AMC clinical exam: how to handle history, counselling and bad-news stations

• Reading time, then the station. Each station is ten minutes: two minutes' reading with the stem and tasks, then eight minutes with a simulated patient and an examiner. The AMC describes 16 assessed stations plus rest stations.
• Several station types. The AMC describes history-taking, examination, diagnostic formulation, and management, counselling or education stations across adult medicine, surgery, women's health, child health and mental health.
• Marking against tasks and a global rating. Each station has expected key steps and domain ratings, and an overall judgement. At the time of writing, the AMC says results are based on 14 scored stations and you need to pass at least 9 of them.
• Online or in person. In online formats there's no hands-on examination — you describe what you would examine and why.

Not completing the tasks is one of the commonest reasons stations go badly. If the stem says 'take a focused history, explain the likely diagnosis and outline your management', you need to reach all three in eight minutes, not deliver a perfect history and run out of time.

During reading time, split the eight minutes roughly by task. For a history-and-explain station you might aim for about four minutes of history, one to summarise and give the diagnosis, and the rest on management and questions. Glance at the clock once or twice, not constantly.

1. Open well. Introduce yourself, confirm the patient's name and age, and ask an open question: 'What's brought you in today?' Then let them talk for a moment.
2. Characterise the main problem (onset, duration, severity, associated features) and ask the red-flag questions early. Examiners want to see you rule out the dangerous causes.
3. Cover the relevant background — past history, medicines, allergies, family and social history — but only as deep as the presentation needs.
4. Ask about ideas, concerns and expectations. 'What were you worried this might be?' often unlocks the real agenda.
5. Summarise back briefly before moving to the next task. It shows structure and gives the patient a chance to correct you.

These stations test whether a patient leaves understanding what's going on and what to do. A reliable shape:

• Find out what they know before explaining anything.
• Explain in chunks, in lay terms. 'Your thyroid is a gland in your neck that controls how fast your body runs' beats 'You have hypothyroidism'.
• Check understanding after each chunk, and use teach-back at the end: 'Just so I know I've explained it well, can you tell me how you'll take it?'
• Address the patient's specific worry — cost, side effects, pregnancy, driving, work.
• Safety-net clearly. Say what symptoms should make them come back or call 000, and when follow-up will happen.

Management should reflect Australian practice: referral pathways, the role of the GP, relevant support services and Australian guidelines.

Many candidates know a framework such as SPIKES (setting, perception, invitation, knowledge, emotions, strategy and summary). The framework helps, but what examiners notice is whether you pace the news to the person in front of you.

Then stop talking. Let the silence do some work, acknowledge the emotion, and only move to next steps when the patient is ready. Avoid false reassurance and euphemisms that leave them unsure what you meant.

When a station involves low mood, ask about suicidal thoughts directly and compassionately — asking doesn't plant the idea, and avoiding it is unsafe. Explore plans, means, protective factors and supports, then agree a safety plan and follow-up. Explain confidentiality and its limits.

• Practise with a timer every time. Eight minutes goes faster than you expect.
• Rotate roles with study partners so you also see stations from the patient's chair.
• Record yourself and listen for jargon, closed-question runs and missed tasks.
• Mix station types so you don't over-prepare one format.

XINGO's AMC clinical exam practice gives you eight-minute stations with an AI patient or relative who answers in character — fatigue with red flags, a febrile toddler, a pregnant patient on valproate, post-operative delirium, breaking bad news and a suicide risk assessment — followed by feedback on task completion and communication. It doesn't assess physical examination, so pair it with hands-on practice.