Anatomy of the 8-minute station
Eight minutes is short enough that structure decides the result. This page sets out what should be done in the first minute, the key transition between minutes five and six — summary, examination, working diagnosis — and how to close safely at eight, and shows which of the three marking domains each minute is feeding.
Reviewed and kept current
Last editorial review: 19 September 2026 · Next scheduled refresh: March 2027.
Six phases, one turning point
The 8-minute station
A default shape for a history-and-management station. Other station types bend it — see below.
▬ Domain 1 is earned mostly before 5:30 · ▬ Domain 2 is earned almost entirely after it · ▬ Domain 3 is assessed from the first second to the last. The Dx box at 5:30–6:00 is the working diagnosis: a brief summary, a check for anything the patient wishes to add, then your working diagnosis and differential diagnoses.
The single most useful rule: be out of history and into explanation before the six-minute mark — with two minutes left. A station with a perfect history and no management scores well in one domain out of three. The GMC feedback statement for this is Time — poor time management: too long on some parts of the encounter at the expense of other, often more important, parts.
About the “six-minute warning”. The GMC’s official website does not mention one. Candidates at previous examinations have reported a bell or announcement with two minutes to go, and our practice stations ring a bell at 6:00 to build the habit — but you must not rely on a warning being provided on the day. Train yourself to know where six minutes falls without being told: most candidates find that is about when the examination and summary are finished.
What to do, and which domain it feeds
| Clock | What should be happening | Domain 1 · Data gathering | Domain 2 · Management | Domain 3 · Interpersonal |
|---|---|---|---|---|
| Reading time 1 min 30 s outside | Read the task line twice: it tells you which domain carries the weight. Note the setting, your role, the patient’s name and age, and any result supplied. Decide your first sentence. | Predict the three diagnoses you must not miss. | Note what the task asks you to do: assess, explain, discuss, manage. | Decide how you will greet this particular person. |
| 0:00 – 1:00 Open | Confirm your name and GMC number. Greet, introduce yourself and your role, confirm the patient’s name. One open question — then stay silent while they answer. Notice pain, distress or anger and respond to it first. | The opening statement usually contains the presenting complaint and the first cue. | — | Rapport, attention and courtesy are being judged from the first second. |
| 1:00 – 4:30 Gather | Characterise the problem, then the relevant past history, medicines and allergies, family and social history. Three things must be confirmed before 4:30: 1 · Establish ICE — the patient’s ideas, concerns and expectations, in natural language. 2 · Establish how the symptom or condition impacts on the patient’s activities of daily living — such as home life or work life. 3 · Screen for red flags for that presentation, out loud. | Focused, systematic, prioritised history. Red flags present or absent. Impact on daily living. | The differential is forming; decide what it changes. | Open then closed questions; pick up cues as they arrive, not later. ICE. |
| 4:30 – 5:30 Examine | Say what you would examine and why; ask for findings or carry out the examination required, and interpret what you are given. Where no examination is needed, move straight on. | Appropriate examination requested or performed; findings interpreted. | Findings confirm or change the differential. | Consent, dignity and explanation while examining. |
| 5:30 – 6:00 Working diagnosis | Consider presenting a brief summary to the patient, and check for anything the patient wishes to add. Then give your working diagnosis and your differential diagnoses — justifying how you have come to the conclusion of your working diagnosis and not the differential diagnoses. | The summary tests your data: the patient corrects it or adds the missing piece. | Formulating a diagnosis is the first skill the GMC lists under clinical management: a named working diagnosis, a sensible range of differentials, and your reasoning. | Summarising proves you listened and invites correction. Plain words, linked to the patient’s own concern. |
| 6:00 – 7:30 Explain and plan | Build on the working diagnosis you have just named. Offer the plan: what happens today, tests, treatment, referral, who you will discuss it with. Offer choices where they exist and ask what the patient prefers. | — | Diagnosis; investigations; treatment that reflects current UK practice; appropriate escalation to a senior. | Jargon-free; chunk and check; shared decisions. |
| 7:30 – 8:00 Close | Specific safety-net: which symptoms, what to do, how fast. Follow-up: when and with whom. Check understanding by asking the patient to tell you the plan. Thank them. Stop when the timer sounds. | — | Follow-up and safety-netting are named in the GMC’s Management feedback statement. | Checking understanding is named in the GMC’s Language statement. |
Two deadlines and one key transition
By 1:00
Identity confirmed both ways. The patient has spoken without interruption. You know why they are here and you have responded to how they look or sound.
Key transition · 5:00 – 6:00
The history is done: ICE known, impact on daily living known, red flags screened. Now consider giving the patient a brief summary and check whether they wish to add anything further; request or carry out the clinical examination; and end with the key statement — your working diagnosis and your differential diagnoses.
By 8:00
Plan explained and agreed, senior involved where appropriate, a specific safety-net, a follow-up with a time and a person, and understanding checked. You finished; you were not cut off.
How the timeline changes by station type
| Station type | What changes | New checkpoints |
|---|---|---|
| Breaking bad news / explaining a result | Data gathering shrinks to: what do they know, what are they expecting, who is with them. The news is given by about 2:00. Most of the station is emotion and next steps. | Warning shot by 1:30 · news delivered by 2:30 · silence allowed · next 1–2 weeks explained from 5:30 · support and follow-up by 7:30. |
| Counselling / a patient declining treatment | The history is the patient’s beliefs. Management is a negotiation, not an instruction. | Their reason understood by 3:00 · misinformation addressed by 5:00 · an agreed compromise and review date by 7:30. |
| Telephone consultation | No visual cues in either direction. Identity, location and call-back number first. You cannot examine, so ask what you would have looked for. | Identity and safety basics by 0:45 · decide “does this person need to be seen?” by 5:30 · explain how any prescription reaches them. |
| Clinical examination / procedure | Consent, hand hygiene, positioning and exposure first. Talk while you do. Present findings or complete documentation at the end. | Hands on by 1:00 · examination complete by 6:00 · findings, differential and next step presented by 7:30. |
| Acutely unwell patient (simulator) | ABCDE replaces the history. Treat as you find. Call for help early. | Airway and breathing addressed by 2:00 · help called by 3:00 · reassess after each intervention · SBAR handover by 7:30. |
| Safeguarding / ethics | Confidentiality and its limits are explained at the start. Pace is set by the patient. Management is safety, support and honest explanation of what you must do. | Private setting confirmed by 0:30 · disclosure explored by 4:30 · immediate safety by 5:30 · plan and safe follow-up by 7:30. |
Natural language, not stock phrases
The GMC’s Rapport feedback statement specifically criticises “use of stock phrases”. Learn the function of each line, then say it your own way.
| Moment | Function | One way to say it |
|---|---|---|
| Opening | Invite the story | “What’s been happening?” — then wait. |
| Concern | Find the fear | “When you’ve been lying awake with this, what’s gone through your mind?” |
| Expectation | Find the agenda | “What were you hoping I could do today?” |
| Summary and check | Show you listened; invite the missing piece | “Let me check I’ve got this right… Is there anything you would like to add, or anything I’ve missed?” |
| Working diagnosis | Name it, justify it, and say why not the alternatives | “You were worried this was your heart. From what you’ve told me and what I’ve found, I think the most likely explanation is … because … . I did think about … and …, but they are less likely because …” |
| Senior | Escalate without losing authority | “I’d like to run this past my senior colleague today to make sure we’ve covered everything.” |
| Safety-net | Specific and actionable | “If the pain spreads to your arm or jaw, or lasts more than ten minutes, call 999 — don’t drive yourself.” |
| Understanding | Teach-back, not “OK?” | “I’ve said a lot. What will you tell your partner when you get home?” |
The checkpoints on this page are the observer’s timing guide on the mark scheme page, and every practice case builds them into its own mark scheme: ICE, impact on daily living and red flags under data gathering; the working diagnosis with justified differentials, the safety-net and the follow-up under clinical management. Practise with the clock visible.
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.
© 2026 MD Acumen Ltd · Registered in England and Wales · Company no. 16538952 · ICO registration ZC105897