As you prepare to take your MRCGP SCA exam, we want to offer you some key strategies that will not only boost your confidence but also improve your performance. This is your moment to showcase your skills and excel. Let’s break down some specific tips that will help you on exam day and in the lead-up to it.

1. Specific Exam Day Tips

• Be calm, be prepared: Make sure you are familiar with the exam format. Each case will test a range of skills—don’t try to guess what’s coming, just respond thoughtfully to each scenario.
• First impressions count: Start each consultation by introducing yourself clearly and professionally. A strong opening will set the tone for the whole consultation.
• Use your time wisely: Allocate roughly 6 minutes of your time for data gathering and the last 5-6 minutes for management. Don’t rush—pace yourself and allow for flexibility.

 

2. When and How to ICE (Ideas, Concerns, and Expectations)

• When: Use ICE shortly after the open questions, once you have a basic understanding of the presenting problem. This gives you a chance to understand the patient’s perspective before proposing management.
• How: Don’t just ask, “Do you have any concerns?”—be more conversational and natural. For example, “What do you think might be going on?” or “Is there anything specific you’re worried about?” This will help you gather key information that can guide your management.

 

3. How to Manage Your Time

• Be conscious of time, but don’t let it overwhelm you: Allocate 6–7 minutes for history and data gathering and 5 minutes for management. Always keep the patient’s agenda in mind.
• Summarise as you go: Summarising key points during data gathering can save you time and ensure you haven’t missed anything important.

 

4. What to Do When Running Out of Time in a Consultation

• Prioritize: Focus on the key issues affecting the patient’s health. You don’t need to address every minor detail—think about what is clinically urgent.
• Effective safety netting: If time runs short, you can wrap up by ensuring the patient knows when and why to seek further help. “Let’s address the most pressing concern today, and we can follow up on the other issues at your next appointment.”

 

5. What to Do When You Can’t Think of What to Say

• Pause and breathe: It’s okay to take a moment. Pausing can give you clarity and help you avoid unnecessary errors.
• Ask for clarification: If you’re unsure, it’s fine to ask the patient to repeat or clarify a point. You can also say, “Let me just check my understanding.”
• Redirect to the patient: If stuck, redirect to the patient’s concerns or ICE to gain insight, which might guide you to the next steps.

 

6. How to Deal with Complaints

• Acknowledge and empathize: If a patient complains about a colleague or the care received, acknowledge their feelings. “I’m sorry to hear that you felt this way.”
• Stay neutral and professional: Avoid taking sides or agreeing/disagreeing with them directly. Instead, focus on how you can help them going forward.
• Clarify the next steps: Be clear about what you will do to address their concerns (e.g., “I’ll note down your concerns and ensure this is looked into, but let’s also make sure you’re getting the care you need today.”).

 

7. How to Safety Net and Follow Up Effectively

• Clear and precise safety netting: Always tell the patient what to look out for and when to seek further help. For example, “If you develop a high fever, please come back to see us or go to A&E.”
• Follow-up plans: Ensure the patient knows what happens next, e.g., “I’ll call you with the test results by the end of the week” or “Let’s see how this goes, and I’ll schedule a follow-up in two weeks.”

 

8. How to Deal with a Patient Refusing Admission/Referral

• Explore their reasoning: Understand the patient’s reasoning—there could be fear or misunderstanding. Ask, “Can you tell me what’s worrying you about the referral?”
• Clarify the risks: Without being forceful, calmly explain the potential consequences of not being admitted or referred, “I respect your decision, but just to clarify, this could put your health at significant risk.”
• Offer alternatives: If they continue to refuse, suggest alternatives or compromise. “If you’d prefer not to go now, could we arrange to review things tomorrow?”

 

9. How to Ensure Management is Holistic and Patient-Centred

• Listen to their agenda: Once you’ve explored ICE, incorporate the patient’s ideas and priorities into your management plan.
• Consider lifestyle factors: Think beyond the medical issue—consider psychological, social, and lifestyle factors. “How is this impacting your daily life?” or “Would you like support with this?”
• Involve the patient in decisions: Present options and let the patient feel empowered in the decision-making process. “We can either start with this treatment or explore another option depending on what feels right for you.”

 

Finally, stay composed and think about the simulated patient in front of you as a real patient.

 

Dr Sakaria Farah
PassCME SCA Tutor