Why candidates lose their place
Most missed gaps in Part A are not about hard vocabulary. They happen because the candidate is looking at the wrong line. The conversation has moved on, and the answer goes past while the eyes are still one gap behind.
The good news is that consultations have a structure. Clinicians move from topic to topic on purpose, and they usually say so. If you learn to hear those signals, you always know which heading you are under.
The note headings are your map
The notes follow the order of the consultation. In the reading time, read the headings as a list of stops on a journey. When you hear the clinician move to a new topic, your eyes should move to the matching heading.
Presenting complaint History of presenting complaint Past medical history Medication Family history Social history Plan
How clinicians signal a new topic
Topic changes are often short and easy to miss. Some are full sentences; some are just a question with a new subject.
So the swelling started about three days ago. OK. Anything regular you take, tablets or inhalers?
Just my blood pressure tablet. Amlodipine, I think it's called.
Thanks. And is there anyone in the family with heart or kidney problems?
My father had kidney trouble, near the end.
I'm sorry to hear that. And at home now, is it just you?
History, then medication, then family history, then social history. None of these moves uses a long signpost sentence. The new subject in the question is the signal.
Signals that a new heading is starting
Let's talk about your medication for a moment.
Clear move to a new heading.OK, I'd like to ask a few questions about your family.
Move to family history.And what about at home? Who's there with you?
A short question that opens social history.And your medication? Anything regular?
Very short. The word 'and' plus a new topic is enough.Right. Going back to the pain for a second...
The clinician returns to an earlier heading. Look back.So, what I'd suggest is...
Usually the start of the plan.
Corrections and self-repair
Real speakers correct themselves, and Part A recordings include this. The first thing said is not always the answer. Wait for the end of the idea before you commit.
When did the rash first appear?
It was Tuesday. No, hang on, it must have been Wednesday, because I'd been to the pool the day before, and I always go on Tuesdays.
Wednesday, then.
Answer: Wednesday. 'No, hang on' cancels the first day.
Correction signals
No, sorry, I mean...
The next word replaces the last one.Actually, it was more like...
A revised amount or time.Well, it was, but not any more.
Something that used to be true. The current fact follows.That's what I thought at first, but...
The first idea is rejected.
When the patient changes their mind or the clinician checks
Sometimes the clinician checks a fact and the patient revises it. Sometimes the patient gives a vague answer and then a precise one. In both cases, the final, precise version is what usually fits the notes.
Do you smoke at all, Mr Haddad?
No, not really.
Not really?
Well, I have two or three cigars at weekends, with my brother. That's all.
Notes: 'smoking: ____ at weekends'. 'No, not really' is not the answer. Keep listening: the line is completed by 'two or three cigars'.
Patient: 'It lasts a while... well, twenty minutes or so, every time.' Notes: 'each episode lasts approx. ____'.
a while
twenty minutes
Why: The precise amount completes the clinical note. 'A while' was said, but it gives the note no information. 'Approx.' is already printed, so 'or so' is not needed.
Recovering after a missed gap
- Accept it in one second. Put a dot next to the gap.
- Look at the next gap and the next heading, not the one you missed.
- Listen for a topic signal. It tells you exactly where the recording is now.
- Keep the missed gap in mind lightly. Speakers sometimes repeat or summarise a fact later.
- At the end, write your best guess. Use the word type you predicted.
Check yourself
4 quick questions. Tap an answer to see why.
1 The doctor says: 'And at home? Who's around to help you?' Which heading are you most likely moving to?
2 Patient: 'I take two tablets in the morning, sorry, one in the morning and one at night.' Notes: 'takes ____ in the morning'. What is the answer?
3 You realise you are two gaps behind. What is the best action?
4 Why is it useful to count the gaps under each heading in the reading time?