SAMPLE training sheets

30 Apr 2016 19:21
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I got these SAMPLE practice sheets from a training Sophia wrote for Chicago Action Medical around 2003ish. She may have gotten them from Black Cross Health Collective or may have written them herself. I love to use them for teaching students how to take a patient history. A fragment from one of my training outlines from 2013 is in this post below the practice sheets.

Besides seeing the utility of SAMPLE and learning the acronym, an objective I always have when teaching SAMPLE is to encourage students to suspend forming an opinion; to live in the question, not the answer.

Finally, I remind students to trust the people they help. Often this interview helps chronic illness sufferers or people with disabilities remember what they need to do. They are already the experts on their conditions! We assist them in locating the problem with SAMPLE. After they decide on an course of action, we may assist them in carrying out their plan.

In affinity group medic (AGM) trainings, I encourage students to talk with their affinity group members confidentially about members' allergies, medications, and past pertinant medical history before an action. This establishes knowledge that can help the AGM be a better wellness buddy, and also establishes trust. If you can keep group members' confidence before they're hurt, they'll trust you more later when they're hurt and scared.


S: Shortness of breath.
A: None.
M: Inhaler for asthma.
P: Diagnosed with asthma at age 15; no other medical problems.
L: Had nothing to eat today.
E: Running from cops; scared.


S: Headache around eyes.
A: Sulfa drugs.
M: Takes birth control pills.
P: Got hit on head one week ago, had a wrist fracture one year ago.
L: Nothing to eat today; has been drinking coca cola and water and peeing "a lot."
E: Went out on blockade at 7 AM; slept 3 hours last night.


S: Nausea and diarrhea.
A: Milk, nuts.
M: Epinephrine for allergic reactions.
P: Nut allergic reaction about 6 months ago; had to go to hospital.
L: "Shitting every 15 minutes," has not vomited; ate big chicken dinner last night but nothing today.
E: Chicken dinner; just been hanging around convergence center all day.


S: "Sprained" wrist with pain (hurts to move it).
A: None.
M: None.
P: Broke same wrist in 1996.
L: Ate oatmeal and drank tea about 2 hours ago, went to toilet a few minutes ago.
E: Fell on wrist, running around in crowd.


S: Fell down, dizzy, feel hot.
A: Aspirin.
M: Seizure medications.
P: Seizures since age 23.
L: Ate breakfast today at 8 AM, lunch at noon, went to toilet an hour ago.
E: Stood in sun at rally for about 6 hours now.


S: Itching on abdominal area.
A: Hay fever.
M: Homeopathic pills for hay fever.
P: Skin condition "with a name I donÕt recall" that cleared up with medication in 2003.
L: Ate pie for breakfast, drank coffee and later tea.
E: Used special soap meant to take oil from skin as protection from tear gas.


S: Drunk, dizzy, nauseous.
A: None.
M: "Just the whisky!"
P: "I drink all the time!"
L: 12 drinks in 3 hours, ate a pizza 2 hours ago, urinating constantly.
E: "Just felt like partying after the big riot."


S: Chest pain, with 'acidic' feeling.
A: None.
M: Rheumatoid arthritis medications.
P: "I have heartburn," denies history of heart problems.
L: "Deep fried Mars Bars" and a pizza for lunch today, no dinner yet, drinking water.
E: Ate about 60 minutes ago; no other events since then.

SAMPLE patient history

Refer students to SAMPLE on chart paper—students must see SAMPLE, not just hear it.

Facilitator says: Sometimes the SAMPLE history is over quickly. Sometimes it is a time consuming and detailed interview that begins in the first few moments of patient care and continues until you walk through the doors at the emergency room. Good SAMPLE histories can be disorderly and divergent. They go off on tangents. They explore deeper than the basic questions. They encourage the patient to talk and elaborate when the patient is able.

S: for Symptoms.
A: for Allergies.
M: for Medications.
P: for Past medical history.
L: for Last food and drink (and last shit and piss).1
E: for Events.

Facilitator says: Run through SAMPLE in your head every time you take a history to make sure you cover all your bases, even if you ask questions out of order. Memorize this acronym.

Trainers model SAMPLE and debrief

Facilitator says: Let's see what we can learn by taking a SAMPLE history.

3 students: volunteer. Each gets a Reader opened to Sophia's SAMPLE practice sheets. Each student gets to pick which patient they want to be without telling trainers.

Trainer buddy pair: interviews each student sequentially in front of class.2

After each interview, facilitator asks class: What did you learn about (patient's name) from the SAMPLE history? What do you still want to know?

Students model SAMPLE and debrief

6 more students: volunteer. They come up in front of the class in pairs and each of 3 students playing medics interviews each of 3 students playing Sophia's patients.

After each interview, facilitator asks class: What did you learn about (patient's name) from the SAMPLE history? What do you still want to know?

OPQRST pain history

You don't get much information by asking, "What are your symptoms?" There are lots of good questions for zooming in on the chief complaint. The most useful a string of letters from later in the alphabet.

O: for Onset.
P: for Provokes/Palliates.
Q: for Quality.
R: for Region/Radiates/Refers.
S: for Severity (1-10).
T: for change over Time.

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