communication — Questions and Answers
Question 1: During a NAC OSCE station, a patient presents with chest pain. Which mnemonic is most commonly used in Canada to structure a systematic pain history?
- SOCRATES (Correct answer)
- OLDCARTS
- PQRST
- OPQRST
Correct answer: SOCRATES
SOCRATES (Site, Onset, Character, Radiation, Associated symptoms, Timing, Exacerbating/relieving factors, Severity) is the standard framework taught in Canadian medical schools for history taking.
Question 2: A 35-year-old woman presents concerned about an unintended pregnancy. According to Canadian ethical and communication standards, what is the FIRST priority when initiating this consultation?
- Explore the patient's own feelings and preferences about the pregnancy (Correct answer)
- Immediately refer to obstetrics
- Discuss all contraceptive options
- Order a serum beta-hCG to confirm
Correct answer: Explore the patient's own feelings and preferences about the pregnancy
Patient-centred care requires exploring the patient's own values and wishes first before providing information or referrals, consistent with MCCQE CanMEDS competencies.
Question 3: In the NAC OSCE, which communication technique is used to demonstrate active listening and encourage patients to elaborate on their concerns?
- Facilitation (nodding, 'go on', open-ended follow-up) (Correct answer)
- Closed-ended questions
- Interrupting to clarify facts
- Summarising before the patient finishes speaking
Correct answer: Facilitation (nodding, 'go on', open-ended follow-up)
Facilitation techniques — such as nodding, brief verbal encouragers, and open-ended follow-ups — signal active listening and are core communication skills assessed in the NAC OSCE.
Question 4: A 70-year-old man presents with a 3-week history of rectal bleeding. Which aspect of the social history is MOST important to elicit in a Canadian primary care context?
- Family history of colorectal cancer and personal screening history (Correct answer)
- Occupation and workplace exposures
- Travel history to endemic regions
- Sexual history and STI risk
Correct answer: Family history of colorectal cancer and personal screening history
Canadian Cancer Society and Cancer Care Ontario guidelines emphasise colorectal cancer screening; family history of CRC and personal colonoscopy history directly influence risk stratification and urgency.
Question 5: When breaking bad news in a Canadian NAC OSCE station using the SPIKES protocol, what does the 'P' stand for?
- Perception (assess what the patient already knows) (Correct answer)
- Plan (treatment options)
- Permission (ask before sharing news)
- Prognosis (expected outcome)
Correct answer: Perception (assess what the patient already knows)
In the SPIKES protocol, 'P' stands for Perception — assessing the patient's current understanding before delivering news prevents information mismatch and supports patient-centred communication.
Question 6: A patient mentions using cannabis recreationally. Under Canadian law since 2018, how should a physician address this in a non-judgemental history?
- Acknowledge its legal status, ask about frequency and route, and assess for health impacts (Correct answer)
- Ignore it as it is now legal
- Document it as illicit drug use
- Refer the patient to addiction services immediately
Correct answer: Acknowledge its legal status, ask about frequency and route, and assess for health impacts
Since the Cannabis Act 2018 legalised recreational cannabis in Canada, physicians should take a non-judgemental approach, clarifying use patterns and potential health impacts including driving, respiratory effects, and mental health.
NAC OSCE History Taking & Communication
During a NAC OSCE station, a patient presents with chest pain.
Which mnemonic is most commonly used in Canada to structure a systematic pain history?