History Taking · Intermediate · O&G

Pregnant Teenager with Morning Sickness

Practise this PLAB 2 history taking station on Hyperemesis Gravidarum. 8-minute voice AI simulation with feedback on all 3 marking domains.

Clinical scenario

You are an FY2 doctor in a sexual health and young people's clinic. Kavita Chawla, a 16-year-old girl, has come in privately to discuss her pregnancy and options. She is experiencing significant morning sickness and is concerned about her health and future. Please take a sensitive history, assess her capacity to consent, and discuss her options in a non-judgemental way.

Background notes: PMH: Nil significant

What this station tests

  • Gillick competence at 16: can consent without parental involvement
  • Safeguarding assessment: age of partner, consensual relationship, any coercion or exploitation
  • Presenting all options without bias: continuing, adoption, termination
  • Not breaking confidentiality without safeguarding concern: her mother cannot be told without consent
  • Time sensitivity: some options become less available with advancing gestation

How to use your 8 minutes

  • 0-1 min — Introduction: Introduce yourself, confirm identity, open question. 'What's brought you in today?'
  • 1-4 min — Systematic History: Presenting complaint detail (SOCRATES for pain, timeline, severity). Systems review. PMH, medications, allergies.
  • 4-6 min — Context and ICE: Social history (smoking, alcohol, occupation, living situation). Family history. Ideas, Concerns, Expectations.
  • 6-7 min — Summary and Plan: Summarise findings back to patient. Share differential/working diagnosis. Outline investigation and management plan.
  • 7-8 min — Closing: Safety netting with specific red flags. Arrange follow-up. Check for questions.

Consultation approach

The opening

A 16-year-old presenting alone about pregnancy requires safeguarding assessment (Fraser/Gillick competence) alongside sensitive clinical care. Kavita is 16, has come alone, thinks she is pregnant (positive home test). She is terrified. Open with: 'Kavita, thank you for coming in. Everything we discuss is confidential. Tell me what has been happening.'

Core approach

Establish confidentiality immediately (critical for adolescent patients). She is 16: in the UK, she can consent to medical treatment including pregnancy-related care under Gillick competence (Fraser guidelines). She does not need parental consent, and you cannot inform her parents without her permission unless there is a safeguarding concern.

Safeguarding assessment. Who is the father? (Her boyfriend, also 16, in her year at school.) Is the relationship consensual? Any age gap concerns? Any coercion? Any adult involved? If the partner is a similar age and the relationship is consensual: no safeguarding referral needed. If any concern about exploitation or coercion: safeguarding duty applies regardless of her wishes.

Confirm pregnancy: urine test in clinic. Estimate gestation from LMP. Discuss all options without bias: continuing the pregnancy, adoption, and termination. She has the right to choose. Explore her thoughts: 'What are your feelings about the pregnancy? Have you thought about what you would like to do?' She is terrified about her mother finding out. Her GCSEs are in 8 weeks.

Closing and safety netting

Do not rush any decision. 'You do not need to decide today. But time is important because some options become less available later in pregnancy.' If she is considering termination: explain the process (medical or surgical, depending on gestation) and refer to the pregnancy advisory service. If continuing: early booking with midwifery.

Support: 'Would you like help telling your mum? Or would you prefer to see someone from the young people's support service first?' Encourage but do not mandate parental involvement. Safety net: 'If you develop severe pain, heavy bleeding, or feel unwell, come in urgently.' Follow-up within 1 week.

How examiners mark this station

Examiners will focus on the thoroughness and structure of your history taking for hyperemesis gravidarum. Domain 1 (Data Gathering) carries the most weight: expect marks for systematic coverage of presenting complaint, red flags, PMH, medications, social and family history. Domain 2 (Clinical Management) requires a clear differential, appropriate investigations, and a safe management plan with safety netting. Domain 3 (Interpersonal Skills) is assessed throughout: genuine exploration of ICE, active listening, empathic responses, and clear communication without jargon.

Domain 1 (Primary focus)

Scores well: Pregnancy confirmed. Gestation estimated. Safeguarding assessed. Confidentiality established. Partner details obtained. Home situation understood.

Costs marks: Not assessing safeguarding. Not confirming pregnancy. Not establishing confidentiality.

Domain 2 (Primary focus)

Scores well: All options presented without bias. Referral pathways known. Time sensitivity communicated. Support services offered.

Costs marks: Being directive. Not knowing referral pathways. Not communicating time sensitivity.

Domain 3 (Primary focus)

Scores well: Sensitive, non-judgmental throughout. Confidentiality established from the start. Supporting without directing. Acknowledging her fear about her mother.

Costs marks: Being judgmental. Breaking confidentiality. Being directive. Not acknowledging her distress.

Common examiner feedback (and how to fix it)

Did not gather sufficient information to make an adequate assessment of the patient's condition

Fix: Use a consistent framework for every history. After covering the presenting complaint, systematically move through PMH, drug history, social history, family history, and ICE. Keep a mental checklist.

Did not identify the patient's problems and/or did not develop a management plan adequately

Fix: Reserve the final 2 minutes to summarise your findings, share your working diagnosis with the patient, and outline your investigation and management plan including safety netting.

Common mistakes in this station

  1. Informing her parents without consent: unless there is a safeguarding concern, confidentiality must be maintained
  2. Being directive about the decision: presenting options with bias (toward keeping or terminating) removes her autonomy
  3. Not assessing safeguarding: the partner's age and the nature of the relationship must be established

Resitting PLAB 2?

If you have previously struggled with history taking stations, focus on building a consistent systematic framework that you apply to every case. Practise structuring your history into clear phases (presenting complaint, systems review, PMH, social, ICE) so that even under pressure, you cover all domains. Many resitters lose marks not on knowledge but on organisation and time management.

Example opening

Good morning/afternoon, my name is Dr [Name], I'm one of the doctors here today. Could I confirm your name and date of birth please? Thank you. So, what's brought you in to see me today?

Frequently asked questions

How should I structure the hyperemesis gravidarum history in this PLAB 2 station?

A 16-year-old presenting alone about pregnancy requires safeguarding assessment (Fraser/Gillick competence) alongside sensitive clinical care. Kavita is 16, has come alone, thinks she is pregnant (positive home test). She is terrified.

What are examiners marking in this hyperemesis gravidarum station?

Marks are won for: Pregnancy confirmed. Gestation estimated. Safeguarding assessed. Confidentiality established. Partner details obtained. Home situation understood. Marks are lost for: Not assessing safeguarding. Not confirming pregnancy. Not establishing confidentiality.

What is the most common mistake candidates make in this hyperemesis gravidarum station?

Informing her parents without consent: unless there is a safeguarding concern, confidentiality must be maintained.

How do I prepare for this station if I have not managed hyperemesis gravidarum in clinical practice?

This station rewards process over personal experience. The skill being assessed: Safeguarding assessment: age of partner, consensual relationship, any coercion or exploitation. The written guidance on this page covers the full approach, and practising the consultation aloud builds the fluency the examiner is listening for.

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