A 25-year-old male presents to the Emergency Department with complaints of frequent loose stools and vomiting since yesterday morning. He reports approximately 15 episodes of watery diarrhoea and 6 episodes of vomiting over the last 24 hours. He also complains of generalised weakness, dizziness while standing, excessive thirst, and decreased urine output. The patient states that symptoms started a few hours after consuming food from a roadside vendor. He denies blood in stool, black-colored stool, severe abdominal pain, abdominal distension, or recent hospitalisation. He has no known history of diabetes mellitus, hypertension, chronic kidney disease, or previous similar episodes. Since the onset of symptoms, he self-administered Oral Rehydration Salts (ORS) 1 sachet dissolved in 200 mL water after each loose stool episode (approximately 5 sachets over 24 hours), Ondansetron 4 mg orally every 8 hours for nausea and vomiting (2 doses taken), Loperamide 2 mg orally after each loose stool (maximum 4 tablets taken), and Paracetamol 500 mg two tablets orally every 6 hours for fever and generalised weakness (2 doses taken). He denies use of antibiotics, NSAIDs, antacids, or any herbal remedies prior to arrival. He has no known drug allergies. Based on the above case scenario, make a rubric for SAMPLER History.
Here is a structured SAMPLER History Rubric based on the case scenario provided.
SAMPLER History Rubric
Case: 25-Year-Old Male with Acute Gastroenteritis and Dehydration
What is SAMPLER?
SAMPLER is a systematic history-taking framework used in emergency and clinical settings:
| Letter | Component |
|---|---|
| S | Signs & Symptoms |
| A | Allergies |
| M | Medications |
| P | Pertinent Past Medical History |
| L | Last Oral Intake |
| E | Events Leading to Presentation |
| R | Risk Factors / Review of Systems |
S - Signs & Symptoms
| # | Expected Finding from Case | Marks |
|---|---|---|
| 1 | Frequent loose/watery stools - approximately 15 episodes in 24 hours | 1 |
| 2 | Vomiting - approximately 6 episodes in 24 hours | 1 |
| 3 | Generalised weakness | 1 |
| 4 | Dizziness on standing (postural/orthostatic component) | 1 |
| 5 | Excessive thirst (polydipsia as a dehydration marker) | 1 |
| 6 | Decreased urine output (oliguria) | 1 |
| 7 | Onset of symptoms approximately since yesterday morning (duration ~24 hours) | 1 |
| Negative findings to elicit (Red Flag Exclusions): | ||
| 8 | No blood in stool | 1 |
| 9 | No black/tarry stool (melena) | 1 |
| 10 | No severe abdominal pain or distension | 1 |
| Subtotal | /10 |
A - Allergies
| # | Expected Finding from Case | Marks |
|---|---|---|
| 1 | No known drug allergies (NKDA) confirmed | 1 |
| 2 | Asks specifically about drug allergies (not just food/environmental) | 1 |
| 3 | Documents nature of any allergy if present (anaphylaxis vs. intolerance vs. side effect) | 1 |
| Subtotal | /3 |
M - Medications
| # | Expected Finding from Case | Marks |
|---|---|---|
| 1 | ORS - 1 sachet dissolved in 200 mL water (incorrect dilution - standard is 1 sachet in 1 L); approximately 5 sachets taken | 1 |
| 2 | Ondansetron 4 mg orally every 8 hours - 2 doses taken | 1 |
| 3 | Loperamide 2 mg after each loose stool - maximum 4 tablets taken | 1 |
| 4 | Paracetamol 500 mg, 2 tablets every 6 hours - 2 doses taken | 1 |
| 5 | Denies antibiotics use | 1 |
| 6 | Denies NSAID use | 1 |
| 7 | Denies antacid use | 1 |
| 8 | Denies herbal/traditional remedy use | 1 |
| Subtotal | /8 |
P - Pertinent Past Medical History
| # | Expected Finding from Case | Marks |
|---|---|---|
| 1 | No known Diabetes Mellitus | 1 |
| 2 | No known Hypertension | 1 |
| 3 | No known Chronic Kidney Disease | 1 |
| 4 | No previous similar episodes of diarrhoea/vomiting | 1 |
| 5 | No recent hospitalisation | 1 |
| 6 | Asks about surgical history / abdominal surgeries | 1 |
| 7 | Asks about immunocompromised status (HIV, malignancy, steroids) | 1 |
| Subtotal | /7 |
L - Last Oral Intake
| # | Expected Finding from Case | Marks |
|---|---|---|
| 1 | Identifies the implicated meal - food from a roadside vendor | 1 |
| 2 | Timing of last intake before symptom onset established | 1 |
| 3 | Type of food consumed (street food - potential contamination source) | 1 |
| 4 | Whether anyone else who ate the same food developed similar symptoms (outbreak identification) | 1 |
| 5 | Current oral intake status - whether patient is able to tolerate fluids at the time of presentation | 1 |
| Subtotal | /5 |
E - Events Leading to Presentation
| # | Expected Finding from Case | Marks |
|---|---|---|
| 1 | Symptom onset - yesterday morning, approximately 24 hours prior to ED visit | 1 |
| 2 | Temporal relationship established - symptoms started a few hours after eating roadside food | 1 |
| 3 | Progression of symptoms documented (frequency of diarrhoea and vomiting over 24 hours) | 1 |
| 4 | Self-medication attempts at home before seeking care documented | 1 |
| 5 | Reason for presenting to ED now - worsening symptoms, dizziness, reduced urine output despite home treatment | 1 |
| 6 | No improvement with home ORS/antiemetics prompted ED visit | 1 |
| Subtotal | /6 |
R - Risk Factors / Review of Systems
| # | Expected Finding from Case | Marks |
|---|---|---|
| 1 | Food source identified as a risk factor - roadside/street vendor food | 1 |
| 2 | Asks about travel history (travel-associated diarrhoea) | 1 |
| 3 | Asks about water source (contaminated water consumption) | 1 |
| 4 | Asks about contact with sick individuals (infectious aetiology, outbreak) | 1 |
| 5 | Asks about occupational history (food handler, healthcare worker) | 1 |
| 6 | Asks about social history - alcohol use (can mimic/worsen GI symptoms) | 1 |
| 7 | Asks about immunisation history (e.g., cholera, typhoid) | 1 |
| 8 | Fever history (suggests infective aetiology) | 1 |
| Subtotal | /8 |
Summary Score Sheet
| Component | Maximum Marks |
|---|---|
| S - Signs & Symptoms | 10 |
| A - Allergies | 3 |
| M - Medications | 8 |
| P - Past Medical History | 7 |
| L - Last Oral Intake | 5 |
| E - Events | 6 |
| R - Risk Factors | 8 |
| TOTAL | 47 |
Examiner Notes
- Award marks only when the student actively asks the question, not if the patient volunteers it unprompted.
- For negative findings (e.g., no blood in stool, NKDA), marks are awarded only if the student specifically enquires about them.
- The ORS dilution error (1 sachet in 200 mL instead of 1 L) is a key clinical teaching point - bonus mark may be awarded if the student identifies and comments on this in the medications section.
- The student should demonstrate a logical, systematic flow through the SAMPLER framework rather than asking questions in a scattered manner.
for making rubrics follow this formating
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Got it. The format uses a rubric table with columns: Criteria | 3 Marks | 2 Marks | 1 Mark | 0 Mark | Total, with descriptive performance anchors for each level. Here is the fully reformatted SAMPLER History Rubric:
SAMPLER History Rubric
Case: 25-Year-Old Male with Acute Gastroenteritis and Dehydration
| Criteria | 3 Marks | 2 Marks | 1 Mark | 0 Mark | Total |
|---|---|---|---|---|---|
| S - Signs & Symptoms | Lists all major symptoms including diarrhoea (~15 episodes), vomiting (~6 episodes), generalised weakness, dizziness on standing, excessive thirst, and decreased urine output. Also elicits key negative findings (no blood/melena in stool, no severe abdominal pain). | Lists most symptoms but misses 1-2 relevant symptoms or fails to elicit key negative findings. | Lists only a few symptoms with significant omissions (e.g., misses postural dizziness, oliguria, or thirst). | Fails to list presenting symptoms or writes incorrect information. | /3 |
| A - Allergies | Specifically asks about drug allergies and correctly documents No Known Drug Allergies (NKDA). Distinguishes allergy from intolerance/side effect. | Asks about allergies but lacks clarification (e.g., does not confirm NKDA or does not specify drug allergies). | Vague or incomplete allergy history (e.g., only asks "any allergies?" without specifying drugs). | Does not ask about or document allergies. | /3 |
| M - Medications | Clearly and completely documents all self-administered medications: ORS (1 sachet/200 mL, ~5 sachets), Ondansetron 4 mg 8-hourly (2 doses), Loperamide 2 mg per episode (4 tablets), Paracetamol 500 mg BD (2 doses). Also confirms no antibiotics, NSAIDs, antacids, or herbal remedies. | Writes about most medications but with incomplete information (e.g., misses doses/frequency, or fails to ask about non-prescription/herbal remedies). | Limited medication history with significant omissions (e.g., mentions only 1-2 medications, misses negative medication history). | Does not ask about or document medications. | /3 |
| P - Past Medical History | Thoroughly documents past illnesses and confirms absence of DM, hypertension, CKD, previous similar episodes, and recent hospitalisation. Also asks about surgical history and immunocompromised status. | Writes the most relevant past medical history but misses one or two areas (e.g., asks about chronic diseases but omits prior episodes or hospitalisation). | Partial past medical history with major omissions (e.g., only asks about one chronic condition, misses surgical or immunisation history). | Does not ask about or document past medical history. | /3 |
| L - Last Oral Intake | Identifies the implicated meal (roadside vendor food), establishes timing (symptoms began a few hours after eating), asks about type of food consumed, enquires if others who ate the same food were also affected, and confirms current ability to tolerate fluids. | Identifies the implicated meal and timing but misses 1-2 components (e.g., does not ask about others affected or current oral tolerance). | Only partially addresses last oral intake (e.g., notes food intake but does not establish temporal relationship to symptoms or asks no further questions). | Does not ask about last oral intake or food history. | /3 |
| E - Events Leading to Presentation | Clearly establishes timeline: symptom onset yesterday morning (~24 hours ago), onset a few hours after roadside food, progression of diarrhoea and vomiting documented, self-medication attempts at home noted, and identifies reason for ED visit (worsening despite home treatment). | Describes most events leading to presentation but misses 1-2 details (e.g., documents onset and food link but does not note progression or home treatment attempts). | Incomplete account of events with significant gaps (e.g., only states "had diarrhoea and vomiting" without establishing onset, timeline, or precipitant). | Does not ask about or document events leading to presentation. | /3 |
| R - Risk Factors | Identifies relevant risk factors: roadside food consumption, asks about water source, travel history, contact with sick individuals, occupational history (food handler), social history (alcohol), and immunisation history (cholera, typhoid). | Identifies most relevant risk factors but misses 1-2 (e.g., asks about food and water but omits travel, occupation, or contact history). | Only identifies 1-2 risk factors with major omissions (e.g., only notes the implicated meal, does not explore other exposures). | Does not ask about risk factors or contextual exposure history. | /3 |
Total: /21
Scoring Guide
| Score Range | Performance Level |
|---|---|
| 19-21 | Excellent - thorough, systematic SAMPLER history |
| 14-18 | Good - covers most components with minor gaps |
| 8-13 | Satisfactory - covers core components but with notable omissions |
| Below 8 | Needs Improvement - significant gaps across multiple components |
Examiner Note: Marks for each component are awarded based on the student's active enquiry, not information volunteered by the patient. The incorrect ORS dilution (1 sachet in 200 mL instead of the standard 1 L) under Medications is a key clinical point worth highlighting in feedback.
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