Dysphagia history

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History Taking Station: Dysphagia

Station length: 7–9 minutes
Task: Take a focused history from a patient presenting with difficulty swallowing.

Candidate Instructions
You are the surgical trainee in clinic.
A patient has been referred with difficulty swallowing (dysphagia).
Please take a focused history and summarise your findings to the examiner.

Examiner Mark Scheme
Total marks: 20

1. Introduction and Communication (2 marks)
   Criterion Marks
   Introduces self and role 1
   Confirms patient identity and explains purpose of consultation 1

2. Presenting Complaint (2 marks)
   Criterion Marks
   Clarifies the nature of the swallowing difficulty 1
   Establishes duration and onset of symptoms 1

3. Characterisation of Dysphagia (4 marks)
   Criterion Marks
   Differentiates solids vs liquids 2
   Establishes progression of symptoms 2
   Key diagnostic points expected:
   Difficulty with solids progressing to liquids
   Whether symptoms are progressive or intermittent

4. Associated Symptoms (4 marks)
   Criterion Marks
   Weight loss 1
   Regurgitation of food 1
   Pain on swallowing (odynophagia) 1
   Persistent vomiting or choking episodes 1

5. Red Flag Symptoms (3 marks)
   Criterion Marks
   Unintentional weight loss 1
   Vomiting or haematemesis 1
   Progressive worsening dysphagia 1

6. Gastro-oesophageal Symptoms (2 marks)
   Criterion Marks
   Heartburn / reflux symptoms 1
   History of long-standing reflux disease 1

7. Risk Factors (2 marks)
   Criterion Marks
   Smoking history 1
   Alcohol intake 1

8. Medical and Drug History (2 marks)
   Criterion Marks
   Relevant past medical history 1
   Drug history including NSAIDs or medications affecting oesophagus 1

9. Summary and Clinical Reasoning (3 marks)
   Criterion Marks
   Provides structured summary 2
   Identifies concerning features suggesting malignancy 1

Example expected summary:
"A middle-aged patient with progressive dysphagia to solids associated with weight loss, raising concern for an oesophageal malignancy."

Candidates should demonstrate the ability to:
Structure a focused surgical history
Identify red flag features of upper GI malignancy
Differentiate mechanical obstruction vs motility disorder
Communicate clearly and summarise effectively

Common Candidate Errors
Failure to ask about progression of dysphagia- Not asking about weight loss
Forgetting smoking and alcohol history
Not summarising the case at the end