A MRCEM station on MedMock, start to finish
This is an illustrative MRCEM station written by MedMock to show what the station is like: the brief, everything the patient says, the candidate’s answers and the feedback were all written by us, not recorded from a real session. The feedback is laid out the way MedMock marks this exam. It is here to show the format and the standard, not as a model answer to learn by heart.
The brief
You are a doctor working in the Emergency Department. Mr Daniel Reid, aged 35, collapsed while playing five-a-side football this evening. He is now fully alert, his observations are normal, and a senior colleague has reviewed his 12-lead ECG and found it normal. He would like to go home. Take a focused history, explain your assessment to him and agree a plan for his care. You do not need to examine him.
History Taking (Adult): the full transcript
Hello, Mr Reid? I'm Dr Adeyemi, one of the doctors in the emergency department. How are you feeling now?
Fine, honestly. Bit embarrassed. The nurse said my heart tracing was normal, so I'm hoping to get off home. I've got work at six.
I'm glad you're feeling better, and I'll be as quick as I can. To work out whether it's safe for you to go home, I need to understand exactly what happened. What were you doing just before you collapsed?
It was the second half. I was sprinting for a through ball, and the next thing I know I'm on my back with the lads standing over me.
Were you still running when you went down, or had you already stopped? And did you get any warning at all?
Still running, flat out. A few seconds before, my heart started pounding, really fast, faster than it does when I'm running. Then everything went grey. No pain in my chest or anything.
Did anyone see it happen, and do you know how long you were out for?
My mate Jamie saw it. He reckons I was out for about half a minute. He said I went white as a sheet and my arms twitched for a couple of seconds, then I came round and knew where I was straight away. He's out in the waiting room.
That's really helpful. If you're happy, I'd like a quick word with Jamie as well. A few seconds of twitching can happen in a faint, but did you bite your tongue, wet yourself, hit your head or feel muddled afterwards?
Yeah, talk to Jamie, that's fine. And no, none of that. I was a bit shaky and I grazed my knee, but I didn't hit my head.
Has anything like this happened before, even just your heart racing or feeling faint when you're exercising?
Now you mention it, a couple of weeks ago I was out running and my heart went mad for a minute or so. I felt dizzy and had to stop. I thought I'd just overdone it.
Thank you. Do you ever get chest pain or unusual breathlessness when you exercise? And do you have any medical problems, or take any medicines, supplements or recreational drugs?
No, never. I'm fit, I play twice a week. No medicines, just a protein shake after the gym. A couple of pints at the weekend. Never touched drugs.
Has anyone in your family had heart problems, or died suddenly or unexpectedly when they were young?
My dad's brother died when he was thirty-four. He just collapsed at work. They said it was his heart, but nobody in the family really talks about it.
I'm sorry to hear that, and it's really important that you've told me. What do you do for work, and who's at home?
I'm a delivery driver, in a van. My wife's at home with our two little ones. That's why I need to get back.
Thank you, that all makes sense. Let me explain what I'm thinking. Most blackouts in young, fit people are simple faints, but yours has features that make me want to be more careful. You went down while you were still running, your heart was racing just before, it's happened in a milder way before, and your uncle died suddenly at a young age. Together, that makes me worried about a problem with the heart's rhythm, possibly from a heart condition that can run in families. Your normal ECG is reassuring, but it doesn't rule that out.
So you're saying I can't go home? I feel completely fine now.
I can see you feel well, and I know this isn't what you wanted to hear. It's your decision, but my strong advice is to stay. National guidance is that anyone who blacks out during exercise, or has a family history like yours, needs an urgent assessment by the heart specialists. So I'd like to put you on a heart monitor, do some blood tests and ask the cardiology team to see you. They may keep you in overnight, and they'll probably arrange a scan of your heart. The reason I'm pushing is that if this is a rhythm problem, it could happen again without warning, and that can be dangerous, even life-threatening.
Life-threatening? Right. OK, I'll stay. But what about work? And if it runs in families, should my kids be checked?
Both good questions. Please don't drive at all, including for work, until the heart team has assessed you, and they'll tell you whether you need to inform the DVLA. I can give you a fit note for work. No football or gym either until they say it's safe. If they find a condition that runs in families, they'll advise which relatives should be checked, including your children. Just so I know I've explained it properly, what will you tell your wife?
That I blacked out while I was running, and with my heart racing and what happened to my uncle, you're worried it's my heart's rhythm. The tracing's normal, but that doesn't rule it out, so I'm staying on a monitor for the heart doctors to see me and scan my heart. No driving or football till they say so, and if it's something that runs in the family, they'll tell us if the kids need checking.
That's exactly right. I'll speak to Jamie and get you on the monitor now. If you feel your heart racing, or you feel dizzy or faint while you're here, press the call bell straight away.
Will do. Thanks, doc, and sorry for being difficult earlier. I'll get Jamie to ring my wife.
Example feedback
85 / 100
8 of 10, weighted 50% in this station. Covered what separates an arrhythmia from a faint: activity at the moment of collapse, palpitations just before, the witness account, tongue-biting, injury and recovery, an earlier episode on exertion, drugs, and a family history that turned up a sudden death at 34. A recent viral illness and the details of the uncle's death were not asked about.
9 of 10, weighted 30%. Recognised two red flags in NICE's blackouts guideline, collapse during exertion and a family history of sudden cardiac death under 40, knew that "Your normal ECG is reassuring, but it doesn't rule that out", and planned cardiac monitoring, blood tests and urgent cardiology assessment.
9 of 10, weighted 20%. Handled his wish to leave without confrontation ("It's your decision, but my strong advice is to stay"), was honest about the risk, answered his questions about work and his children, and checked understanding with teach-back.
What went well
- Asked the question that separates an arrhythmia from a faint after exercise: "Were you still running when you went down, or had you already stopped?" NICE's blackouts guideline uses exactly this distinction.
- Sought the witness account ("If you're happy, I'd like a quick word with Jamie as well") and read it correctly, "A few seconds of twitching can happen in a faint", instead of labelling the event a seizure.
- Gave safe, specific advice for the wait for cardiology, "Please don't drive at all, including for work, until the heart team has assessed you", with no football or gym until cleared and a fit note, in line with NICE's advice for people awaiting specialist cardiovascular assessment.
What to improve
- Ask about a recent viral illness. A flu-like illness or chest infection in the weeks before would raise the possibility of myocarditis, a recognised cause of palpitations and collapse on exertion in a young adult.
- Take the family history one step further: whether his uncle had a post-mortem or a named diagnosis, and whether anyone else in the family has had heart tests. That shapes what the cardiology team looks for and whether the family needs screening.
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