Our MRCPG SCA coaching case study. How did we help our trainee improve their consulting technique and confidence?

I’d like to share a case study from a trainee we worked closely with over six weeks in this blog piece. The trainee passed the MRCGP SCA with a fantastic score in all domains. We receive many enquiries for SCA coaching and are limited in how many GP trainees we can accommodate. This blog will highlight how our MRCGP SCA coaching typically runs and will help you decide if its an approach you’d like to consider. Additionally, there is plenty of learning opportunities through the cases and action plans we share.

I’d like to share a case study from a trainee we worked closely with over six weeks in this blog piece. The trainee passed the MRCGP SCA with a fantastic score in all domains.

 

We receive many enquiries for SCA coaching and are limited in how many GP trainees we can accommodate. This blog will highlight how our MRCGP SCA coaching typically runs and will help you decide if its an approach you’d like to consider.

 

Additionally, there is plenty of learning opportunities through the cases and action plans we share.

 

Why did they sign up for MRCGP SCA coaching?

This trainee signed up for our coaching programme as they wanted to work on their confidence leading up to their examination.

We aimed to provide our trainee with an environment where they felt comfortable and receptive to constructive criticism. 

 

Our challenge…

We knew six weeks to implement wholesale changes was tight, so we needed a reasonable foundation to work with.

 

Session one

Focus: Data gathering and diagnosis.

 

In our first session, the trainee worked with our SCA coach on a one-to-one basis, presenting five cases to the trainee. We allocated six minutes for each case, but each case took longer and closer to eight minutes to complete.

 

As soon as the trainee entered the management, we would stop the case and provide immediate feedback. We then encouraged the trainee to take one pointer from the case and implement this into the second case.

 

Here are some learning examples from the cases we presented:

 

Case one

Does the trainee take a focused history?

Do they recognise the patient’s cues leading to the ICE?

Are they able to contextualise why this case is unique to this patient?

 

Case two

Is the trainee able to conduct a safe triage across numerous complaints?

How does the trainee process pre-existing medical records?

Is the trainee able to recognise subtle cues leading to the ICE?

 

Action plan

 

  1. The trainee needed to build their confidence in data gathering to keep their history concise. 
  2. We encouraged the trainee to keep their initial questions broad to allow the patient to keep sharing their story and possible cues.

 

Session two

Focus: Data gathering and diagnosis.

 

Our SCA coach observed the candidate complete three SCA cases with an actor in our second session. Each SCA case was completed under exam conditions.

 

The trainee was given two options: they could receive feedback after each case or at the end of the session. We agreed that feedback after each case would be better.

 

Unlike the first session, we encouraged trainees to enter into the second phase of the consultation, this helped us understand how the trainee was likely to tackle clinical management in line for session three, but most learning was focused on data gathering and diagnosis.

 

Here are some learning examples from the cases we presented:

 

Case one

Was the trainee able to take a concise history for an undifferentiated problem?

Was the trainee able to recognise the impact on the patient’s job?

How would the trainee utilise the information from the data gathering in their management plan?

 

Case two

How does the trainee manage an uncertain diagnosis?

How does the trainee manage a patient who may be an expert in their chosen presentation?

How does the trainee communicate a differential rather than a single diagnosis?

 

Action plan

 

  1. In all cases, the trainee had built a good understanding of the likely clinical cause for each presentation by four minutes. However, they would need up to seven minutes before moving into clinical management. We encouraged the patient to move on at six minutes, even if they did not feel 100% comfortable.

 

  1. We encouraged the trainee to embrace their uncertainty and recognise that there will be times during the exam when you may not know the absolute diagnosis. Still, the key was to complete a safe assessment and offer a secure management plan.

 

  1. In preparation for the third session, we encouraged the trainee to reference the patient’s concerns early in the clinical management.

 

For example, “I recognise that you’re worried that this could be infected because your leg is red, hot, tender and swollen, but actually, I’m worried it could be a blood clot because you’ve recently been bed-bound and you’ve continued to take your combined contraceptive pill, both of which can increase your risk of having a blood-clot.”

 

Session three

Focus: Clinical management and medical complexity

 

After completing two sessions, the third session involved a change of focus to clinical management. There was an overlap in sessions two and three, as session two provided our coach with the necessary baseline assessment of how our candidate will begin their management domain.

 

The candidate is provided with a summary of the data-gathering findings for this session. Everything is supplied from symptoms, signs, psychosocial, ICE and background information. The candidate is allowed to ask questions to help clarify their understanding of the case, and we allocate a few minutes to enable candidates to plan how they will manage the patient.

 

The challenge from each session gradually increases as we try to replicate the challenge of the exam whilst ensuring we do not push too hard early on!

 

We recognise the importance of time management and the increased weighting of clinical management in the MRCGP SCA. We encourage trainees to consider their priorities as the clinician and the patient’s priorities to ensure the management remains patient-centred and safe.

 

Here are some of the issues that our GP trainee needs to consider;

 

What is the diagnosis?

What does the patient want from this consultation, and how will they meet their need?

What would they like to prioritise?

Is there an opportunity to bring in management options?

Have you provided a safe and effective safety net?

Have you ensured that the patient understands the entire management plan?

Do you take ownership of the management and follow up?

 

Action plan

 

  1. We recognised that the trainee had good diagnostic skills based on the history provided, and they could communicate their diagnostic reasoning well.  The trainee struggled with uncertain diagnoses, and we recognised that we needed to work on managing clinical uncertainty in undifferentiated disease cases.

 

  1. When the trainee felt uncertain about the management, they would lose their structure and forget there was still benefit in providing red flags, checking for understanding and appropriate follow-up.

 

  1. The safety net provided was vague and confusing for the patient. There was no explanation as to why the red flag symptoms were of concern. The trainee also struggled to offer specific instructions on how the patient should act on red-flag symptoms.

 

Drop in session 

 

Given the six week timeframe we had to work with this trainee, we missed the opportunity to offer one of our regular drop in sessions. However, we provided the trainee with an additional session to practice cases.

 

Our drop in sessions vary in terms of their offering and we generally build the session based on how many trainees we have attending.

 

In our most recent session, we had six trainees attend and all trainees were able to practice handing over results which is an important aspect of the MRCGP SCA exam.

 

Session four 

Focus: Clinical management and medical complexity

 

Our final sesion took place with our actor. The trainee was allocated three cases under exam conditions. The session was similar in set up to session two, but this session allowed trainees to demonstrate competence in all domains.

 

We challenged the trainee with cases that had large candidate briefs with information from previous consultations and consultant letters. The aim was to replicate a typical GP scenario where you are likely to encounter patients seeking follow up care from their GP.

 

The trainee found the cases challenging, but following their exam, they were grateful that we practised cases with longer briefs as this replicated the MRCGP SCA exam.

 

Should I consider the MRCGP SCA coaching package?

 

The MRCGP SCA is your final hurdle before qualifying as an independent GP, and for many, it’s a daunting experience.

 

We appreciate that you are an experienced doctor, and you do not need to be spoonfed and retaught how to consult patients, we do not provide formulaic “copy-cat” sentences and phrases that could be easily detected from experienced examiners! Our course aims to fine-tune your already fantastic skills!

 

The coaching package is a tailored experience to your individual consulting needs. Within the coaching sessions, you will have one-to-one sessions with our GP educators to help you fine-tune your consultation skills through practice, feedback and the use of professional medical actors.

 

If you’d like to sign up you can visit our coaching page by clicking here.

 

 

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