Five behaviours the assessor listens for
Information gathering is how you find out what is happening. On a recording, the assessor hears the shape of your questions and how much space you leave for answers. A B grade usually needs around 2 out of 3 on this criterion (approximate). In our words, there are five behaviours:
| Indicator | What the listener hears |
|---|---|
| D1 Active listening, minimal interruption | The patient finishes their sentences. You give small signals ("mm", "I see", "go on") and reflect key words back. |
| D2 Open then closed questions | You start broad ("Tell me about...") and narrow down later for specific facts ("Is it worse at night?"). |
| D3 No compound or leading questions | One question at a time. Questions do not push the patient towards the answer you want. |
| D4 Clarifying | When an answer is vague ("a bit", "sometimes", "a lot"), you ask what they mean. |
| D5 Summarising | You repeat back the main points so the patient can correct or add to them. |
D1 and D2: listen first, then narrow down
Start with an open question and let the patient talk. Use short encouragers so they know you are listening. Only then move to closed questions to fill gaps. This pattern is often called the questioning funnel: wide at the top, narrow at the bottom.
Nurse. A patient on day two after abdominal surgery says she is in pain.
Is it sharp? Is it a ten? Is it near the wound? Did you take the tablets?
Can you tell me about the pain? ... [listens] ... I see. And where exactly do you feel it most? ... On a scale of zero to ten, where would you put it right now?
Why: The better version lets her describe it in her own words first, then uses closed questions to get specific facts. The weak version is a rapid list of closed questions that sounds like an interrogation.
D3: avoid compound and leading questions
A compound question asks two or more things at once. The patient usually answers only the last part, so you lose information. A leading question suggests the answer, so the patient may just agree.
| Weak | Better | Problem fixed |
|---|---|---|
| Do you smoke or drink? | Do you smoke at all? [answer] And how about alcohol? | Compound: two topics in one question. |
| Is the pain in your chest and does it go down your arm? | Where do you feel the pain? [answer] Does it spread anywhere? | Compound and partly closed. |
| You've been taking your tablets every day, haven't you? | How are you getting on with the tablets? | Leading: invites a yes even if it's not true. |
| You're not feeling depressed, are you? | How has your mood been lately? | Leading towards no, and may feel dismissive. |
| So the cough is better now? | How is the cough now compared to last week? | Leading: assumes improvement. |
D4 and D5: clarify and summarise
Patients often give vague answers: "I drink a bit", "it hurts sometimes", "I'm a bit off". A good clinician asks what that means in practice. Then, after gathering several facts, you summarise so the patient can correct anything you misunderstood.
Doctor. Asking about alcohol.
Patient: "I drink a bit at the weekend." Doctor: "Okay, that's fine."
Patient: "I drink a bit at the weekend." Doctor: "When you say a bit, roughly how much would that be on a usual Saturday?"
Why: "A bit" could mean one glass or ten. Clarifying turns a vague answer into useful information without sounding judgemental.
Phrase bank: information gathering
Can you tell me what's been happening?
Opening question. Lets the patient start wherever they want.Tell me more about that.
Encouraging them to continue a topic.Go on, I'm listening.
When the patient pauses mid-story.How has it been affecting your daily life?
Open question about impact.When you say sometimes, how often would that be?
Clarifying a vague frequency.What do you mean by feeling off, exactly?
Clarifying vague symptoms.Is there anything else you've noticed?
Checking you have the whole picture before narrowing down.And has it changed at all over the last few days?
Closed-ish follow-up after open questions.So, let me check I've got this right.
Starting a summary.You've had the pain for about a week, it's worse at night, and paracetamol isn't helping much. Is that right?
A full summary with an invitation to correct.Have I missed anything?
Ending a summary, so the patient can add information.
Weak vs better: a short dialogue
So you took the bandages off because they were tight or itchy or what?
Itchy, I suppose.
You know you're supposed to keep them on, right?
A compound question with offered answers, then a leading and judgemental question. The patient gives a one-word answer and closes up.
I noticed the bandages were off this morning. Can you tell me what happened?
They just drive me mad at night.
Drive you mad in what way?
They're hot, and I can't sleep because my legs feel squeezed.
So they're hot and they feel too tight, and that's stopping you sleeping. Have I got that right?
Open question, clarification of a vague phrase, then a summary. Now the nurse knows exactly what to address.
How it plays out across 5 minutes
- Most cards have at least one task that starts with "Find out..." or "Ask about...". That is where these behaviours show most.
- Start that task with one open question and stay quiet for the answer.
- Use two or three closed questions to fill gaps. Keep them one at a time.
- Before moving on, give a one-sentence summary and ask, "Is that right?"
- If time is short, a summary is still worth the 10 seconds. It is clear evidence for the assessor.
Check yourself
4 quick questions. Tap an answer to see why.
1 Which question is best for starting to gather information?
2 A patient says, "I get breathless sometimes." What is the best follow-up?
3 Which of these is a compound question?
4 Why is summarising useful in the role-play?