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I recently passed the Simulated Consultation Assessment (SCA) exam with a score of 103.5 out of 126, exceeding the pass mark of 77.
Notably, I scored highly in the Relating to Others domain (33/36). This post aims to share valuable insights I learned to help you excel in this crucial aspect of the SCA.
Use stock phrases strategically
Having a repertoire of helpful phrases to guide the conversation and buy time can be valuable. However, overuse of the same phrases can sound artificial.
Practice using a variety of expressions naturally in your daily consultations to ensure they feel genuine in the exam.
Table 1. Examples of stock phrases mapped to RCGP marking descriptors.
| Marking descriptor from RCGP |
Stock phrases examples |
|
Demonstrates ethical awareness |
That must be very difficult I am sorry that it is such a tricky situation, may I suggest…. |
|
Shows ability to communicate in a person-centered way.
|
I can hear how much it has been weighing on your mind I can hear how important this job is to you, and I would like to support you. How would you feel about… |
|
Demonstrates initiative and flexibility in using various consultation approaches in order to overcome any communication barriers and to reach a shared understanding with the patient.
|
I have spoken a lot there. Is there anything you would like to clarify? We’ve talked about a lot today. Was there anything that was unclear? I want to make sure I am supporting you in the best way I can. Was there anything I missed? |
|
Shows respect for patients, treating them fairly and without discrimination.
|
I can hear where you are coming from… I hear you… I respect your decisions and thoughts, I want to support you in your choices, may I suggest we… |
|
Takes ownership of decisions and with confidence, whilst being aware of own limitations.
|
I am aware this isn’t an area I am too familiar with but we could consider… I appreciate there is uncertainty about our next steps however, the important things to consider here are… |
|
Recognises cultural and personal differences in patients and/or colleagues |
Thank you for explaining that, I understand your view better, should we consider… I hear your perspective, how do you feel about… |
|
Recognises that everyone has their own values and beliefs |
I can see that it is a tricky position that you are in, how can I best support you? I value your views and perspectives, how do you think I can best help you? |
|
Acts non-judgmentally with equity and fairness |
This is a safe space for you and there is no judgement at all from me and my team, how can we best help/support you? |
|
Recognises and respects patient autonomy |
I hear you and respect your decisions, should we consider…. |
|
Acts with beneficence, and in the patient’s best interests |
I hear you, however, I am concerned that… I can see you are facing a lot of distress with this, I want to support you through this difficult time, may I suggest that we… |
|
Shows awareness of medico-legal concepts, such as informed consent, mental capacity and best interests of the patient
|
May I check that you understand what I’ve explained? Would you mind repeating it back to me so I can check there are no misunderstandings? May I ask you to explain your decision further? |
|
Explores and clarifies the patient’s agenda, health beliefs and preferences |
It sounds like this is really affecting you/has been on your mind, sometimes people look things up on Google before they come to see me, is that something you’ve done, and did you have any thoughts as to what might be going on? Was there anything you were hoping we could do or try for you? |
|
Employs a range of communication skills, both verbal and non-verbal, including active listening skills.
|
Active listening, nodding, maintaining eye contact through the webcam, repeating the last phrase/word back to the patient: “You’re in a lot of pain, and it’s affecting your sleep… how else is it affecting you?’” |
|
Responds to important, significant cues (verbal and non-verbal). Uses language that is understandable and takes into consideration the needs and characteristics of the patient. |
Avoid jargon, identify emotion. I can see that you seem very worried, is there anything else you had on your mind? Sometimes patients come in worried about other things such as xx or xx, does that sound like you? I can see you are quite worried about what will happen next, I want to reassure you that I am here to support you, do you have any questions at the moment? |
|
Uses a variety of communication techniques and materials to adapt explanations to the patient. |
Consider checking the patient’s understanding of the condition and adapting the explanation to patient’s ICE I can see you are worried about lung cancer due to your family history, however, based on your gradually worsening breathing symptoms and your smoking history, I wonder if you might have a condition called COPD. Have you ever come across that term before? |
|
Uses the patient’s understanding, agenda, health beliefs and preferences to help tailor any explanation offered. |
You were worried about … however, based on your symptoms, I think it is more likely that you may have a condition called … You mentioned you did not want to go through …, what do you understand of what it offers, and would you like a further explanation of what it looks like for you? |
|
Works in partnership with the patient, negotiating a mutually acceptable plan which is clear and understandable. |
Taking everything you’ve said into consideration, how would you feel if we… I’ve mentioned a few options there of what we can do to take this forward, was there any particular option you preferred? |
|
Checks the patient’s understanding of the consultation including any agreed plans. |
We’ve spoken about a lot there, was there anything you would like me to go through again? In summary, our next steps are … do you have any questions for me? |
|
Demonstrates an empathic approach, including a willingness to help and care for the patient. |
I can hear that you have a lot on your plate, how can I best support you? It sounds like your mum has been through a lot and you are really struggling, I have a few suggestions of what we can do to help support you both if that is helpful? |
|
Works collaboratively, understanding the context within which different team members work, respecting their role, and valuing their opinions. |
Thank you for all of this information, I really appreciate your assessment of the patient. What are you most worried about How can I best support you? |
|
Shows respect for colleagues, treating them fairly and without discrimination. |
I appreciate the work you do, and you obviously have good rapport with the patient, was there anything else you were worried about…? |
|
Recognises and acknowledges the impact of the problem on the patient, their family and/or carers. |
It sounds like this is really affecting you and your mum’s day-to-day, how are you coping? It sounds like a lot to cope with, who do you have around to support you through this difficult time? |
|
Challenges assertively unhelpful health beliefs or behaviours, whilst remaining respectful and maintaining a continuing and productive relationship |
It sounds like you are really worried about … however, I am more worried about … how would you feel if we …. |
|
Recognises what matters to the patient and works collaboratively to enhance patient care |
I can see how important this job/hobby/etc; is to you, I have a few options of steps we can take moving forward, would you be open to discussing them? |
Remember to explore ICE
Understanding a patient’s Ideas, Concerns, and Expectations (ICE) is vital for tailoring your approach and building rapport. Practice exploring ICE with different colleagues to learn different techniques and hone your own style.
Avoid asking ICE prematurely. Begin by building rapport with open-ended questions, then introduce ICE when the conversation feels natural. Delaying it might lead you astray, but rushing it can feel awkward for the patient.
Record yourself
The SCA’s virtual nature demands intentional communication. Record yourself conducting mock consultations on platforms like Teams/Zoom.
Pay close attention to your body language, including eye contact, fidgeting, and microphone adjustments. Aim for a confident posture and consider recording yourself in your exam environment for greater familiarity. Consider placing a bright sticker by the camera so you remember to maintain eye contact with it for your video consults!
Use silence effectively
Effective communication isn’t just about speaking. Give the patient space to process information and guide the consultation towards their concerns.
Resist the urge to rush- it will pay off! Patients will often share more when they feel heard and comfortable. Employ strategic pauses between explanations or after breaking bad news, checking for their understanding before proceeding, and then tailoring the plan based on their ICE.
Practice with different people
People communicate differently and that is especially true in an exam like the SCA! I found a lot of value in practising with different people in and outside of my VTS. This exposed me to a range of communication styles and personalities.
By adapting my approach to each person, I honed my ability to connect and build rapport effectively – a crucial skill for the SCA. I also approached different colleagues to run mock exams for me to help me build up stamina for the exam, whilst adapting the way I communicate with different people!
Use a collaborative approach
The SCA proved invaluable in sharpening my skills for presenting management options. The key? Tailoring the approach to each patient’s needs and preferences, all within a patient-centered framework.
Instead of a “do as I say” approach, I found success by framing myself as a supportive guide helping patients achieve their best lives. This was particularly effective for complex cases.
While showcasing conservative management options was important, I always prioritised patient readiness. Before delving into specifics, I ensured the patient was in the right headspace to receive the information. If their agenda didn’t align with what I had to offer, I adjusted my approach accordingly.
For example, instead of directly presenting options, I might ask, “It sounds like you’re concerned about how … affects your life. We have various support options, along with self-management strategies. Would you be interested in learning more about what you can do?“
Be comfortable being uncomfortable!
The SCA might throw curveballs – topics you feel less confident about. But here’s the secret: discomfort is normal. In fact, embracing it can be an advantage.
During preparation, focus on techniques to navigate uncertainty. Practice voicing your thought process and uncertainties clearly.
Here’s what worked for me:
- Uncovering hidden concerns: If I sensed the patient might have unvoiced worries, I’d say something like, “I get the feeling there might be other things on your mind besides … Would you like to add anything?”
- Addressing knowledge gaps: When unsure about a specific management option, I’d acknowledge it and outline next steps. For example, “I need to consult with colleagues for the best management approach, I can call you by the end of the week with a plan.”
By anticipating discomfort and practising how to address it, I felt more prepared for the exam.
Conclusion
By actively refining your communication skills and using these strategies, you can confidently approach the Relating to Others domain of the SCA. Remember, practice and self-reflection are key.
Thank you for reading! I hope this information proves valuable in your SCA revision.
