Abstract
Welcome to a new Simulated Consultation Assessment (SCA) revision section of the journal, developed to provide focus for GP trainees preparing for the SCA. This section includes a ‘Doctor’s sheet’ and a ‘Patient’s sheet’ to facilitate practising consultations with your trainer and colleagues. An ‘Examiner’s sheet’ describes the areas trainees need to display in each of the marking domains and finishes with key points and tips for the trainee. It is important that trainees are familiar with the SCA pages on the RCGP website as this provides further highly relevant information and guidance.
Doctor’s sheet
Patient: Ruth Davies Age: 35 years
Routine appointment for tiredness.
The last consultation was 2 years ago for work-related stress.
Patient’s sheet
Name: Ruth Davies Age: 35 years
Background
A mum of two young children who assumes she’s tired from a busy lifestyle.
Opening line
I have come to the surgery doctor because my husband is complaining that I’m constantly sleeping early.
Behaviour
Wants to be able to tell her husband that she’s tired from having to look after her children and the busy lifestyle she has. She doesn’t feel she needs to be at the surgery and constantly apologises for wasting your time as she understands the pressures the NHS is under.
Ideas: Tired from taking care of two young children Concerns: Nil Expectations: Agreement from the doctor that she is tired from having a young family to take care of
Information given freely
Has a 4-year-old girl and a 2-year-old boy at home. Must do most of the childcare as her husband works away a lot. Sleeps very soon after the children have gone to sleep. She works as a lawyer so does admit to having a high-pressure job. Wakes up early in the morning to prepare everything before the children wake up. Finds life stressful trying to juggle everything, but feels this is normal for her stage in life.
Information to be given if prompted
Periods are regular but heavy since having her children. Has put weight on and is struggling to lose it. Tends to feel cold in the evenings but doesn’t think much of this at all. She is eating and drinking well. There is no chance of being pregnant. Her mood is generally okay, but she does feel stressed by her job and childcare duties. She doesn’t have many other relatives who live locally.
Past medical history: Nil Current medication: Nil Social history: Lives with husband (but he works away a lot). Non-smoker and no alcohol. Works full time as a lawyer Examination: General examination, including observations and checking for any goitre and general cardiovascular and abdominal system
Examiner’s sheet
Data gathering
Ask questions that encompass the different causes of tiredness.
Explore ideas, concerns and expectations, and recognize the priority in this scenario without using formulaic phrases.
Understand she feels she is wasting your time, but reassure that she has done the right thing, and her husband is clearly looking out for them.
The candidate should explore the patient’s social support system, namely nanny, friends, relatives.
Red flags
Cover questions relating to causes of tiredness.
Clinical management
Empathise that they clearly have a stressful lifestyle and congratulate them for managing a job and the children.
Cover the potential of a mental health cause for their tiredness.
Suggest that blood tests may be sensible to rule out any physical causes of their tiredness.
Explore the possibility of the husband being able to reduce his working hours a little to be able to contribute at home.
Interpersonal skills
Talks sensitively to the patient and conducts an examination.
Explain any initial thoughts but include their ideas.
Be empathic to their situation and congratulate them on everything they’re managing.
Builds up a good rapport by encouraging the patient’s contribution and by identifying cues.
While acknowledging the patient’s perspective, suggest blood tests to rule out a physical cause.
Key points
This scenario is all about acknowledging the patient’s perspective while being able to take an objective history to try and find any physical causes of their tiredness.
Discussion with trainee
Being able to acknowledge a patient’s perspective, but also have a clinical objective history and advocate for the patient by suggesting further investigations (possibly when patients don’t feel they’re needed).
How to strike the right balance between patients’ dismissive attitudes and being ‘firm’ to ensure and encourage a good management plan.
How to communicate with empathy.
Top tips
The best way to prepare for the SCA is to consult with patients in general practice Trainees should build on feedback from previous Workplace-based Assessments like Consultation Observation Tools (COTs) and case-based discussions (CbDs), as well as constructive comments during observed clinics or hot reviews and by watching consultation videos Trainees should review their own consultation skills and develop their own style, with input and feedback from senior colleagues and trainers Be aware of the marking domains and ensure appropriate areas within each domain are covered during the consultation
