An MD Acumen school · PLAB 2 OSCE / CPSA course · free practice resources
Practice case P2-02 · Telephone · simulated patient
Telephone consultation — head pain
Modelled on the GMC’s published sample station: a 45-year-old man has phoned about pain in his head. You have no other information.
Reviewed and kept current
Station family: History, diagnosis and management · 8-minute station · 1 min 30 s reading · Last editorial review: 19 September 2026.
Candidate instructions
Read this as you would outside the room
You have 1 minute 30 seconds to read, then 8 minutes. Candidates: everything below this section is folded away — leave it closed until you have finished the station.
| Information | |
|---|---|
| Your role | Foundation Year 2 doctor in general practice, taking telephone consultations |
| Patient | Mr James Horton, 45 |
| Reason for call | He has phoned complaining of pain in his head. You have no other information. |
| Format | Telephone. The call is already connected when you enter; the patient cannot see you. |
Your task
•
Assess the patient over the telephone.
•
Reach a working diagnosis and explain it.
•
Agree appropriate management, including anything that needs prescribing.
•
Address his concerns.
Folded away
For the actor and the examiner
1 · Actor script — role player only
Candidates: do not open until you have consulted.
Persona and manner
- James Horton, 45, office manager. Married, two children aged 7 and 9; your wife works nights this week so you are doing the school run.
- Speaking quietly from a darkened bedroom. Co-operative, tired, a little frightened.
Opening line — say this verbatim
- “Hello doctor. It’s my head — it’s been pounding since yesterday and nothing’s touching it.”
Volunteer freely if given the space
- It started yesterday morning, built up over an hour or so, and is on the right side, behind the eye and temple. Throbbing. About 8 out of 10.
- You feel sick and have vomited once. Light and noise make it worse; lying still in the dark helps.
- Paracetamol and ibuprofen “took the edge off for an hour”.
Only if asked
- Before the pain you saw shimmering zig-zag lines at the edge of your vision for about 20 minutes; they went completely before the headache began. You have had the same thing with previous headaches.
- You have had headaches like this since your late twenties, three or four a year — more recently one a month. A GP once called them migraines and gave you sumatriptan, which worked well. You ran out over a year ago.
- It did NOT come on suddenly. No head injury. No fever, no neck stiffness, no rash. No weakness, numbness, speech or balance problems. No confusion. Not worse on coughing or bending. It did not wake you from sleep.
- Painkillers: only with these attacks — perhaps four or five days a month.
- No regular medication. No allergies. No heart disease, no chest pain, no high blood pressure that you know of (last checked two years ago: “fine”). Non-smoker. Alcohol: a couple of beers at the weekend.
- Lifestyle: you skip breakfast, often miss lunch, drink three or four coffees a day, sleep five to six hours. A big presentation tomorrow.
- Family: your father had high blood pressure and a stroke at 60.
Ideas, concerns and expectations
- Idea: probably a migraine, “but it has never lasted this long”.
- Concern (if asked what worries you): a brain tumour or a stroke like your father’s. “Do I need a scan?”
- Expectation: something that works, and to know whether you need to be seen. You would rather not come in because of the children, but will if told it matters.
Cues to deliver, timed
- Minute 2: “Sorry — can you speak up a bit, I’ve got the phone away from my ear.”
- Minute 4: “My dad had a stroke at 60, you know.” — said flatly, then silence.
- If the doctor has not explained by minute 6: “So what is it, doctor?”
How to respond to the doctor
- If the doctor explains this fits migraine with aura, explains why a scan is not needed today (long-standing pattern, no warning features), offers a triptan with a painkiller and something for sickness, and tells you exactly what would change the picture: relieved — “That makes sense. So when should I worry?”
- If the doctor simply says “it’s just a migraine”: “But how do you know it’s not something worse?”
- If told to go to A&E now without explanation: “Really? With the kids here? Why?”
- If asked how you will get the prescription: your usual pharmacy is the one on the High Street; you can collect it after the school run.
Do not
- Volunteer the aura, the previous sumatriptan or the family history unless asked.
- Report any red-flag feature. There are none.
2 · Examiner mark sheet — generic scheme, identical at every station
Domain marks
| Domain (GMC wording) | 1 | 2 | 3 | 4 | Score |
|---|---|---|---|---|---|
| 1 · Data gathering, technical and assessment skills | ☐ | ☐ | ☐ | ☐ | /4 |
| 2 · Clinical management skills | ☐ | ☐ | ☐ | ☐ | /4 |
| 3 · Interpersonal skills | ☐ | ☐ | ☐ | ☐ | /4 |
| Station total | /12 |
Examiner's overall judgement (standard-setting only — it does not decide your result): ☐ Unsatisfactory ☐ Borderline ☐ Satisfactory ☐ Good
What each mark means
| Mark | Acumen training descriptor — applies to each domain | Typical picture |
|---|---|---|
| 4 | Complete, prioritised and fluent. Every key task for the domain achieved; nothing unsafe; the patient's agenda visibly shapes the consultation. | A confident F2 you would be happy to have on your team. |
| 3 | Competent. Most key tasks achieved; omissions are minor and do not affect safety or the patient's understanding. | Safe and sound, with small gaps. |
| 2 | Borderline. Some key tasks achieved but important gaps, poor prioritisation or a disorganised approach. Nothing dangerous. | Would be safe with supervision; the station could go either way. |
| 1 | Poor or unsafe. Few key tasks achieved; major omissions or incorrect reasoning; communication that damages rapport — or a safety-critical action missed, harmful advice given, or disrespectful behaviour, whatever else was done well. | Below the standard expected of an F2; patient safety or trust compromised. |
GMC feedback statements — where underperformance was identified
A feedback statement marks where underperformance was identified in the consultation. With PLAB 2 results the GMC may attach any combination of the ten statements to a station — none, one or several. Tick every statement that applied; leave all blank if none did.
| Tick | GMC feedback statement | Underperformance it signals |
|---|---|---|
| ☐ | 1 · Consultation | Disorganised or unstructured consultation |
| ☐ | 2 · Issues | Key issues or priorities not recognised |
| ☐ | 3 · Time | Poor time management |
| ☐ | 4 · Findings | Abnormal findings or results, or their implications, not identified |
| ☐ | 5 · Examination | Physical examination or use of instruments not competent |
| ☐ | 6 · Diagnosis | Working diagnosis or differential diagnoses not correct |
| ☐ | 7 · Management | Management plan not reflecting current best practice |
| ☐ | 8 · Rapport | Rapport and sensitivity to the patient’s feelings and concerns not shown |
| ☐ | 9 · Listening | Verbal and non-verbal cues not used; poor active listening |
| ☐ | 10 · Language | Language or explanations not understandable; understanding not checked |
Timing checkpoints (observer)
| Timing checkpoint (8-minute station) | Done | Minute |
|---|---|---|
| Name and GMC number confirmed; patient greeted and identified; patient opens without interruption | ☐ | |
| Presenting problem characterised and red flags screened by 3:30 | ☐ | |
| Ideas, concerns and expectations elicited by 4:30 | ☐ | |
| Examination requested / findings obtained and a summary offered by 5:30 | ☐ | |
| In management — explanation started — by 6:00, with two minutes left (no warning bell is guaranteed in the real examination) | ☐ | |
| Specific safety-net, follow-up and understanding check before 8:00 | ☐ |
Full explanation: the mark scheme and how PLAB 2 is passed · anatomy of the 8-minute station.
3 · Station-specific marking standard — what earns 4, 3, 2 and 1 here
Use with the generic sheet. The top row lists what a competent F2 would do at this station; lower rows describe how performance falls away. Acumen training standard — the GMC does not publish station mark sheets.
| Mark | Domain 1 · Data gathering, technical and assessment skills | Domain 2 · Clinical management skills | Domain 3 · Interpersonal skills |
|---|---|---|---|
| 4 |
|
|
|
| 3 | Headache well characterised and red flags screened; one of previous treatment, analgesic frequency or cardiovascular screen missing. | Correct diagnosis and appropriate acute treatment; safety-net specific; one or two of anti-emetic, contraindication check, diary or follow-up missing. | Warm and clear; cue acknowledged; understanding checked only with “is that OK?”. |
| 2 | Reasonable history but red-flag screen partial or implicit; ICE not elicited until the patient raises it. | Diagnosis correct but management thin (simple analgesia only, or “see your GP”), or safety-net generic. | Polite but checklist-driven; cue noticed late; some jargon (“aura”, “triptan”, “prophylaxis”) unexplained. |
| 1 | Disorganised questioning; no systematic red-flag screen. Or unsafe: no meaningful history; or telephone safety basics ignored and patient cannot be identified. | No clear diagnosis offered, or unnecessary urgent scan/ED attendance arranged without reason. Or unsafe: unsafe: opioid prescribed, triptan given without any cardiovascular check in the presence of a contraindication, or red flags missed and patient falsely reassured. | Talks over the patient; concerns not addressed. Or unsafe: dismissive (“it’s only a migraine”) or rude. |
4 · Examiner points of fact and guidelines
Points of fact the examiner should have to hand
- This scenario mirrors the GMC’s published sample station. The GMC’s own pass list: history of the head pain; medication and trauma; lifestyle; concerns and empathy; a diagnosis of possible migraine; appropriate management; fluent, professional consulting.
- Migraine with typical aura: fully reversible visual (or sensory/speech) symptoms developing over at least 5 minutes and lasting 5–60 minutes. Motor weakness, double vision, aura lasting over an hour or reduced consciousness need further assessment (NICE CG150).
- Acute treatment (NICE CG150): an oral triptan with an NSAID or paracetamol; consider an anti-emetic even without vomiting. Do not offer opioids or ergots.
- Sumatriptan (BNF): 50–100 mg; repeat after at least 2 hours only if the migraine recurs; maximum 300 mg in 24 hours. Contraindicated in ischaemic heart disease, previous MI, previous stroke/TIA, peripheral vascular disease and uncontrolled hypertension.
- Do not refer for neuroimaging solely for reassurance in a diagnosed primary headache (NICE CG150).
- Medication-overuse headache: triptans, opioids or combination analgesics on 10 or more days a month, or simple analgesics on 15 or more, for over three months.
- Prevention becomes a conversation when attacks are frequent or disabling: propranolol, topiramate (not in pregnancy; Pregnancy Prevention Programme applies to women of childbearing potential) or amitriptyline.
- In the examination room the call is connected before you enter. The GMC asks candidates not to touch the telephone or monitor.
Where candidates lose marks at this station
- Forgetting the patient cannot see you nod.
- Asking about red flags only after giving the diagnosis.
- “It’s just a migraine.”
- No plan for how the medicine actually reaches him.
Guidelines for this station
5 · MLA content map tags for this case
| MLA content map | This station |
|---|---|
| Domain 1 · Areas of clinical practice | Neurosciences · General practice and primary healthcare |
| Domain 3 · Clinical and professional capabilities | History, examination and differential diagnosis · Safe prescribing · Pain management |
| Domain 5 · Patient presentations | Headache · Nausea · Vision change/ loss (acute and gradual) |
| Domain 6 · Conditions | Primary headache disorders (including migraine, cluster headache, tension headache) |
| Station family | History, diagnosis and management — History, diagnosis and management |
6 · My marks and reflection — practice log form
Record your three domain marks, your station total, the GMC feedback statements that applied (where underperformance was identified), and what you will keep and change. The form is already labelled with this case and its web address; a copy of your entry is emailed to you, so your practice log builds up in your inbox and can be downloaded.
Record my marks and reflection for P2-02
Revision link for this case: acumenprimarycare.com/plab-2-osce/case-02-telephone-headache
Independence & scope. Independent, formative training material from MD Acumen Ltd. Not affiliated with, endorsed by, or delivered on behalf of the General Medical Council. The GMC does not publish its station mark sheets: every mark scheme and descriptor on these pages is an Acumen training tool calibrated to the GMC's published marking domains, feedback statements and the MLA content map. Practice scores are not a prediction of examination performance. Clinical content reflects UK guidance at the date of editorial review — always check the current guideline. All patients are fictional.
© 2026 MD Acumen Ltd · Acumen Institute of Primary Care · An MD Acumen school · Registered in England and Wales · 16538952PLAB 2 OSCE course · Practice cases · IMG roadmap · Observership · Legal & Regulatory · enquiry@mdacumen.com