The nursing process
Case Study: History Taking (Chest Pain)
Students — practising systematic SOCRATES pain assessment with a synthetic chest pain patient.
Simulated patient — "Arthur" reveals clinical details only when asked, rewarding open questions.
Escalate, don't simulate — real chest heaviness needs an immediate 12-lead ECG and clinical escalation.
Scenario & Simulation Brief
Simulated Patient Persona: "Arthur" (65yo, Central Chest Heaviness)
Students often struggle to remember the systematic approach to pain assessment (SOCRATES) when under pressure. This prompt creates a simulated patient who only reveals clinical details when specifically asked.
Act as a 65-year-old male patient named 'Arthur'.
You have come to A&E with 'heaviness' in your chest.
Your Secret Clinical Data (Do not reveal unless asked):
* Site: Central chest.
* Onset: Started 1 hour ago while gardening.
* Character: Like an elephant sitting on me.
* Radiation: Going down my left arm.
* Associations: Feeling nauseous and sweaty.
* Time: Constant since onset.
* Exacerbating/Relieving: Worse on movement, nothing makes it better.
* Severity: 8/10.
Rules for this Roleplay:
1. Do not volunteer information. Wait for me to ask.
2. Use lay titles (e.g., don't say 'radiating', say 'going down').
3. If I ask a yes/no question, give a short answer.
4. If I ask an open question, give more detail.
Start by saying: 'Nurse, I don't feel right...' and then wait for my response.Interactive SOCRATES tracker
Use this scorecard during or right after your roleplay with "Arthur" to check whether your open questions uncovered all eight clinical cues:
SOCRATES History-Taking Tracker ("Arthur")
Ask openly: "Can you show me or tell me where you feel the heaviness?"
Ask openly: "What were you doing when it started, and did it come on suddenly or gradually?"
Ask openly: "How would you describe the feeling in your own words?"
Ask openly: "Does that heavy feeling travel anywhere else, like your arms, neck, jaw or back?"
Ask openly: "Have you noticed anything else alongside it — feeling sick, sweaty, dizzy or short of breath?"
Ask openly: "Has the heaviness been there the whole time, or does it come and go?"
Ask openly: "Does sitting still, breathing deeply, or moving change it at all?"
Ask openly: "On a scale from 0 (nothing) to 10 (the worst you can imagine), where is it right now?"
Learning Activity
Run the Simulation
Students interact with 'Arthur' for 10 minutes using text or Voice Mode.
Review Transcript
Students export their chat transcript and highlight each open vs. closed question.
Gap Analysis
Did they uncover all 8 elements of SOCRATES, including radiation to the left arm?
Real central chest heaviness needs an immediate 12-lead ECG and clinical escalation.
Notice how the prompt instruction "Do not volunteer information" is crucial. Real patients rarely walk in and recite their clinical signs in alphabetical order. This forces the student to be proactive.
Quick self-check: Open Questions & Clinical Assessment
During the simulation, Arthur says 'I wouldn't call it pain, nurse — just a heavy feeling across my chest.' Why is it essential to ask open questions across all 8 SOCRATES elements rather than stopping when a patient denies sharp pain?