mccQbank
The 11-minute NAC OSCE station — history-taking schematic
Where the minutes go, what examiners tick, and the mnemonics that keep you on the clock. Built by Canadian physicians. Free to print and share.
NAC Examination · Sep 19–20, 2026
0:00
0:45
6:00
8:30
10:00
11:00
Open
0:00 – 0:45
- Hands, name, role.
- Confirm the patient’s name and age.
- Reason for the visit, in their words.
- Consent for the interview.
- “What worries you most today?”
AGENDA before questions
Say it the same way every time“Hi, I’m Dr. ___, one of the physicians here. Can I confirm your name and age? What brings you in today — and what worries you most about it?”
Then signpost“I’ll ask about the pain first, then a few background questions, then we’ll talk about what to do.”
Scored: rapport, identity check, agenda-setting. Same opening at every door.
History of presenting illness
0:45 – 6:00
O P Q R S T U
- Onset — sudden or gradual, what were you doing?
- Provoking / palliating — better, worse?
- Quality — in their words.
- Region / radiation.
- Severity — 0 to 10, function.
- Timing — constant, episodic, progression, ever before?
- U — “What do you think is going on?”
- Associated symptoms · pertinent negatives · one differential question per major diagnosis.
- Mid-way summary at ~4:00: “So far…” — earns marks, buys thinking time.
Red flags — ask them out loud
Chest pain: tearing, exertional, syncope, dyspnea
Headache: thunderclap, worst-ever, fever + neck stiffness, deficit
Abdomen: peritonism, GI bleed, pregnancy, jaundice
Back pain: saddle numbness, retention, weakness, fever, cancer, IVDU
Child with fever: <3 months, lethargy, non-blanching rash, poor feeding
Mood: suicidal ideation, plan, means; psychosis
Headache: thunderclap, worst-ever, fever + neck stiffness, deficit
Abdomen: peritonism, GI bleed, pregnancy, jaundice
Back pain: saddle numbness, retention, weakness, fever, cancer, IVDU
Child with fever: <3 months, lethargy, non-blanching rash, poor feeding
Mood: suicidal ideation, plan, means; psychosis
If the station asks for an examVerbalise every step: “I’m inspecting for…”, “I’m palpating for…” — inspect, palpate, percuss, auscultate, special tests. An unspoken exam is an unscored exam.
Scored: focused, structured, open-to-closed questions; the red flags asked by name; the mid-way summary.
Background
6:00 – 8:30
P M A F S
- Past history — medical, surgical, admissions, screening.
- Meds — prescribed, OTC, herbal, adherence.
- Allergies — and the reaction.
- Family — first-degree, age at onset.
- Social — SAD (smoking, alcohol, drugs), occupation, home, supports, safety at home.
Alcohol: CAGE
Teen: HEADSS
Women: GTPAL · LMP · contraception
Child: BINDS — birth, immunizations, nutrition, development, social
Low mood: SIGECAPS
Elevated mood: DIGFAST
Risk: SAD PERSONS
Elderly: falls, function, cognition, meds
Teen: HEADSS
Women: GTPAL · LMP · contraception
Child: BINDS — birth, immunizations, nutrition, development, social
Low mood: SIGECAPS
Elevated mood: DIGFAST
Risk: SAD PERSONS
Elderly: falls, function, cognition, meds
Scored: the checklist items live here — say each heading as you go so the examiner can tick it.
Patient’s perspective
8:30 – 10:00
F I F E
- Feelings — “How has this been for you?”
- Ideas — “What do you think is causing it?”
- Function — work, sleep, family, driving.
- Expectations — “What were you hoping we’d do today?”
Counsel in plain words
- Likely cause, one line. No jargon.
- The plan: test, treatment, or reassurance — and why.
- Check understanding: “Tell me what you’ll do when you get home.”
Empathy lines that score“That sounds frightening.” · “You’ve been carrying a lot.” · “It makes sense you’re worried about work.” · “Thank you for telling me that.”
Scored: empathy statements, plain language, shared decision. Communication is scored on every station.
Close
10:00 – 11:00
- Summary — two sentences, back to the patient.
- One next step — what happens now.
- Safety net — “Come back or call 911 if…”
- Follow-up — when, and with whom.
- “Anything I haven’t asked?” Thank them.
S N S F
The 30-second close“So, you’ve had two days of right-sided chest pain, worse on breathing, no red flags. The next step is a chest X-ray and an ECG today. If the pain becomes crushing or you’re short of breath, call 911. I’ll see you back in 48 hours. Anything I haven’t asked?”
Scored: closure. Candidates lose more marks running out of time than getting the diagnosis wrong — close before the bell, always.
Three rules
- Open every station the same way — the script settles you and scores.
- Verbalise the physical exam: an unspoken exam is an unscored exam.
- Close before the bell: summary, next step, safety net, follow-up.
Practise it timed. OSCE-R: 112 NAC stations across 16 systems, history and history-plus-physical, each with its rubric. Free 30-question trial.
mccqbank.com/nac-osce-help
© 2026 mccQbank · Dr. Bilal Akil, MD, CCFP-EM · Not affiliated with the Medical Council of Canada.