Introduction to the SCA consultation toolkit

This toolkit was developed by two RCGP examiners in the north west of England to help trainees to improve their consultation skills and succeed in the Clinical Skills Assessment (CSA). Later the toolkit was updated to provide guidance for the current version of the examination: the Simulated Consultation Assessment (SCA). 

Trainees can work with their trainer or educational supervisor, and use the toolkit to analyse their consultations and develop their weaker consultation skills.   

To learn more about the toolkit and its history, please watch the toolkit introductory presentation.

All the information you need to use the toolkit is described in the toolkit "how to" presentation video. You should watch this first, before using the toolkit.

There are three parts to the toolkit:

• The SCA consultation overview: this allows the trainee to get a feel for the structure and components of the consultation.
• The SCA RAG rating: this allows the trainee to self-assess their own consultations and share this information with their educational supervisor.
• The educational section, all available from this webpage's menu: this provides the trainee with information and exercises to improve their consultation skills.

To get started, access the SCA consultation overview in visual form below. You can also read about its format.

Download the visual consultation overview (PDF file, 53 KB).

The overview consists of a diagrammatic representation of the three domains of the SCA consultation along with additional global skills, arranged in columns. There is also a timeline which helps you to manage time during the consultation.

• A 12-minute consultation starts with data gathering and making a diagnosis, followed by clinical management and medical complexity. 
• The relating to others skills run throughout the consultation.
• The global skills may apply at any time during the consultation.

It's recommended to print out the consultation overview and have it available for reference whenever you are consulting.

Once you are familiar with the overall structure of the consultation shown in the Overview, you can use the RAG Self-assessment tool to assess your consultations. Note that the RAG tool uses very similar headings to the Overview but adds in an element of analysis. Download the RAG rating or edit it on screen and save a copy.

Download the editable and printable RAG self-assessment tool (PDF file, 126 KB).

You will see that each task or skill can be rated as "Red", "Amber", or "Green". You should share one or more consultation recordings with your trainer and assess each of the individual tasks and skills as "Red", "Amber", or "Green". There are word pictures in the educational section to help with this assessment process, as illustrated in the educational guide example below.

Next, discuss the RAG rating with your trainer. It is important to initially focus on those tasks and skills that have been assessed as "Red". For each of the "Red" tasks and skills, you should try to determine how that particular task or skill can be improved – to "Amber" and eventually to "Green". Use the educational activities in the education guide to do this, as illustrated in the educational guide example below.

The educational guide can be accessed to the left of this Introduction.  Each task or skill has its own educational section, which is divided into four sub-sections:

• About this task
• Audio consultations
• Educational activities
• Reflective exercises

Each sub-section begins with a series of word pictures for the relevant task or skill together with an overall rating – either "Good" or "Needs development".

Educational guide example

For the task "Offers a safe patient-centred management plan", there is:

• Good: produces an evidence-based or in the absence of evidence a ‘reasonable’ and up-to-date management plan
• Needs development: Produces a poorly evidenced and/or outdated management plan, which may be incorrect or dangerous
  
  
• Good: Presents the management plan to the patient
• Needs development: Fails to present the management plan to the patient
  
  
• Good: Produces a management plan that is realistic and feasible in current NHS conditions
• Needs development: Produces a management plan which may be unrealistic and/or unachievable in current NHS conditions
  
  
• Good: Produces a management plan that reflects the natural history of condition
• Needs development: Produces a management plan that disregards the natural evolution of the condition

When RAG-rating this task:

• A "Red" rating is awarded if the most of the behaviours described above "need development"
• An "Amber" rating if there are some that "need development" but others are "good"
• A "Green" rating if most of the behaviours are "good"

"Red" rated skills or tasks can be improved by using the educational activities in the toolkit. 

An educational supervisor can also share the specific section with a trainee by sharing the direct URL to the section, e.g.: "Offers a safe patient-centred management plan".

Below is a summary of how to get the best out of the SCA consultation toolkit:

1. Familiarise yourself with the consultation overview.
2. Analyse some of your consultations using the RAG tool.
3. Ask your supervisor to analyse the same consultations.
4. Identify any "Red" tasks in the consultation, along with its related skill if also "Red" rated.
5. Read the education sections and discuss with your supervisor.
6. Work with your supervisor to improve.
7. Rate some further consultations, concentrating on the "Red" tasks and checking that they are moving to "Amber" and "Green".
8. If you identify multiple weak areas, you must allow enough time to improve before you are ready to sit the SCA.
9. Choose the education activities with your supervisor that seem most appropriate for your learning style and approach. The education sections are extensive and intended to be used selectively.
10. Practise skills, in order to embed any changes or improvements you have developed.

If you'd like to access a PDF version of this toolkit, you can find a printable PDF version on the North West Deanery website.

There is also an interactive version on FourteenFish (only available as part of the SCA Plus educational package).

With thanks to the toolkit's authors Dr Anne Hawkridge FRCGP and Dr David Molyneux FRCGP, and to the North West England Deanery GP School, for developing and sharing this resource.

© Copyright 2024 Anne Hawkridge and David Molyneux. Not to be reproduced or published in either part or full without prior permission of the authors.