Dr Tilney shares her experiences of passing the MRCGP SCA exam! What do I need to do to PASS the MRCGP SCA?

In this conversation, Victoria Tilney discusses her experience preparing for and taking the SCA exam. She shares her apprehensions leading up to the exam and how she overcame them. Victoria highlights the importance of practice and feedback in improving consultation skills. She also discusses the impact of the exam on her day-to-day practice and the challenges faced in general practice. Victoria emphasizes the need for a holistic approach in general practice and the importance of listening to patients. She offers advice for trainees preparing for the exam and concludes with well wishes for her future career.

In this conversation, Dr Victoria Tilney discusses her experience preparing for and taking the SCA exam. She shares her apprehensions leading up to the exam and how she overcame them. Victoria highlights the importance of practice and feedback in improving consultation skills. She also discusses the impact of the exam on her day-to-day practice and the challenges faced in general practice. Victoria emphasizes the need for a holistic approach in general practice and the importance of listening to patients. She offers advice for trainees preparing for the exam and concludes with well wishes for her future career.

Takeaways

  • Start preparing for the SCA exam early and seek support from trainers and colleagues.
  • Practice and feedback are crucial for improving consultation skills.
  • The SCA exam reflects the complexity of cases seen in general practice.
  • A holistic approach, including listening to patients and considering their preferences, is essential in general practice.
  • Avoid formulaic approaches and focus on individual patient needs.
  • Reflect on and learn from each consultation to continually improve.

 

 

 

 

If you’d like to sign up for SCA coaching – click here!

 

Transcript for this episode:

Sham (00:01.866)
Hello, thanks for joining us, Vicky, how are you? Awesome. So we’re here to talk about your SCA.

Victoria Tilney (00:04.526)
Hello. Very well, thank you. Very well.

Victoria Tilney (00:10.67)
Yes, yes, so it was an exam that I was really not looking forward to. I had built it up in my mind that it was going to be a torture and I was pretty scared of it to be honest.

Sham (00:24.874)
So why don’t you tell us a little bit about yourself, where you’re at in your training, where you’re training.

Victoria Tilney (00:30.318)
So I’m actually a quite late graduate to medicine and introduction to medicine, so I had a career beforehand and I’m now in the very final months of my ST3 year. I work down in the southwest, I work in Devon and that’s where I went to medical school and I did my training and I’m working for a rural practice. So my practice is largely villages and sort of

farmland up to sort of the edge of board of Devon, sorry of Dartmoor. And I’m now finally finished all my exams. I’m now at the point where I’m compiling the last of my portfolio and I’ve got my final ARCP in about six weeks time.

Sham (01:18.698)
Awesome, awesome. So it’s all very rapid after passing isn’t it in terms of trying to get ready for your your CCT. So you said you were apprehensive. So tell me a little bit about what apprehensions you had leading up to the exam.

Victoria Tilney (01:21.614)
It is.

Victoria Tilney (01:32.622)
So I’ve actually had quite a few problems during my training. I’m actually dyslexic and I’ve known that since I was seven. So, you know, coming to medical school was late, was probably not a surprise. And I’ve struggled with certain aspects of training throughout my training. And I ended up in this GP practice because I actually had to take a couple of months out of training because of stress. So I was struggling with timing.

I was struggling with a memory deficit and also struggling with the practicalities of trying to struggle dyslexia alongside training and actually becoming a good GP, becoming a GP that is able to take a comprehensive history and absorb what’s the patient said to them. And there’s so many different strands which you have to think about in that really precious time that you’re given.

Sham (02:05.738)
Mm -hmm.

Victoria Tilney (02:29.998)
And it is complicated and, you know, it’s so easy to miss something. And so when I faced with the exam, I got through the AKT with WellMedic support and that was really helpful. So when I got to the point where I needed, you know, I was just sort of very apprehensive about the exam and felt I was struggling really to get.

the information, the history taking and gets a point where I was really comfortable to move on in the consultation.

Sham (03:05.002)
Yeah, no, that makes sense. And if you now think about, you know, having taken the exam and if you compare the apprehensions that you had leading up to the exam, how would you say your experience compared to the exam itself?

Victoria Tilney (03:19.214)
So the exam itself actually went really well for me and I know a of trainees have had real difficulties with the system, with the recording. I was very lucky, I didn’t have any problems and it went smoothly. The actors were actually really pretty good at…

giving me the cues necessary to pick up wasn’t 100%. So there was occasional situations where we’re getting to the management plan and they slipped in a, you know, a bit of a bomb. And I thought, I’m pretty certain I asked you some of these questions. But actually, altogether, I think what the important thing was, is I’d had plenty of practice beforehand, and I’d built a confidence level that I could

Sham (03:48.81)
Uh huh.

Sham (03:57.258)
Haha!

Victoria Tilney (04:14.638)
go through the system and I could go through the consultation and be safe and get all the information and get the especially the psychosocial information early, get all of the playing cards out on the table and then reassure myself, do my little reassurance that I’d get all the red flags that had got all the safety netting and it just gave me a real security going into the exam that I knew what I was going to see and

and that actually really felt like, it felt like I was well prepared going in. And when I came out, it felt it had gone well.

Sham (04:51.082)
Awesome. Awesome. So I think if I think back to the first time we worked together, so the first case that we did together, if I remember correctly, it was one on opiate overuse. And then we did a case on prostate afterwards. And if I remember back to that, when we did the case on the opiate overuse, we did an excellent history and there was an excellent management plan in place.

Victoria Tilney (05:03.31)
Yes, yes.

Victoria Tilney (05:08.878)
Yes.

Sham (05:18.186)
But I remember you managed to do the consultation in about nine minutes 30, the same one, the prostate one as well. And one of the things that I felt was missing was that kind of getting the psychosocial information there. So, yeah, I guess one of the things that we worked on was just taking a breath and just letting things naturally fall and just giving the patient that encouragement to share their story and things like that. So it was really nice to see that progression from where you were probably one of the only trainees that was doing it within 12 minutes.

Victoria Tilney (05:28.91)
Hmm.

Sham (05:47.818)
but actually by the end, I felt that you were taking the whole 12 minutes and there was this really good balance between you speaking, the patient speaking, and then coming up to this kind of joint management plan. So that was really good. So do you feel that your structure did get better as you kind of progressed through the weeks of practice?

Victoria Tilney (05:51.246)
Mm.

Victoria Tilney (06:01.166)
Hmm.

Absolutely, and it’s really helpful the iterative process because each week I could do the learning online, absorb some of that and then during the actual training, one -to -one training, it was very much a case of do a case, right, where did I go wrong there? Here we go, that’s that and then I can immediately practice it and it was really helpful because…

You very rarely, even in joint tutorials, get that level of care taken over exactly what you’ve said, how has it come across, have you got all the information, do we really understand where the patient’s coming from? Are we consulting with this patient with our own agenda in mind and not really seeing what’s going on in the patient and therefore opening ourselves up to missing something really important and or not really, you know,

being very medical because we are very medical, it’s understandable, it’s what patients expect in many ways, but actually, you know, consultations in GP are, it’s a different relationship to a lot of medicine elsewhere. And yeah, it was good.

Sham (07:14.25)
In your regular practice now, do you feel that you have changed the way that you consult on a day -to -day basis? Do you find that you do get opportunities to practice some of the skills that you used during the exam?

Victoria Tilney (07:29.196)
Oh, we do, I do that all the time now. So my, and, and it’s really helpful for the really difficult days where you are, I’ve had a really, I had a really good difficult Monday where the practice was massively overburdened with lots and lots of very sick patients. And, you know, we had to increase our capacity at quite short notice to try and cope. And actually you.

going back to a structure which you’ve really well rehearsed and you’ve really honed is a safety net. And it allows you to say, well, no, I know I got this. I’ve done the exam. I’ve practiced this over. And you can just use it as a safety net and as a way of really making sure that you are coping and safe and actually not overwhelmed, which is, I think,

really important, so very useful in my day -to -day.

Sham (08:29.226)
I guess a lot of that comes down to the uncertainty that you have to experience and tackle as a general practitioner as well. And there’s huge amounts of uncertainty and there’s also lots of pressures where you work in Devon. It’s known as one of the more difficult places to work at the moment due to the resources in that area. I guess we know that patients wait longer to see secondary care. Do you feel those…

Victoria Tilney (08:32.078)
Hmm.

Victoria Tilney (08:40.558)
Mm.

Victoria Tilney (08:52.822)
Mm -hmm.

Sham (08:56.394)
So when I was listening back to a webinar by the RCGP, when they were talking about the SCA, it’s very much, it’s meant to reflect a modern day general practice clinic. Do you feel that your exam did that? Did it, did it reflect what general practice is like at the moment?

Victoria Tilney (09:14.638)
Yes, so I think in many ways the complexity of the cases weren’t actually as complex as I see day to day, which I suppose is reassuring if you’re going into the SCA at the moment. You think, well, actually you do see a lot of complicated stuff in general practice. And at the moment, particularly, you see patients which you have this really difficult medical, ethical,

Sham (09:24.616)
Mm -hmm.

Victoria Tilney (09:44.798)
dilemma of actually they need to see secondary care and you know you are you know and it’s clearly then don’t need to be immediately admitted and you’re managing patients in the community far longer than that used to be the case so you’re taking that is a lot of clinical uncertainty and concern that you take on and I think it’s really helpful to do the SCA and see where the RCGP expects us to be.

Sham (09:46.568)
Mm -hmm.

Victoria Tilney (10:14.798)
And, you know, that’s really helpful in many ways. It’s an interesting exam from that point of view. It’s an interesting one.

Sham (10:23.786)
How far into one’s ST3 year do you feel that somebody should actually take the exam? Should they do it early? Should they wait till later on? I know now you have to reserve your place in advance and you can change it but what advice would you give to trainees that are you know thinking of doing the exam?

Victoria Tilney (10:39.662)
Mm.

Victoria Tilney (10:45.998)
So I would say do do it later because when you first move into ST3, you’ve got to get yourself into your practice. You’ve got to adjust to it. There’s a lot of pressure initially where you are pushing the boundaries of your time and knowledge. And I think the answer is actually you’ve got to give yourself time to bed in and actually do those other…

things in your portfolio, so the prescribing assessments and all of your assessments get those pretty much done because they feed into all of those things, the AKT knowledge, everything feeds into the SCA and the SCA is sort of the final cherry on the top of the cake and doing it too early, first of all I think you can give yourself an awful lot to do in that first six months of your SC3.

Sham (11:34.186)
Mm -hmm.

Sham (11:45.13)
Mm -hmm.

Victoria Tilney (11:45.4)
And also you don’t give yourself the experience that you really need because every single consultation you do in general practice is a practice for LSEA. And you can all, yeah, so you can always find, you can always go back and reflect. Well, it’s like, actually, I think the patient didn’t really understand what I said there or, oh, actually, I really needed to have known that piece of information earlier in that consultation.

Sham (11:55.562)
I’m really glad you said yes.

Victoria Tilney (12:13.07)
And actually you need to have an understanding of the sorts of things you could, the art of what is possible and what is impossible in general practice.

Sham (12:23.914)
Absolutely, absolutely. And treat it like you would any other patient. Don’t try to do everything in that 12 minutes because it’s not always possible, but you should be able to signpost as to what needs to be immediately managed and what could be managed at a later point. And that feeds back to that opiate withdrawal case that we did together where, yes, it’s about building rapport with a patient so that you can then start to think about how you’re going to manage their prescribed drug addiction over time, which I was really impressed by when we first did it together.

Victoria Tilney (12:40.204)
Mm.

Sham (12:53.522)
You raised some really interesting points there about just the kind of general preparation and you know how your day to day practice just feed in to you know actually taking and sitting the exam and how all of the different exams and assessments do actually come together. If I think back to our third session when we switched from data gathering to clinical management and we started to talk about management one of the things that we talked about and I know you did this in the last

days leading up to your exam was start to look at management or creating lists of management options for conditions that you could expect in the exam. How important do you think it was to start thinking about management in that way in terms of having options available that you could then feed back onto in certain cases?

Victoria Tilney (13:44.27)
Well, I think it’s really, it’s good practice anyway. First of all, it gets you, I found I was getting right back into the guidance again and into the BNF, into treatment summaries. And that’s always worthwhile time to spend. It got me to think of options and patient preference and actually, you know, severity of disease. And I found that actually sort of following,

the WellMedic lead of thinking about five clear management practices or ideas for common cases, you know, was really helpful way of to just hone down exactly what you would use as a management plan in the common sort of diseases. So I actually, I mean, I did, I don’t know how many I did, I did a whole book of them.

Sham (14:39.018)
I think you just want to…

Victoria Tilney (14:41.102)
And I did lots of different diseases, which I would see commonly. And it was really helpful to sort of also pick out the common threads of it, and the importance of bringing in lifestyle advice and making sure that every interaction you have with a patient isn’t just about disease, it’s about promoting health in that patient and really giving them the power and empowerment back to manage themselves.

Sham (14:52.81)
Uh huh. Uh huh.

Victoria Tilney (15:10.444)
if they can.

Sham (15:11.946)
Yeah, I think it’s thinking about it in the trimodal association of health and looking beyond just the physical and biological process. No, not that. That is a it’s an essential skill. And I guess it goes all the way back to thinking of patients holistically. And I think it’s much harder to do that in practice, because actually you’re now finding that there isn’t necessarily continuity. And there was a recent article that I read about how actually seeing the same.

Victoria Tilney (15:20.014)
Hmm. Hmm.

Victoria Tilney (15:34.254)
Hmm. Hmm.

Sham (15:38.506)
Doctor is actually much better for patient outcomes and actually much better for doctor stress as well. So it’s interesting how, you know, when we’re in a system that is overburdened, that it might be difficult to do that. In terms of coming to kind of Wild Medic and how we supported you, you’ve mentioned about how we work together and we use this kind of iterative approach, which is somewhat different to like mock exams because…

Victoria Tilney (15:48.78)
Mm -hmm.

Victoria Tilney (16:02.22)
Mm -hmm.

Sham (16:02.686)
We don’t necessarily in the traditional sense work do mock. So there was never we didn’t just do like one full day of cases. We did a few cases and then we worked on them and then and then you kind of implemented things for the next session. Did you feel that we challenged you enough from session to session?

Victoria Tilney (16:20.942)
Yes, so I think the benefit of the way the iterative approach is that you can hone in particularly on an area and really you take the information that you provide, you work, the cases were complex enough to really, you know, you always were looking out for something. I felt they were very realistic to what I then experienced in the SCA. So each one of these cases, I could have easily have

seen it come up which was helpful but I think by doing it in this sort of you know honing in one area you gave each area an opportunity to be explored thoroughly and that and learn so you just you challenge it and then challenge it and challenge it so that you’re able to put in place immediately the feedback you’re given which is great.

Sham (17:17.61)
Excellent. And you mentioned then there was the theory within the course that you kind of looked back on in between sessions as well, where we felt that there was something that needed to be looked at. I guess one of those areas was when we talked about results and handing results over to a patient and, you know, do you, is good news always good news for the patient and how do you work, how do you manage your time where you’ve never seen a patient before, you’re expected to give them a set of results.

Victoria Tilney (17:29.612)
Mm.

Sham (17:43.818)
You’ve got all this information that’s provided to you in the candidate notes. Do you take a history or do you just go ahead and give the notes and those types of, you know, dilemmas that you may face in the exam? If you were now backing, you know, when you were first thinking about the SCA and preparing or there’s a trainee out there that’s listening to this, that’s thinking about the SCA, that’s maybe considering our coaching programme, what should they expect or what would you share with them in terms of what they can expect over the next?

not six, eight weeks or so.

Victoria Tilney (18:15.822)
So obviously, first of all, my expectation was I needed help really understanding what the exam was. I’d read everything, I’d done all the RCGP and I still felt insecure about what to expect. And I think that was the real, the course gave me some real security.

but it was an opportunity, you know, you do this online learning alongside it, which showed me a really good way of thinking and a simple way, so easily recallable way of structuring your consultation. I loved how it was divided into the patient’s part and the doctor’s part and the shared part, because actually that is how general practice is structured. And it was a really simple way of consulting.

when you’re under stress in that exam. And so you get this, you do it, you know, piece by piece. You have access to the reading materials, you know, the video cast and go through all that in your own time. And then, you know, you get to put that into practice and explore areas and raise areas and say, I’m really worried about this. So, you know, actually I’m really not very good at giving results or I don’t know how I should do that.

actually do I gather a lot of information? And so I could ask questions and interrogate you really and how best to approach each scenario. That was really helpful. And that backwards and forwards meant that I was able to, you know, when I was practicing with other trainees, which I did alongside it, I was really able to

gain a lot of, you know, I can say, I want you to look at this because this is where I was weak last week. This is the area I need a bit of care and attention taken. I want positive feedback. It gave me permission to ask and listen to difficult feedback.

Sham (20:28.746)
Yeah, yeah, it was a pleasure working with you. It really was because you were open to constructive criticism. I think that’s a challenge. It’s a challenge. It’s a challenge that you see with some trainees where, especially, I think, if I’ve had trainees that have failed an exam before, then I find that it can be a little more difficult and you can be a bit more guarded to bringing in or being open to that feedback. But I always find that you are very, very receptive.

Victoria Tilney (20:37.934)
Okay.

Sham (20:58.89)
The actors that we used, how did you find your interaction with them? Because the cases change from young to old, easy to complex. So how is that interaction for you?

Victoria Tilney (21:03.116)
They – yeah.

Victoria Tilney (21:09.414)
That was good. I’ve always managed to get myself completely absorbed and I forget that I’m working with an actor to the point when I did my ALS training I had the dummy that died and therefore I was in tears. I like, but I did everything right. I needed a hug at the end by the course instructor.

Sham (21:25.674)
Oh.

Sham (21:32.872)
Oh my goodness.

Victoria Tilney (21:34.094)
So I get very quickly absorbed into the patient and I certainly found that the actors were very good and they were to me patients, unfortunately, I get this.

Sham (21:45.62)
Absolutely. It’s the best way to do it. And I think that’s sometimes the difficulty because when you do work with a trainee, and I’ve had this feedback recently, that when you work with a colleague, sometimes your colleague’s not going to challenge you in the way that you’re going to be challenged by someone who isn’t one your colleague, but also somebody who’s not an actor. Because I think what ends up happening is you can be very receptive to your colleague. Naturally, so we have natural empathy.

Victoria Tilney (22:01.612)
Mmm.

Victoria Tilney (22:13.23)
Yes. Yeah.

Sham (22:15.402)
So you’re probably a little bit more inclined to give information easily, whereas sometimes the actors are kind of caught to hold off giving information and things like that. So I think it’s important.

Victoria Tilney (22:26.062)
Yeah, I certainly found the actors and in the SCA as well. That’s the important thing is actually it’s really difficult to just practice between trainees because you know what they need to know in order to get the case and it’s really difficult to hold back and not just basically go, oh, you know, how can I help you today? And you just basically regurgitate the case to them.

Sham (22:43.434)
Mm -hmm.

Sham (22:54.506)
Exactly that. And I guess even when ice comes into play, because we talked a lot about how not to appear formulaic and listen to the ice rather than just icing patients, because I think you can go that one step too far away. So what’s your idea? What’s your expectation? How would you like to leave this consultation? Whereas often, as you picked up on lots of times where…

Victoria Tilney (23:14.734)
Mm.

Sham (23:23.048)
patient would give a cue and actually just receding that cue back to the patient would often be enough for them to then share the ice with them. So I think that’s something that sometimes doesn’t come across when you work with trainees as well.

Victoria Tilney (23:33.87)
Yeah, absolutely, absolutely. And actually, it’s, you know, to do well, I think in the SCA, you have got to be clearly not following some sort of, you know, formats. You have got to follow a format, but you can’t make it explicit. And that’s a quite skillful thing.

Sham (23:53.034)
Exactly, exactly. It’s interesting. Absolutely. It’s interesting because you know, when we were developing this course and I’ve actually never shared this with anyone before, but when we were thinking about doing the course, we did some surveys of trainees who used our AKT stuff and we were actually the probably one of the last educators to actually enter into the SCA market on purpose because we wanted to really see what was out there already. And a lot of feedback that we received was that people wanted a set of notes of

a hundred cases that could appear in the AKT and that basically questions that needed to be answered and management options that should be offered for that cases. And we didn’t do it because we felt that all that we would be then encouraging is people to learn, okay, if I get a chest pain case, these are the questions that I need to ask and these are the management options I need to give. Whereas actually you don’t want to do that. You want to listen to that patient’s perspective of that chest pain because that’s going to massively change the way that you then go to management. So, so now I think that’s a really interesting point as well.

Victoria Tilney (24:49.742)
Yeah, this is really important to, I think being trying to, there’s no shortcuts, unfortunately, to passing the SCA because there’s no shortcuts to medical education and you’ve got to understand the anatomy and the physiology, you’ve got to understand your pharmacology, but you’ve also got to understand the patient. And that’s it.

Sham (24:58.826)
I’m comfortable that we don’t see.

Sham (25:12.778)
Exactly that, exactly that. It’s hard, it’s never easy and it’s only going to get more complicated. Final question. You’ve been a real help and I’m sure everyone who’s listening to this is going to find it incredibly helpful because you’ve given a very candid opinion on the exam and your preparation and you’ve shared your intimate journey through this exam process. But if there was one piece of advice that you were to give to somebody listening to this today.

about the SCA, what would that piece of advice be?

Victoria Tilney (25:47.246)
So I would say start fairly early with your preparation. I probably left it too late. I got a bit panicked in the end and that was a little bit overwhelming. So don’t book yourself in for the SCA too early. This is an exam that is rigorous. It needs to be. And you need to, and as I say, there’s no shortcuts. So…

starting early and actually asking whoever you’re training with. So that’d be no well medic, but with your trainer, with the supervisor and with your colleagues, make sure that at the start of each case, work out what it is that you want to have support with. You know, is it the ice? Is it the management? Is it the safety netting? And have someone give you proper criticism.

proper feedback because actually it’s gold, it’s gold dust and lots of people will want to skip around it and be nice to you but the exam’s not going to be nice to you and actually you know you can people can be you know say it with kindness and I always felt that the feedback I received was always really supportive but you need to know

where you’re going wrong or what you’re missing out, you need to know.

Sham (27:19.434)
Absolutely, absolutely. I think that’s really, really helpful. Thank you very much for your time today. It’s been an absolute pleasure speaking to you about the exam and I would like to join everyone who’s listening today to wish you the very best in your career. I’m sure you’re going to make an excellent GP and yes, I’m sure you’re well prepared for anything that’s going to come your way in the next six, 12, 24 months and yeah, and if anyone who’s listening to this today is interested in signing up.

Victoria Tilney (27:32.91)
Thank you.

Sham (27:48.306)
Wild Medic you can head over over to our website and there’s some information on both our SEA courses and coaching there and we’ve also got some information on our blog as well. Thank you very much Vicky, anything that you’d like to share before we finish?

Victoria Tilney (27:59.95)
Thank you.

No, no, it was sir. Thank you very much.

Sham (28:04.874)
You’re very welcome.

 

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