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How to pass SCA?

SCA preparation

Preparing for the MRCGP Simulated Consultation Assessment can be challenging for a lot of GP trainees. Finding the time to revise, staying motivated and practicing for SCA can feel overwhelming.

If you haven’t been taught the essentials of remote consulting, it can be dauting to navigate phone or video consultations. Every GPST needs to develop their consulting skill in managing challenging and complex cases to succeed their final MRCGP exam.

Roger Neighbour’s Top Tips

Roger Neighbour introduced groundbreaking concepts including safety netting and housekeeping in The Inner Consultation. This book has transformed the way we approach patient care. Safety netting is crucial to manage the degree of uncertainty in general practice.

Effective communication is vitally important in General Practice. It’s the lifeblood that keeps everything running smoothly. It can be difficult to build rapport remotely but it doesn’t stop a clinician from providing compassionate care without seeing a patient. Neighbour believes in treating patients as whole individuals, focusing not just on their medical needs but also on their emotional well-being.

There is a risk GP trainees can be overtaught in the early stage of learning consultation models. When someone first learns to drive a car, it can be overwhelming to think of all the tasks involved. However with exposure, some tasks can be internalised and become second nature. It is vital that GPSTs practice and refine consultation skills early so they can embed good practice for your exam.

In 1969 Matthew Broadwell, introduced 4 stages of learning to acquire a skill. This model applies to consultation skill.

  1. Unconscious Incompetence: At the beginning of any learning journey, we may not even realise what we don’t know. It’s the stage of blissful ignorance, where skills and knowledge gaps exist but are not recognised. Acknowledging this phase is the first step towards growth.
  2. Conscious Incompetence: As we delve deeper into our profession, we start to recognise our limitations and the areas where we need improvement. This can be a humbling experience but is crucial for growth. It’s where we consciously acknowledge what we don’t know and become motivated to learn.
  3. Conscious Competence: With dedicated effort, learning, practice and refinement, we begin to master the skills and knowledge. However, this competence requires conscious focus and effort. You’ve likely experienced this phase when certain tasks that once seemed daunting become second nature through practice and repetition.
  4. Unconscious Competence: Finally, we reach the stage where our skills and knowledge have become so ingrained that they flow naturally without conscious effort. Imagine the difference between driving a manual and an automaic car. It’s the stage of mastery, where you perform tasks effortlessly and instinctively.

If you are developing your communication and consultation skill for SCA, it is helpful to ask yourself what stage are you currently at. Found this article hepful, you might want to check MRCGP SCA resources we have for you.

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.

Dr Lawrence’s Case-study

MRCGP SCA: 5 Common Pitfalls

Are you making these pitfalls?

By the end of this article you will learn what you can do to avoid them and pass the MRCGP SCA.

Failing to build rapport

It is more difficult to develop a genuine connection over the phone. This can affect the patient’s willingness to open up and share important details about their condition.

Start the conversation by introducing yourself and your role. Greet the patient. It helps to speak with a smile and a friendly tone. Confirm their name and date of birth to ensure that you are speaking to the correct person. Be mindful that there may be other people in the patient’s environment or they may be out and about. Check whether it’s a good time to start the consultation. Explain why you’ve called and that you’d like to ask some questions to see how you can help.

Incomplete medical history

Without being able to physically perform an examination, a doctor may take shortcuts and forget to ask key questions about the patient’s medical history. This can lead to misdiagnosis or incorrect treatment.

It’s important to make a safe assessment and consider a range of differentials. Ask red flag questions to exclude serious conditions. Jot down important issues you need to address so you don’t forget them.

Missing cues

It’s so easy to miss important non verbal cues such as changes in a patient’s breathing or tone of voice. Some of which may indicate a worsening of their condition.

I asked a 60-year-old man over the phone about the impact of work on his illness. I heard a long sigh before he said it was fine. The sigh turned out to be a cue. Had I not picked up the non verbal cue, I would not have learnt about the stress he experienced because of pressure from his boss.

To ensure effective communication, active listening is critical. Pay close attention to what patients say and how they say something. Pick up on verbal and non verbal cues

Are you looking for dedicated guidance? You might be interested in Consultation Blueprint, our comprehensive programme to help you with your exam.

Inadequate communication

Some doctors have a tendency to use medical jargon or complicated terms such as FBC, TFT and PSA. Patients may get confused since they don’t understand these medical terms.

The choice of language is critical. Use the patient’s own words in your explanation. This will help them understand what you wish to convey. Avoid using jargon where possible. Chunk and check to ensure your advice is understood.

Not taking into account the patient’s unique circumstances

Its more tricky to fully understand a patient’s unique circumstances without seeing the latter, such as their living situation or support network. It’s important to consider these factors when making treatment recommendations or providing medical advice. For example, a patient may refuse to be admitted because he is worried of leaving his cat alone.

If you found these tips helpful, you will probably find our free 7-Day SCA Teaching useful. Claim your Free SCA Blueprint and start applying proven strategies to get ahead in your MRCGP SCA revision.

My Story: From Shy to Confident Speaker

Watch the video on YouTube

As a child, I was a timid soul. The mere thought of speaking in front of others sent shivers down my spine. My heart would race as I worried about what others might think.

The Shiest student of the year

Growing up, my shyness was so pronounced that in my sixth-form year, I was voted the shiest student of the year. Being introverted and shy, I was petrified of social interactions. Speaking with confidence was a distant dream, something that seemed unattainable to me.

Confronting my fear of public speaking

Rewind to my days at medical school, where I was the quiet one in class. My tutors would often encourage me to contribute more during group discussions. But it wasn’t until my second year of university when I was part of a peer mentoring group, that I truly faced my fear of public speaking.

We were asked to give a talk in a lecture theatre filled with over 400 students, with little notice. It was a daunting and overwhelming experience. I didn’t know what to say and my words stumbled out of my mouth. Walking away from that embarrassment, I made a promise to myself that I would never let that happen again.

Stepping outside my comfort zone

Like most people, I didn’t know how to speak on stage. After that one bad experience, I could have avoided putting myself in similar situations. Instead of letting this haunt me, I decided to step out of my comfort zone and take action. I enrolled in a public speaking course to learn how to prepare, craft, and deliver speeches.

In the past, I focused a lot on what others might think of me and was overly self-conscious, known as the spotlight effect. I found it helpful to stop focusing inward and instead focus outward on the message I was conveying to the audience.

Developing new skills is never easy. Like any other skill, to be good at public speaking, one needs to practice and improve. I took every opportunity to practice by volunteering to present, seeking feedback and analysing great speakers to learn their techniques.

Fast forward a few years, and I’ve conquered my fear of public speaking. It has opened new opportunities such as the thrill of speaking about wellbeing in front of healthcare professionals and managers at conferences.

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    Sympathy Vs Empathy

    People often think sympathy and empathy are the same thing without realising they are very different concepts.

    Sympathy is an expression of care or concern for someone. In contrast, empathy is the ability to understand and feel the emotion of the other person. When you empathise, you understand the other person’s perspectives, predicament and share their emotions. According to Brené Brown, empathy fuels connection where as sympathy drives disconnection.

    A while ago, I was on a coaching call with a Doctor. Let’s call him Sam for confidentiality. Sam asked me whether I had any phrases he could use to be more empathetic. He didn’t know how to show empathy. This is a common problem I have observed among some doctors.

    Sympathy may be appropriate in certain situations but tend to be expressed in surface level conversation. If an acquaintance suffered a loss, expressing sympathy is a polite thing to do.

    People might say

    “I’m sorry to hear that.”

    “I’m really sorry for your loss!”

    When someone says I’m sorry to hear that it is often uttered in a transactional exchange. Moreover, the phrase doesn’t fulfil essential components to demonstrate empathy.

    Emotional and cognitive empathy

    To demonstrate empathy, it’s helpful to understand

    • Humans feel a need be heard.
    • Humans wants to be understood.
    • Humans need to feel someone can relate to their experience

    People will forget what you said, people will forget what you did, but people will never forget how you made them feel.

    Maya Angelou

    Imagine a doctor consults Mr Smith who presents with severe abdominal pain.

    Doctor replies “I’m sorry to hear that” followed by an unrelated question “Who is at home with you?”

    If you were in Mr Smith’s shoes would you feel heard, understood or that the doctor related to your pain?

    Instead of “I’m sorry to hear that” a statement that reflects to the patient you can almost feel his pain would be more empatheric.

    Doctor replies “I can see this abdominal pain is awful Mr Smith. Has it stopped you from doing anything?”

    This empathetic response enables the patient and doctor to connect at a much deeper level than the first reply. The follow-up question offers the patient an opportunity to talk about the impact of the pain.

    Trying to use stock phrase to demonstrate empathy won’t be effective if you don’t mean what you say. You ought to be congruent with your emotions.

    People can easily pick up if someone is not being genuinely empathetic. The way you express yourself is as important as what words you use.

    How to convey empathy without words?

    Let’s imagine someone you know lost his dad. You give that person a hug. The proximity and touch communicate to the other person you share their emotions without the need for any verbal communication.

    So, I asked Sam if a family member were in severe pain, would you need a stock phrases to know what to day?

    When I saw Sam laughed I knew he understood empathy is not about what phrases to use but it’s about conveying what he naturally feels to another human being he cared deeply.

    ​
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      5 Benefits of writing

      Writing has been life-changing for me. It has helped me to sharpen my mind, learn more about myself and connect with some of you who enjoy my work. Today, I’d like to show you 5 benefits of writing.

      1. Boost your happiness

      Our mind is often focused on negatives. We get caught up by things that go wrong and overlook positive events in our life. Writing three good things that went well in a day increases our level of happiness. This practice trains the brain to notice positive things. In so doing, we create a space to savour goodness in life thereby making us feel a sense of gratitude.

      Writing down positive things about our life gives more permanence to fleeting events you might otherwise not remember.

      2. Build resilience

      During World War II, Viktor Frankl, an Austrian neurologist, was stripped of his identity and humanity by German Nazi. He survived the atrocities of concentration camp because he realised he needed to personally complete an important task.

      “When I was taken to the concentration camp of Auschwitz, a manuscript of mine ready for publication was confiscated. Certainly, my deep desire to write this manuscript anew helped me to survive the rigors of the camps I was in.” – Viktor E. Frankl

      Frankl considered this manuscript as his life work. When Frankl succumbed to typhoid fever in concentration camp, he wrote keywords from his manuscript on scraps of paper to keep his mind alert. In April of 1945, Frankl’s camp was liberated. He returned to Vienna only to discover his loved ones did not survive holocaust. Frankl showed incredible resilience in hardship. He wrote the best-selling book Man’s Search for Meaning that recounts his ordeal. Writing about difficult experience helps us cope better. Engaging in expressive writing builds resilience.

      3. Sharpen the mind

      The process of putting thoughts on a blank sheet of paper make them tangible. Great thinkers write. They don’t worry their writing might be crap. They expect it to be bad so they intentionally download their thoughts on paper. i.e vomit everything out. Once they have a draft, they edit it as many times needed. The process of editing and re-writing enables great thinkers to organise and articulate their thinking. Writing brings clarity to the mind.

      4. Communicate complex ideas clearly

      Sometimes we have ideas that seem confusing or difficult to express. When we draw a mind map and lay down these complex ideas, we can see them for what they are. The simple exercise of writing these ideas down and putting them on paper helps us think more clearly. When it’s clear to us it’s easier to communicate our ideas to others.

      ​
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        5. Learn about yourself

        ‘Who are you?’ is a question many people struggle to answer with clarity. In fact, most people don’t really know who they are because they haven’t thought about it deeply. Connecting with your inner thoughts and examining life is a profound exercise that can help you understand your true self.

        Journaling is a great practice to learn about oneself and self-reflect. Having spent the last few years writing down my honest thoughts in a notebook with little judgement has allowed for self-discovery. As a result, I have got to know myself better and developed a deeper understanding of my emotions, reactions and choices.

        Enjoyed this article, you might want to check out How GRATITUDE Can Transform Your Life: The Power of starting a Gratitude Journal video on YouTube.

        The secret to a fulfilling career

        So many doctors feel stuck working in a job not conducive to their health and wellbeing. Early in my career, I didn’t take good care of my wellbeing due to heavy workload and the enormous pressure. I was so busy to complete my never-ending list of jobs that I skipped meals and breaks. I knew if I continued on this path, my career was not sustainable.

        The challenges doctors face

        Medics are infamous for not looking after their wellbeing. We kind of know wellbeing is important but don’t prioritise it. This quote resonated with me “Put on your oxygen mask first”. In other words, look after your health and wellbeing first before attending to others’ needs.

        Chronic stress and burnout are major problems in the profession. A few weeks ago, I spoke with Dr Sana Khan, a GP registrar who suffered from crippling anxiety due to the stress and pressure of MRCGP exam. Her mental health went into a melt down. You can watch her story on YouTube.

        Creating the career of your dream

        Even though medicine is hard and requires a lot of sacrifices, I firmly believe every doctor can develop a fulfilling career. Being a portfolio GP has been by far one of the best career decisions I’ve made.

        I’ve pursued my passion for teaching. Being able to do something I enjoy that impacts others is truly fulfilling. Moreover, I have control over my time. If you want to create a future that inspires and excites you, a portfolio career might be the answer.

        I’m not saying developing a portfolio career is easy. If you are not prepared to put in time and effort then it’s not for you. However, if you are serious about creating a career that excites you, think about the benefits.

        Get paid to do something you enjoy

        You could be compensated to do meaningful work you enjoy. Most people are not satisfied with their situation yet they don’t do anything about it. Picture yourself doing the same thing for the next 10 years. If you are happy with that trajectory then good for you. If that’s not what you want then why not do something about it. You are one decision away from transforming your life.

        The World is your Oyster

        Opportunities to develop a portfolio career are endless. If you don’t have an interest, seek experience by trying various activities. During my training, I had an inclination for medical education since I enjoy learning. The best way to learn is by teaching.

        Being naturally an introvert, I intentionally developed my communication skills. It turns out some registrars also struggle with communication skills and need help. I’m grateful to combine my passion for teaching and purpose to help doctors lead a fulfilling life. Finding that sweet spot is very fulfilling.

        I hope this article inspires you to explore new opportunities and get closer to your goal. What is stopping you from your dream career?

        Passing MRCGP Exam despite crippling anxiety

        mrcgp sca

        If there is a stumbling block and you’re not able to find the answer your your CS or ES is not able to find the answer probably a third person can find you the answer so then I felt that because I had real respect for you seeing your videos and your approach so I contacted you and it definitely did benefit.

        Dr Sana Khan

        What challenges did Dr Sana face?

        The final MRCGP exam is challenging. Dr Sana Khan faced enormous pressure while sitting her exam. She suffered with anxiety while recording.

        I’m not talking about the usual exam stress. Imagine blanking out in the middle of a consultation and not being able to review your cases due to anxiety. She also experienced anxiety attacks that manifested in palpitation and chest discomfort. Dealing with debilitating anxiety while sitting the RCA was an uphill battle and she unfortunately failed first attempt in January.

        Seeking support

        The chronic stress and pressure associated with the RCA caused her emotional and mental health go into a meltdown. She reached a breaking point and had no choice but to take time off. She sought professional support and spoke with her GP. Often times, doctors don’t seek support until things get out of hand. Seeking support is wrongly perceived as a sign of weakness when it is a true sign of strength. Fortunately, she received the right support and was able to recover.
         

        After a few months, she braced herself to re-sit the exam. Taking the RCA again is a real pain. The anxiety issues set in again but she was still receiving professional support. She managed to record consultations but hit a big stumbling block in her preparation. She was stuck and wasn’t making any progress. Her recordings were stagnant.
         

        She decided to seek more guidance and support. She got in touch with me and we agreed to work together. We strategised and worked on her mindset, consultation skills and aptitude so she could consult better despite the stress and pressure due to anxiety.

        Passing the MRCGP RCA

        Dr Sana Khan kept going and didn’t lose hope. She eventually overcame the difficulties on her path. She jumped the big stumbling block that held her back from CCT. I was delighted to receive a message she sent to tell me she passed her exam. Her perseverance and hard work paid off. She is looking forward to CCT soon.
         

        I hope Dr Sana’s story has inspired you. I’m incredibly grateful to Dr Sana Khan who agreed to share her story with you. Mental health problem among doctors is unfortunately a major problem in the medical profession that is not talked about enough. If you are currently struggling, please seek support and don’t wait for things to get out of hand.

        If you are stuck and have hit a stumbling block just like Dr Sana, please seek the right support and don’t struggle alone. 

        Need help with your exam? Apply on the RCA Blueprint coaching programme

        Ready to get help?

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

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

        Book your Free 15min call

        Resources Dr Sana used

        👥 Professional Support Unit

        🧐 RCA Blueprint Download your Free copy

        IMG Success Story

        How an IMG passed MRCGP Exam after failing 4 times?

        case study

        In the next couple of weeks, my confidence skyrocketed because I could take the history in a reasonable time. Then, I had all the time to do the clinical management.

        Dr Inamuna Beregha

        After failing his MRCGP exam four times, Dr Inamuna Beregha hit rock bottom. He worked so hard to re-sit the exam only to find out he didn’t pass yet again.

        Consequences of failing four times

        Re-sitting the final MRCGP exam had consequences not just on the length of training and the financial cost but also on his emotional wellbeing. Dr Inamuna was given one last chance to re-sit the RCA.

        This was his fifth and final chance. International doctors who graduate abroad find the clinical part of the MRCGP exam challenging. The pass rate of International Medical Graduates is notoriously low 49.6%. Unfortunately, the odds were not in Dr Inamuna’s favour.

        Self-awareness

        After hitting his head against a brick wall, Dr Inamuna recognised his approach was not working. He understood the stake was high as this was his make-or-break time. He decided to get personalised support and expert help.

        Seeking support

        When Dr Erwin first spoke with Dr Inamuna, he saw someone who lost his confidence. The hardship of having to re-sit the RCA for the fifth time had demoralised him but it wasn’t going to stop him.

        During our 1:1 coaching, we identified his areas of weakness and built his confidence back. It was not easy as Dr Inamuna had to unlearn things that didn’t work and implement new changes to his consultation.

        From failing four times to passing with flying colours

        The personalised support enabled Dr Inamuna to take a focused history and formulate a shared management plan within 12 minutes. This is what he said about his progress

        ” In the next couple of weeks, my confidence skyrocketed because I could take the history in a reasonable time. Then, I had all the time to do the clinical management. “

        Dr Inamuna made a breakthrough in his career and experienced a remarkable transformation. Several months after our coaching, I received an email from him.

        “ Just wanted to say thank you for your help. I can definitely say my confidence was boosted after the sessions.”

        Dr Inamuna cracked the RCA with a score of 164 on his 5th attempt. He completed training and is currently enjoying life as a GP.

        The other day, we met for the first time. We had a deep conversation on career opportunities, new challenges and goals. Being able to help and see the transformation of doctors from a place of desperation to inspiration is really rewarding.

        If you need help with your exam, apply on the RCA Blueprint coaching programme

        Ready to get help?

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

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

        Book your Free 15min call

        Resources

        📚Books

        Symptom sorter by Keith Hopcroft

        CSA Symptom Solver by Muhammed Akunjee

        🧰 Other Resources

        🧐 Blueprint Download your Free copy

        How to stop living an unfulfilled life?

        “You were put on this earth to achieve your greatest self, to live out your purpose, and to do it courageously.” – Steve Maraboli, Life, the Truth, and Being Free

        So many people are unfulfilled with their life. Every weekday is the same. They wake up, go to work, come home, watch Netflix and then fall asleep. The missing piece in their life is a sense of meaning.

        Few people think about their purpose. Exploring what it means to live in alignment with your core values and beliefs is vital to lead a fulfilling life.

        Fewer are clear on their North star and are committed to lead a purposeful life. It may seem complicated to find one’s purpose but it doesn’t have to be. You can make a start today by choosing to lead a fulfilling life.

        A good start is to ask yourself what future do you want. Create a compelling future of what your ideal life looks like. Envision what you are doing in that life.

        Question for you

        Are you creating a future that excites you?

        Want to be happier and more fulfilled in 2022

        Happiness

        The end of the year is in sight. December may be the month of Winter Holiday and Christmas but you may want to set aside time for these 3 important steps before you say Goodbye to 2021. Completing these three steps will help you to make a great start for the new year.

        1. Reconnect with yourself

        It’s so easy to lose touch with our true self due to the day to day distractions. Many people are unhappy and stuck in old patterns. They are lost because they haven’t spent time to examine their lives. We often experience feeling of frustration and anxiety about the future when we are disconnected with who we really are. Carving time to reconnect with yourself is vital to get unstuck and start leading a fulfilling life.

        2. Reflect on the past 12 months

        Taking time to review the past year is an extremely useful activity to not only draw lessons from 2021 but to reminisce the good times and celebrate your wins. Here are some questions to get you started:

        What were my biggest accomplishments?

        What goals I didn’t achieve and why?

        What could I have done differently?

        What stressed me most?

        What has 2021 taught me?

        How do I want to remember 2021 in 3 words?

        3. Plan 2022

        Having reflected on the year, it’s now time to start thinking of your goals.

        Goal gives us direction and a sense of meaning. Research has shown you are more likely to achieve your goals when they are aligned to what you naturally want to do and have talent for. 

        What do you want to focus on in 2022? Think of your short-term and long-term goals.
        Most of us do not achieve our goals because we are not intrinsically motivated or we set the wrong goals.

        How to create SMART goals?

        The SMART method is useful to create your goals

        Specific-‘I want to lose weight’ (too vague) vs ‘I will go to the gym 3 times a week’ (specific)

        Measurable- consider a method to measure your progress

        Attainable- aim high but be reasonably unreasonable with yourself

        Relevant- make your goal intrinsically motivated so it is in complete alignment

        Time-bound- give yourself a time frame that adds a sense of urgency

        To learn more about creating SMART goals, watch this video

        Start to lead a happier and more fulfilling life by setting some time aside to reconnect, reflect and plan for the new year. Most people would not have read until here. If you are reading this, I hope you consider taking some time for yourself to reconnect, reflect and plan.