What you must demonstrate
- Focused history with relevant negatives
- Targeted cardiovascular, respiratory, abdominal and neurologic examination
- Prioritized differential diagnosis
- Initial investigations and interpretation
- Immediate stabilization plus disposition
11-minute performance map
1. Opening and immediate safety
Introduce yourself, confirm identity, explain the task, obtain consent and identify instability before routine questioning.
2. Focused assessment
Clarify onset, progression, severity, associated features, discriminating positives/negatives and the most relevant background risks.
3. Targeted examination
Perform only the examination maneuvers needed to assess severity, confirm localization and discriminate the leading diagnoses.
4. Synthesize
Give a one-sentence summary, leading diagnosis and two to four prioritized alternatives including the dangerous diagnosis you cannot miss.
5. Investigations
Choose tests that answer a specific diagnostic or safety question; state urgent tests first.
6. Immediate management
Treat instability, begin syndrome-specific care, consult early when needed and define disposition.
7. Communication and safety net
Explain the plan, check understanding, address concerns and state exact deterioration/return criteria.
Focused history prompts
Define the presentation
- Onset, chronology, triggers and progression.
- Severity and effect on function.
- Associated symptoms that support the leading diagnosis.
- Relevant negatives that reduce dangerous alternatives.
Risk context
- Relevant past medical/surgical/obstetric/psychiatric history.
- Medications, allergies and adherence.
- Family, social, substance, travel/exposure or safeguarding factors as applicable.
- Patient ideas, concerns, expectations and goals.
Dangerous alternatives to prioritize
- Acute ischemic stroke
- Intracranial hemorrhage
- Hypoglycemia
- Seizure/Todd paresis
- Time-critical reperfusion delay
Targeted investigations
Focused bedside observations and ECG/point-of-care tests when indicated
CBC, electrolytes/renal function, glucose and targeted biochemical tests
Disease-specific imaging or physiologic testing based on the leading differential
Microbiology/cultures when infection is plausible and results will change management
Immediate management and disposition
- Stabilize ABC problems first and treat immediately reversible threats.
- Start evidence-based initial therapy matched to severity and contraindications.
- Consult the appropriate service early when the diagnosis is time-sensitive or high-risk.
- State disposition, reassessment plan, follow-up and explicit return precautions.
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