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Practice case P2-04 · Face-to-face · simulated patient
Follow-up after an emergency department visit — adult safeguarding
A 30-year-old woman attends after an emergency department visit for a forearm injury. The discharge letter says the injury did not fit the story.
Reviewed and kept current
Station family: Safeguarding, ethics and law · 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 a general practice |
| Patient | Ms Sana Rahman, 30 |
| Reason for appointment | Follow-up after attending the emergency department last night with a forearm sprain and bruising. She has come alone. |
| ED discharge note |
|
Your task
•
Explore the mechanism and context of the injury.
•
Assess for domestic abuse and her immediate safety.
•
Agree a plan, explaining the support available and your safeguarding responsibilities.
•
Do not examine the patient.
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
- Sana Rahman, 30. Married to Imran for six years; one daughter, Aisha, aged 4. You gave up your job as a teaching assistant two years ago because Imran preferred it.
- Anxious, quiet, apologetic; you avoid eye contact and keep your sleeves pulled down. You check the time — you need to be home before he rings the landline at one o’clock.
Opening line — say this verbatim
- “Hello doctor… I’m sorry to bother you. A&E said I should follow up with you.”
If asked about the injury
- First answer, quick and rehearsed: “I slipped down the stairs. It was clumsy of me.”
- If gently challenged or told the pattern does not quite fit: pause, look uncomfortable — “It’s nothing… I just want to go home.”
- About the older bruises: nervous laugh — “I bruise easily.”
Disclose only to sensitive, non-judgemental questions
- If the doctor explains that they ask everyone, that this is confidential, and asks whether anyone at home has hurt or frightened you: lower your head — “…Sometimes things get a bit heated at home.”
- “My husband can be short-tempered. He doesn’t mean it. It’s my fault sometimes — I make him angry.”
- With continued gentleness: “This isn’t the first time.” “He pushed me yesterday — that’s how I hurt my arm.”
- “He checks my phone. I’m not allowed to see my family without him. He keeps the bank cards.”
- “He said if I told anyone he’d make things worse.”
Only if specifically asked
- It is getting more frequent — every couple of weeks now. It is worse when he has been drinking.
- Once, about a month ago, he put his hands round your throat. You did not pass out.
- He has never used a weapon. He has not threatened to kill you in so many words. You are not pregnant.
- Aisha has not been hurt, “but she gets scared. She hides behind the sofa.” She was in the room yesterday.
- Right now: “He’s at work. I’m okay for the moment.” Going home today: long pause — “I don’t feel safe when he’s angry.”
- Your mother lives 20 minutes away and would have you; Imran does not like you going there.
- Mood: tearful most days, poor sleep. No thoughts of harming yourself — “I couldn’t leave Aisha.”
Ideas, concerns and expectations
- Idea: you did not plan to say anything; you came because the hospital told you to.
- Concerns: that he will find out; that “social services will take Aisha”; that no one will believe you.
- Expectation: a sick note for the arm, and to get home on time.
How to respond to the doctor
- If the doctor believes you, says it is not your fault and explains the help available: “…I didn’t realise there was help.” “I want things to change. I just don’t know how.”
- If safeguarding is explained honestly — that the aim is to keep you and Aisha safe and together, that you will be told before anything is shared: frightened, then accepting — “As long as he doesn’t find out it came from me.”
- If the doctor offers a leaflet or to text you: “He looks at everything.” Accept a number written as something else, or memorised.
- If the doctor asks how to contact you safely: mornings, on your mother’s phone.
- If the doctor says they must tell the police, or pushes you to leave him today: shut down — “I shouldn’t have said anything. I need to go.”
- If the doctor accepts the stairs story: thank them, ask for a sick note, leave.
Do not
- Disclose anything to blunt or rapid questioning (“Does your husband hit you?” as an opener → “No! Of course not.”).
- Volunteer the strangulation or that Aisha was present unless asked about them.
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 | Disclosure achieved; control and immediate safety explored; one of high-risk markers, the child, or her mental health not covered. | Safety plan, specialist support and child referral addressed; one of consent/confidentiality explanation, safe contact, or senior discussion missing. | Empathic and non-judgemental; safeguarding explained clearly but plan more clinician-led than shared. |
| 2 | Some exploration but leading or rushed questions; risk to the child or immediate safety touched on only superficially. | Helpline given and sympathy offered, but no safety plan, or the child not addressed. | Kind but rushed; some leading or judgemental phrasing; limited response to her fears about social services. |
| 1 | Asks about abuse bluntly once, accepts denial, moves to the arm. Or unsafe: accepts “fell down the stairs”; no safety assessment. | Treats the arm; vague “you know where we are”; or promises total confidentiality that cannot be kept. Or unsafe: unsafe advice: suggests couple counselling or speaking to the husband; hands over an obvious leaflet; pressures her to leave today or reports to police against her wishes without explanation. | Interrogative style; visible shock; pressure. Or unsafe: blaming, disbelieving or dismissive (“it’s a private matter”). |
4 · Examiner points of fact and guidelines
Points of fact the examiner should have to hand
- Domestic abuse includes controlling or coercive behaviour, economic abuse and threats — not only physical violence (Domestic Abuse Act 2021). Children who see, hear or experience the effects of the abuse are victims in their own right.
- Ask in private — never with the partner, a relative or a child old enough to understand in the room, and never through a family interpreter (NICE PH50).
- High-risk markers include non-fatal strangulation (a specific offence since 2022), escalation in frequency or severity, threats to kill, weapons, pregnancy, recent separation and stalking. The DASH risk checklist structures this; high risk → MARAC referral.
- There is no general legal duty in England to report domestic abuse of an adult who has capacity. Seek consent. Disclosure without consent can be justified to protect her from death or serious harm, and information must be shared where a child is at risk (GMC Confidentiality; GMC Protecting children and young people).
- What to say: “I believe you.” “This is not your fault.” “You are not alone.” What not to do: advise couple counselling or mediation; confront the perpetrator; ask why she stays.
- Safe practice: agree a safe way to contact her; do not send letters or texts home; ensure the consultation cannot be seen through online record access; document her words verbatim, with injuries described precisely.
- National Domestic Abuse Helpline (Refuge): 0808 2000 247, free, 24 hours. An IDVA is a specialist advocate for people at high risk.
- An F2 would discuss this with the practice safeguarding lead the same day. Say so in the station.
Where candidates lose marks at this station
- Opening with “Does your husband hit you?”
- Promising that nothing will leave the room.
- Forgetting there is a four-year-old.
- Handing over a leaflet she cannot hide.
Guidelines for this station
5 · MLA content map tags for this case
| MLA content map | This station |
|---|---|
| Domain 1 · Areas of clinical practice | General practice and primary healthcare · Acute and emergency · Mental health |
| Domain 3 · Clinical and professional capabilities | Safeguarding vulnerable patients · Legal and ethical responsibilities · Capacity, consent and confidentiality · Managing risk · Using and recording information safely |
| Domain 5 · Patient presentations | Domestic abuse · Bruising · Soft tissue injury · Child abuse and neglect |
| Domain 6 · Conditions | No single condition — professional capability station |
| Station family | Acute care, ethics and safeguarding — Safeguarding, ethics and law |
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 P2-04
Revision link for this case: acumenprimarycare.com/plab-2-osce/case-04-injury-follow-up-domestic-abuse
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.
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