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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 by telephone · 8-minute station · 1 min 30 s reading · Last editorial review: 19 September 2026 · Next scheduled refresh: 11 April 2027.
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 Martin Whitmore, 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
- Martin Whitmore, 45, sales 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.
- Family: your father had high blood pressure and a stroke at 60.
Impact on daily life — home and work (only if asked)
- You left work early yesterday and have not gone in today. A neighbour did the school run this morning.
- You have a presentation tomorrow that decides a contract; you are dreading it.
- With one attack a month you have used most of your sick days this year.
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?”
If the doctor summarises and asks whether you want to add anything
- If your father has not yet come up: “Only that my dad had a stroke at 60. That’s what’s really on my mind.”
- If he has: “They’re getting more often — about one a month now. Is that normal?”
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? Who’d fetch the kids? 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.
- If the doctor has not said what to look out for, ask near the end: “And if it’s still there tomorrow?”
Do not
- Volunteer the aura, the previous sumatriptan or the family history unless asked or invited to add anything (apart from the timed cues).
- Report any red-flag feature. There are none.
2 · Examiner mark sheet — generic scheme plus the key facts for this case
Domain marks — with the key facts that earn a 4 at this station
| Domain (GMC wording) · key facts for this case | 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 |
Domain score (educational construct):
| Score | Descriptor |
|---|---|
| 1 | Unsatisfactory (did not achieve safe FY2 standard) |
| 2 | Borderline (just achieving minimum safe FY2 standard) |
| 3 | Satisfactory (competent and safe FY2 standard) |
| 4 | Good (exceeds FY2 standard) |
This 1–4 domain score and its descriptors are an Acumen educational construct: the GMC publishes the three marking domains and the four-mark maximum, but not the descriptors its examiners use, and it does not publish station mark sheets. See Legal & Regulatory.
Marks are 1 to 4 in each domain; the generic descriptor for each mark is on the mark scheme page, and the structure of the eight minutes is on the 8-minute station page. The full standard for this case is in section 3 and the GMC feedback statements, with examples from this case, are in section 4.
3 · Expanded station-specific marking standard — what earns 4, 3, 2 and 1 here
The top row is the full picture of what a competent FY2 could do at this station, including the working diagnosis with its justified differentials, the safety-net and the follow-up; lower rows describe how performance falls away. It is a debriefing aid, not a checklist to recite: nobody says every line in eight minutes, and a 4 is a judgement that the essentials — the italic key facts on the mark sheet — were done well, in plain language and at the patient’s pace. 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, cardiovascular screen or the impact on work and home missing. | Correct diagnosis with some reasoning; appropriate acute treatment with triptan contraindications checked; safety-net specific; one or two of anti-emetic, trigger advice, 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; impact not explored. | Diagnosis correct but unexplained — no differentials; management thin (simple analgesia only, or “see your GP”); safety-net generic; no follow-up. | Polite but checklist-driven; cue noticed late; some jargon (“aura”, “triptan”, “prophylaxis”) unexplained. |
| 1 | Disorganised questioning; no systematic red-flag screen; no ICE. Or unsafe: no meaningful history; or telephone safety basics ignored and the patient cannot be identified. | No clear diagnosis offered, or unnecessary urgent scan / ED attendance arranged without reason; no safety-net. Or unsafe: opioid prescribed; a triptan issued with no check at all for heart disease, stroke or blood pressure; or red flags not screened and the patient falsely reassured. | Talks over the patient; concerns not addressed. Or unsafe: dismissive (“it’s only a migraine”) or rude. |
4 · GMC feedback statements — where underperformance was identified — with case-specific examples
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. The right-hand column shows what each one looks like at this station. Record the statements that applied in the practice log.
| GMC feedback statement | Underperformance it signals (generic) | Case-specific examples |
|---|---|---|
| 1 · Consultation | Disorganised or unstructured consultation | Jumps between headache questions, family history and lifestyle; asks red flags after giving the diagnosis; no summary before the plan. |
| 2 · Issues | Key issues or priorities not recognised | Does not recognise that the core tasks are to exclude a secondary headache and then treat the attack — spends the call on caffeine and sleep hygiene while he is vomiting in a dark room. |
| 3 · Time | Poor time management | A complete SOCRATES, systems review and social history; the call ends before a diagnosis, a prescription or a safety-net. |
| 4 · Findings | Abnormal findings or results, or their implications, not identified | Hears “zig-zag lines for 20 minutes” and does not recognise a typical aura; or does not register that monthly attacks and used-up sick leave mean prevention should be discussed. |
| 5 · Examination | Physical examination or use of instruments not competent | Cannot examine by telephone — but never asks the questions that stand in for examination (rash, neck stiffness, weakness, speech, walking) or considers whether he needs to be seen. |
| 6 · Diagnosis | Working diagnosis or differential diagnoses not correct | “It’s just a headache — probably stress”; does not name migraine with aura, or cannot explain why it is not a bleed, a tumour or a stroke like his father’s. |
| 7 · Management | Management plan not reflecting current best practice | Paracetamol and rest only; or codeine; sumatriptan issued with no check for heart disease or blood pressure; no anti-emetic although he has vomited; “call back if worse” with no specifics; no follow-up for monthly attacks. |
| 8 · Rapport | Rapport and sensitivity to the patient’s feelings and concerns not shown | Reads questions like a form; no acknowledgement of the children, the presentation or the fear behind “do I need a scan?” |
| 9 · Listening | Verbal and non-verbal cues not used; poor active listening | Misses “My dad had a stroke at 60” and the silence after it; talks over him on the telephone; never asks what he thinks is going on. |
| 10 · Language | Language or explanations not understandable; understanding not checked | “You have migraine with aura; I’ll prescribe a triptan and consider prophylaxis” — speaks fast, no pauses, and ends without asking him to repeat the plan. |
5 · 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. Atypical aura — motor weakness, double vision, visual symptoms in one eye only, poor balance or reduced consciousness — needs further investigation or referral (NICE CG150). So does an aura outside the typical 5–60 minutes.
- Aura versus TIA: aura spreads gradually and is usually “positive” (shimmering, zig-zags); TIA is sudden and “negative” (loss of vision, power or speech).
- 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, coronary vasospasm, previous stroke/TIA, peripheral vascular disease, and moderate or severe hypertension (or mild hypertension that is uncontrolled).
- 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; a Pregnancy Prevention Programme applies to women of childbearing potential) or amitriptyline.
- A migraine lasting more than 72 hours is status migrainosus and needs review.
- 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.” — a diagnosis with no reasoning.
- No plan for how the medicine actually reaches him.
- “Call back if it gets worse” — with no symptoms, no action and no timescale.
Guidelines for this station
6 · 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) |
| Appendix A · Body system | Brain and spinal cord |
| Interpersonal skill (GMC PLAB 2 guide) | Explaining diagnosis, investigation and treatment · Clear written instructions (e.g. prescribing) · Involving the patient in decision-making |
| Station family | History, diagnosis and management — History, diagnosis and management by telephone |
7 · 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: mdacumen.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. This course never provides, and will never ask you to share, real GMC exam content — full regulatory statement: Legal & Regulatory.
This case's topic and its Golden Triangle, for review after the station.
Golden Triangle
Migraine (uncomplicated)
Knowledge Green · Evidence Green · Real-world Amber
Not yet at the Equinox · UK (NHS England) · as of 7 October 2026 · How the triangle works
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