Blog

Are your consultations running late? Time management is a major challenge in the MRCGP SCA.

Tom is a GP Registrar, preparing to take the MRCGP SCA in three months. He is currently on a 20-minute appointment slot. He has started revising for SCA. Tom often finds himself running late. He struggles to fit everything within 12 minutes.

He is okay with straightforward cases but things don’t go so well for challenging cases. Poor time management is usually a symptom. It is vital to diagnose the underlying causes.

Some candidates take more time due to a lack of structure, not committing to a diagnosis or excessive use of summary. GP trainees often dwell on data gathering past 7-8 minutes due to a fear of missing important information. The first step is to audit your time in the consultation. This is where recording your consultation is helpful.

1. Use a timer

Do you keep track of time? Many trainees don’t keep an eye on time and only start clinical management eight minutes into the consultation. As a result, they don’t have sufficient time to conclude the consultation. You can’t manage your time efficiently without gauging yourself.

Use a timer and keep track of the length of time you spend in data gathering and clinical management. Aim to move to clinical management after six minutes.  

2. Strategic priming

How do you prepare before starting a consultation? It’s vital to use the information provided in the patient’s record to plan the consultation. Priming a case beforehand will help you prepare and anticipate what to do in the consultation.

In the three minutes of reading time, read the case carefully and write down key questions you shouldn’t miss to enable a safe assessment. Consider management you might like to discuss.

3. Structure your consultation

Do you find yourself going back to history-taking and asking disjointed questions? Without a structure, trainees may appear to take a history haphazardly. Trainees can miss important clinical issues because the consultation is chaotic.

Organising a consultation is vital to take a history systematically. It is helpful to revisit consultation models to learn how to structure your consultation. By using a structure, trainees can take a targeted history.

4. Avoid over summary

Do you find yourself summarising excessively? It’s a common mistake. Many trainees tend to recount everything which is an inefficient use of time. Remember, summarising the consultation extensively doesn’t earn you any points. It is more effective to focus your efforts elsewhere to make better use of your consultation time.

If you find this tips useful so far and want more in-depth resources, get 7-day SCA Blueprint for free

5. Pace your speech

Have you ever found yourself searching for words? Some trainees might speak more slowly since English is not their native language. This may affect the pacing of the conversation.

Preparation helps you maintain a steady flow without unnecessary pauses or deviations. Organise your thoughts and main points before the explanation. Practice delivering your content several times to get comfortable with the flow and timing.

Time management is key in the SCA. After implementing these changes, you will notice an improvement in your consultation without rushing clinical management. Moreover, you will have time to provide safety netting advice, an important component of the consultation first introduced by Neighbour.

How Dr Lawrence passed SCA?

After a failed SCA attempt with a score of 69, Dr Lawrence’s confidence was crushed. Check out how Dr Lawrence conquered SCA after this major setback.

Delivering difficult news in a remote setting presents unique challenges. Effective communication must adapt to the absence of physical presence, emphasising empathy and sensitivity.

This guide outlines enhanced strategies for GP trainees preparing for the MRCGP SCA, focusing on the SPIKES protocol and ABCDE method. You will also learn from a mock SCA case demonstration.

SPIKES Protocol

The SPIKES protocol provides a structured approach for delivering bad news with clarity and compassion:

Setting: Ensure a private, comfortable environment with minimal interruptions. Confirm the patient is in a suitable place and it’s a good time to talk.

Perception: Before sharing news, understand the patient’s perspective and awareness of their condition. Ask, “What have you understood about your condition so far?” Listen more than you speak to gauge their insight.

Invitation: Respect patient autonomy by asking if they’re ready for the information and how much detail they prefer.

Knowledge: Communicate clearly, using simple, non-technical language. Break the news in manageable segments, allowing time for absorption and understanding.

Emotions: Recognize and address the patient’s emotional responses. Express empathy and support, encouraging them to share any immediate feelings or concerns.

Strategy and Summary: Collaborate on a forward plan. Summarize the key points discussed to confirm understanding and clarify next steps.

ABCDE Method

The ABCDE method supports the above protocol with additional focus:

• Advance Preparation: Gather all relevant information. Anticipate and prepare for potential reactions. Emotionally ready yourself for delivering the news.
• Build a Therapeutic Relationship: Establish trust through empathy, active listening, and respecting the patient and their family’s viewpoints.
• Communicate Well: Use straightforward language and pause frequently for questions. Encourage the patient to express any concerns or misunderstandings.
• Deal with Patient and Family Reactions: Prepare for varied emotional reactions. Offer empathy, validation, and support. Provide resources for additional help if needed.
• Encourage Emotions and Empathic Responses: Create a safe space for the patient and their family to process and express their feelings, facilitating a supportive healing environment.

Mock SCA Practice

The approach to delivering bad news differs significantly from routine history-taking. One common error in SCA is extending the initial history-taking phase, thereby postponing the disclosure of test results beyond the advisable timeframe.

To avoid unnecessary patient anxiety and the subsequent rush in clinical management, share the results around three minutes or earlier if possible.

4 Actionable SCA Practice Tips

Give a Warning Shot

Begin with a gentle preface to prepare the patient, known as a “warning shot”:

“I’m afraid it’s not the news we hoped for.”

This statement sets the tone for the seriousness of the information that follows.

Communicate the Diagnosis Clearly

Proceed with delivering the results, ensuring your language is clear and direct to avoid any ambiguity. For example:

“The scan has revealed cancer in your bowel.”

Allow Time for Absorption

After sharing such significant news, it’s crucial to provide the patient with a moment to process the information. This pause not only respects their emotional response but also prepares them for further discussion about their health.

Address Patient’s Emerging Concerns

Once the initial news has been absorbed, it’s essential to explore the patient’s concerns and questions. Treat this phase as a fresh start to the consultation, focusing on the patient’s needs and emotions as they adjust to the news.

By using proven methods, you can ensure that the delivery of difficult news is handled with clarity and sensitivity, facilitating a supportive patient-doctor relationship during these challenging conversations.

How Dr Lawrence passed SCA?

After a failed SCA attempt with a score of 69, Dr Lawrence’s confidence was crushed. Check out how Dr Lawrence conquered SCA after this major setback.

Did you know that most GP trainees fail the Simulated Consultation Assessment (SCA) not because of insufficient medical knowledge, but due to poor communication skills?

In this article, we dive deep into how you can flip this trend and ace your exam by focusing on what really matters—practical skills.

Why Practical Experience Outweighs Theory 

It’s crucial to know your medical guidelines, but the SCA exam tests more than just your memory. You are assessed on how well you listen, gather targeted history, and navigate the often murky waters of medical complexity and uncertainty.

Think of it this way: reading about swimming won’t make you a better swimmer. You’ve got to get in the pool!

Similarly, to truly prepare for the challenges of the SCA consultations, you should shift your focus from the books to real or simulated patient interactions. Here’s how you bring your knowledge to life and ensure you’re ready for anything the exam throws your way.

Expert Insight: Roger Neighbour’s Technique 

Recently, I spoke with the esteemed Roger Neighbour and asked him about the best way to enhance consultation skills. Without a moment of hesitation, he recommended one key technique: recording your consultations.

It might seem daunting at first, but consider this: the temporary discomfort of recording yourself is a small price to pay compared to the potential setback of not performing well in the exam.

Engage with More Resources For more of Neighbour’s evidence-based tips on passing the SCA confidently, check out this informative video: 

How Recording Can Transform Your Practice 

Recording your consultations, whether video or audio, is a high-yield tool that can pinpoint areas for improvement and refine your approach. Here are a few insights you might gain from this practice:

• Active Listening: If you find yourself frequently interrupting the patient, it’s a sign to focus on active listening. Let your patients express themselves fully before you respond.
• Body Language: Are you projecting openness or unintentional impatience? Watching your recordings can help you become more aware of your non-verbal cues and adjust them to foster a more welcoming consultation environment.

For instance, if interruption is a concern, make a conscious effort to give the patient time to process the information. This small tweak can significantly improve the flow of information during a breaking bad news scenario.

Practical experience is key to excelling in the SCA exam. By recording your consultations and actively seeking feedback, you can significantly enhance your communication and clinical skills.

How Dr Yoginee passed SCA?

Dr Yoginee was consumed by self-doubts and fears. Check out how she conquered her fears and passed SCA on her first attempt.

I passed! It’s been a difficult journey but I thank God for the end result.

Dr Lawrence Apenteng

Dr Lawrence felt completely crushed when he got his first SCA exam results. After a failed attempt with a score of 69, he found it incredibly difficult to bounce back.

The results shook his confidence. Despite the turmoil, he braced himself to re-sit SCA. A month before his exam, Dr Lawrence reached out for help. We had a conversation but time was not in his favour.

Overcoming self-doubts

We embarked on a journey together, one that wasn’t just about practising more cases but about shifting perspectives, starting with his mindset.

It is common for trainees to have a self-defeating mindset after an unsuccessful attempt. We addressed his lack of self-confidence.

Dr Lawrence had a lot of self-doubts. He was concerned about the looming SCA re-sit. However, we devised a clear strategy to optimise his preparation over the next four weeks. Instead of wasting precious time doing cases here and there, we focused on high-yield scenarios.

You can watch ​Dr Lawrence’s case study​ to learn about his unique preparation and the proven strategies he used to pass the SCA in his second attempt.

Turning point

He had to unlearn old habits, manage the fear of failure and embrace each consultation as an opportunity to connect and make a difference. It was about listening to understand, not just to respond, and seeing patients as stories waiting to be heard. With guidance and personalised support, Dr Lawrence leveled up his consultation and communication skills.

Slowly, I watched Lawrence transform. The doubt that once clouded his vision began to clear, replaced by a growing confidence. Dr Lawrence could start seeing a ray of light at the end of the tunnel.

In one role-play, Lawrence delivered difficult news to a patient. I could see the struggle in his eyes, the search for the right words. But when he found them, it was like watching a flower bloom in fast-forward.

When the exam day came around again, Dr Lawrence was confident. He strode in with the confidence of someone who had faced his fears and came out stronger on the other side.

When the results came in, he passed with a solid score. It was proof of his journey, of the resilience and strength he had found within himself. Lawrence didn’t just pass an exam but he overcame a hurdle that had once seemed insurmountable.

From SCA Exam failure to a clear pass

I was able to make it from 69 to 87 within a month. You can also make it do not lose hope there’s support and help available.

Dr Lawrence Apenteng

If you are facing setbacks, feeling the sting of failure, please seek help. Sometimes, all it takes is a shift in perspective, a bit of guidance, and the belief that you can overcome.

Don’t let failure define you. Let it teach you, let it strengthen you. Every setback is just a setup for an even greater comeback.

Are ready to get help?

Like Dr Lawrence, you may be feeling unsure about the SCA. The intensive 1 to 1 coaching is ideal if you need personalised support.

Join over 200 trainees who sought help to achieve their goals. Applications for 1 to 1 coaching are considered on an individual basis.

Failed MRCGP Exam

In the relentless pursuit of becoming a fully-fledged GP, Dr Charles encountered a big obstacle on his journey. He couldn’t clear the final part of the MRCGP Licensing Exam.

His journey was marked by a major setback after failing RCA exam by only one mark. Dr Charles didn’t let anger consume him in the face of adversity. He harnessed that anger to propel him towards conquering the challenges posed by SCA.

Fueled by a commitment not to fail again, Dr Charles embarked on a transformative journey of self-improvement.

Turning anger into fuel

Recognising the need for a change in approach, Dr Charles decided to work smarter. He used resources that GP trainees used to pass SCA exam.

As an IMG, it was particularly difficult for Dr Charles to be conversational and person-centered. Interpersonal skills let him down in the last sitting. He set his ego aside and was ready to receive help.

Taking full ownership

With constructive feedback, Dr Charles understood the flaws in his consultation. The SCA companion became a cornerstone in his preparation, enabling him to revise effectively. His thorough preparation not only equipped him to handle all cases with poise but also gave him hope.

Dr Charles emerged as a leader within his practice groups, taking advantage of collaborative learning to bolster his strengths. The systematic documentation of cases using a companion became a cornerstone, enabling him to consolidate his knowledge and refine his skills. Armed with a unique consultation style and the ability to connect naturally with patients, he was ready to sit SCA.

Passing SCA exam and CCT

After failing RCA by one mark, Dr Charles cracked SCA with a score of 85.5, securing a resounding success and achieving the coveted CCT on the same day.

Dr Charles’ journey serves as an inspirational testament to resilience. His journey is a prime example of the transformative power of embracing failure as a catalyst for growth.

Testimonial

“With the one on one session of Dr Kwun i must say it’s worth the funds invested on it. The first time i saw his page was through a random browsing seeking for some form of additional eyes to see my blind spots. I happened to work with him in my RCA but didn’t actually take on board all we usually discuss at the sessions. When i missed passing the RCA by one mark, anger enveloped me, i realised that am now going to face SCA which is a role play exam and this role play was what i detested during my time with Dr Kwun, i never liked role play as i considered it fake. but here am i saddled with SCA in less than 50 days. i had to use the anger as a fuel, wear the garment of humility and obedience to taking feedbacks onboard and truly strategically working on them and even going extra mile to find ways i can customise my own consulting to impress the examiner so as not to hover around pass mark again, i clearly wanted to pass far away from pass mark, the experience of missing the pass mark by one mark was the greatest nightmare in this journey. coming so close yet you can’t touch it. Dr Kwun has role plays which were so real and lookalike like the exam, then he gives you this surreal feedback that after working on my mindset i have started using the feedbacks better. unlike my first time where i became impervious to some feedbacks. my general basis of my issue in this exam both RCA and SCA were interpersonal skills as i have good grasp of data gathering and management but if you don’t gather data and manage with good interpersonal skills you will still suffer. First meaningful measure was to start using his consultation blue prints, the sca companion i chose to do it pen and paper way to take stock of all the cases i’ve practiced with their feedbacks and what was missed, then taking the lead and charge in all the groups i belonged to in practicing cases daily, twice a day. i must say courses may be expensive but installation payment made it easier. still hoping more discounts on case by case variant to make it affordable for some people whose situation is very dire. i knew i will pass the exam because i have obeyed all the rules of the game, even when i had issues in my first case at the exam which affected the second case, i had only ten cases to challenge the exam and i knew i will pass just that my desire of passing far away from pass mark was what i wasn’t so sure of. but surprisingly the two first cases that didn’t go well like desired were where i got two fail scores while the rest of the ten cases had only clear pass and pass scores and eventually 85.5 against pass mark of 77 out of 126. 

i will encourage anyone doing this exam again, i understand your anger it’s valid but tune it to be your fuel, please take on board all feedbacks, see the feedbacks as a challenge to disprove things just the  way i took them then cos DrKwun would always in his usual calm gentle manner dish out mind piercing feedbacks that can knock you off. 

Part of my self tasks is this, told myself that before this exam i must make Dr Kwun use the same voice he used to dish these disturbing feedback and say charles, i am satisfied and happy with your performance. for me that is the litmus. and i must encourage anyone using the services to use this litmus and have this mindset cos if you can make your greatest critic before the exam day i am satisfied with your works before the exam, the conversation forth with is not if you will pass but how high is your passing mark.” – Dr Charles, GP

The intensive 1 to 1 coaching is ideal if you need support to pass MRCGP SCA exam.

Applications for 1 to 1 coaching are considered on an individual basis.

The Simulated Consultation Assessment (SCA) is a challenging exam GP trainees need to pass to qualify as independent GPs. A vital skill that high-performing trainees master is the ability to recognise patterns. They develop pattern recognition through exposure to diverse patient interactions and continuous learning.

In this article, you will learn five actionable tips to enhance your skill in managing uncertainty and medical complexity.

The Power of Recording

So many GP trainees shy away from recording their consultations. Video or audio recording is a high-yield activity to develop consultation skills. Neighbour recommends trainees record at least one video a week and review their consultations. Identify moments where your communication could be more patient-centered. For instance, if you notice a tendency to interrupt, consciously work on active listening. Recognise patterns in your body language – are you displaying openness or unintentionally conveying impatience?

Example: If you observe instances where you interrupt patients, make a conscious effort to pause and allow them to express themselves fully. This small adjustment can significantly improve the flow of information during consultations.

Recognise Nonverbal Cues

Patients often communicate more through nonverbal cues than words. Practise decoding these signals to uncover subtle concerns or emotions. For instance, notice if a patient avoids eye contact, fidgets, or exhibits tense body language – these could indicate underlying stress or anxiety.

Example: A patient avoiding eye contact might be signaling discomfort in discussing a particular issue. Acknowledge this nonverbal cue by expressing empathy and creating a safe space for them to share their concerns.

Be Genuinely Curious

Developing a curious mindset involves asking open-ended questions to unearth comprehensive information. For example, instead of asking, “Are you in pain?” try, “Can you describe the type of pain you’re experiencing? How does it impact your daily activities?”

Example: When a patient complains of chronic pain, explore the specific nature, triggers, and patterns. This approach not only aids in diagnosis but also builds rapport by showing genuine interest in their wellbeing.

Embrace Humility

You may face an unusual situation in the SCA exam that tests the limit of your knowledge. Admitting this transparently fosters trust. For example, if faced with an unfamiliar condition, you could say, “I’m not familiar with this condition. Let me seek a second opinion and get back to you with the best possible guidance.”

Example: Imagine a patient asks about a rare condition you’re unfamiliar with. Acknowledge your limited knowledge, reassure the patient, and commit to researching the topic before the next consultation.

Want to pass SCA Exam?

Then, you’ll love SCA Blueprint

Yes I want the Blueprint

Be Patient-Centric

Practice patience actively by allowing patients to share their stories without rushing. In instances where time constraints are present, communicate clearly about the limitations, and schedule a follow-up appointment to cover things that may need another consultation.

Example: A patient with multiple concerns may require additional time. Schedule a longer appointment, ensuring ample time to discuss each issue thoroughly, promoting a comprehensive understanding of their health patterns.

Transforming pattern recognition from a concept into actionable steps is integral to success in the MRCGP SCA. By watching, reflecting, and adjusting your communication style, decoding nonverbal cues, embodying curiosity, embracing humility with transparency, and practicing patient-centric patience, you’ll not only excel in your exam but also become a more adept and compassionate GP.

How Dr Lawrence passed SCA?

After a failed SCA attempt with a score of 69, Dr Lawrence’s confidence was crushed. Check out how Dr Lawrence conquered SCA after this major setback.