Membership of the Royal College of General Practitioners (MRCGP) Clinical Consultation Skills (SCA) Syllabus

Clinical Consultation Skills (SCA) syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Clinical Consultation Skills (SCA) in Membership of the Royal College of General Practitioners (MRCGP), not a summary of it.

1. 1

   Consultation Models and Communication

   5 topics

   • Recognised consultation frameworks
     • Calgary-Cambridge model
     • Neighbour and Pendleton models
   • Data gathering and clinical reasoning
   • Shared decision-making and management planning
   • Explaining diagnoses and risk to patients
   • Safety-netting and follow-up planning
2. 2

   Managing Complexity and Uncertainty

   4 topics

   • Multimorbidity and competing priorities
   • Dealing with diagnostic uncertainty
     • Watchful waiting and review strategies
     • Using time as a diagnostic tool
   • Medically unexplained symptoms
   • Risk assessment and red-flag prioritisation
3. 3

   Challenging Consultations

   5 topics

   • Breaking bad news
   • The angry or distressed patient
   • Managing patient expectations and demands
     • Negotiating around inappropriate requests
     • Antibiotic and investigation requests
   • Third-party and remote consultations
     • Telephone and video consulting
     • Consulting with carers and relatives
   • Working with interpreters and addressing health literacy
4. 4

   Person-Centred and Holistic Care

   4 topics

   • Eliciting ideas, concerns and expectations
   • Cultural competence and health inequalities
   • Promoting self-care and behaviour change
     • Motivational interviewing
     • Brief interventions
   • Continuity of care and the therapeutic relationship

Clinical Consultation Skills (SCA) flashcards for Membership of the Royal College of General Practitioners (MRCGP)

23 of 54 cards from the Clinical Consultation Skills (SCA) deck — real questions with worked answers.

1. What are the three domains assessed in the MRCGP Simulated Consultation Assessment (SCA)?

   1) Data gathering, technical and assessment skills; 2) Clinical management skills; 3) Relating to others (interpersonal/communication skills). Each consultation is marked across these three equally-weighted domains.

2. Name the five sequential stages of the Calgary-Cambridge consultation model.

   1) Initiating the session; 2) Gathering information; 3) Physical examination; 4) Explanation and planning; 5) Closing the session. Two continuous threads run throughout: 'Providing structure' and 'Building the relationship'.

3. In Neighbour's consultation model, what are the five 'checkpoints'?

   1) Connecting (rapport); 2) Summarising (eliciting and confirming reasons for attendance, ICE); 3) Handing over (sharing management, patient ownership); 4) Safety-netting (anticipating what could happen); 5) Housekeeping (clearing the doctor's own mind before the next patient).

4. What does the mnemonic ICE stand for in consultation skills, and why is it important?

   Ideas, Concerns and Expectations. Eliciting the patient's own ideas about what is wrong, their concerns/worries, and what they expect or hope for from the consultation. It is central to patient-centred care and a key SCA marker.

5. List the seven tasks of the Pendleton consultation model.

   1) Define the reason for attendance (including ICE); 2) Consider other problems; 3) Choose an appropriate action with the patient; 4) Achieve a shared understanding; 5) Involve the patient in management and encourage responsibility; 6) Use time and resources appropriately; 7) Establish/maintain a relationship.

6. What is the BARD model of consultation analysis?

   A model describing the doctor's contribution: Behaviour, Aims, Room, Dialogue. It focuses on how the doctor's behaviour, consultation aims, physical environment (room) and language (dialogue) shape the encounter.

7. In Byrne and Long's model, what are the six phases of a consultation?

   1) Doctor establishes a relationship with the patient; 2) Doctor discovers the reason for attendance; 3) Conducts a verbal/physical examination; 4) Doctor (and/or patient) considers the condition; 5) Doctor (and patient) details treatment/further investigation; 6) The consultation is terminated.

8. What is the 'golden minute' in a GP consultation?

   The opening period (roughly the first 60-90 seconds) where the patient is allowed to speak uninterrupted about their presenting concerns. Avoiding early interruption improves disclosure of agendas and reduces 'door-handle' presentations.

9. Define open versus closed questions in data gathering and give the typical use of each.

   Open questions (e.g. 'Tell me more about the pain') invite expansive, patient-led answers and are used early to gather a broad narrative. Closed questions (e.g. 'Does it radiate to your arm?') elicit specific yes/no or factual detail and are used later to test hypotheses and clarify.

10. What is 'hypothetico-deductive reasoning' in clinical practice?

    A reasoning process where the clinician generates early diagnostic hypotheses from initial cues, then gathers and interprets further data (history, examination, tests) to confirm or refute each hypothesis, iteratively refining toward a diagnosis.

11. Contrast 'pattern recognition' (System 1) with 'analytical reasoning' (System 2) in clinical decision-making.

    System 1 (pattern recognition) is fast, intuitive, automatic, based on illness scripts and experience — efficient but prone to bias. System 2 (analytical) is slow, deliberate, hypothesis-testing — more reliable for atypical/complex cases. Expert clinicians switch between both.

12. What is an 'illness script' in clinical reasoning?

    A structured mental knowledge package a clinician holds about a disease, comprising its predisposing/enabling conditions, the underlying pathophysiological fault, and the typical consequences (signs, symptoms, course). Matching a presentation to a stored illness script enables rapid recognition.

13. Define 'anchoring bias' and give a clinical example.

    Anchoring is the tendency to fixate on initial information or an early diagnosis and fail to adjust despite new evidence. Example: labelling a patient's chest pain as 'anxiety' from the referral note and ignoring later features suggesting cardiac ischaemia.

14. What is 'premature closure' as a cognitive error?

    Accepting a diagnosis before it has been fully verified — stopping the diagnostic process too early once a plausible explanation is found, thereby missing the correct or additional diagnosis. It is one of the commonest causes of diagnostic error.

15. What is 'confirmation bias' in diagnosis?

    The tendency to seek, notice and interpret information that supports a favoured hypothesis while discounting or ignoring evidence that contradicts it, leading the clinician to over-confirm an initial impression.

16. Define shared decision-making (SDM).

    A collaborative process in which clinician and patient jointly make health decisions, combining the best clinical evidence with the patient's informed preferences, values and circumstances. It requires informing the patient of options, benefits and risks, and supporting deliberation.

17. What three 'talk' steps describe Elwyn's model of shared decision-making?

    1) Team talk — establishing that options exist and offering support; 2) Option talk — describing the realistic options and their pros/cons; 3) Decision talk — eliciting and integrating the patient's informed preferences to reach a decision.

18. What are the elements of valid informed consent in UK practice?

    The patient must have capacity, be given sufficient information (including material risks and reasonable alternatives), and give consent voluntarily (free from coercion). Consent is an ongoing dialogue, not a one-off signature.

19. Following Montgomery v Lanarkshire (2015), what standard governs disclosure of risk to patients?

    Doctors must disclose any 'material risk' — a risk to which a reasonable person in the patient's position would attach significance, or which this particular patient would attach significance to. The test is patient-centred, replacing the doctor-centred Bolam test for consent.

20. What does the 'teach-back' technique involve and why is it used?

    Asking the patient to explain back, in their own words, what they have understood about their condition or plan. It checks comprehension, identifies misunderstandings, and is especially valuable for low health literacy — framed so the patient is not made to feel tested ('I want to be sure I explained that well').

21. How does absolute risk reduction (ARR) differ from relative risk reduction (RRR), and why does it matter when explaining risk?

    ARR is the arithmetic difference in event rates between groups ($ARR = CER - EER$); RRR is that difference as a proportion of the control rate ($RRR = \frac{CER - EER}{CER}$). RRR can sound dramatic while ARR is small, so quoting ARR or natural frequencies gives patients a truer sense of benefit.

22. What is the Number Needed to Treat (NNT) and how is it calculated?

    The number of patients who must be treated for one additional patient to benefit (avoid one adverse outcome) over a defined period. $NNT = \frac{1}{ARR}$. A lower NNT indicates a more effective treatment.

23. Why are 'natural frequencies' preferred over percentages when explaining risk to patients?

    Natural frequencies (e.g. '2 in 100 people' rather than '2%') are easier to understand, reduce numerical confusion, and are less prone to misinterpretation. Using a consistent denominator and visual aids further improves comprehension.

See more Clinical Consultation Skills (SCA) flashcards →

Planning Clinical Consultation Skills (SCA) for Membership of the Royal College of General Practitioners (MRCGP)

Clinical Consultation Skills (SCA) (Membership of the Royal College of General Practitioners (MRCGP)) FAQ