LESSON 2.3: Building Your SCA Consultation Framework

Here is a practical hybrid structure optimised for the SCA's 12-minute format. This is not a rigid script but a scaffold you can adapt:

First 6 Minutes: Data Gathering & Diagnosis

1. Open: Read the candidate instructions carefully during your 3-minute reading time. Note the patient's name, age, any results or letters provided, and the stated reason for attendance.
2. Connect: Greet the patient by name. Use an open question: "How can I help you today?" or "I see from the notes that [X] - tell me more about what's been going on."
3. Explore: Let the patient talk. Use open questions first, then targeted closed questions. Explore the presenting complaint systematically. Listen for cues.
4. ICE: Elicit ideas, concerns, and expectations naturally - not as a bolt-on checklist.
5. Psychosocial: Ask about impact on daily life, work, relationships, mood. This is not optional.
6. Red flags: Screen for serious disease relevant to the presentation.
7. Summarise and signpost: "So what I'm hearing is... Let me now share my thoughts with you."

Last 6 Minutes: Clinical Management & Complexity

1. Working diagnosis: Share your thinking with the patient. Name the likely diagnosis and explain your reasoning. Use the information the patient gave you.
2. Management plan: Offer evidence-based options. Tailor to the patient's preferences and circumstances. Involve them in the decision.
3. Prescribing: If appropriate, name the drug, dose, and duration. Mention key side effects and monitoring.
4. Referrals and investigations: Only if appropriate. Don't over-investigate.
5. Health promotion: Brief, relevant advice (e.g., smoking cessation, exercise, diet).
6. Safety netting: Specific, not generic. What to look out for, when to return, what to do if symptoms worsen.
7. Follow-up: Book a review if appropriate. Offer written information or useful websites.
8. Check understanding: "Does that make sense? Is there anything else you wanted to discuss?"

⭐ KEY POINT: The "Relating to Others" domain is scored throughout both halves. Rapport, empathy, active listening, and responding to cues should be continuous, not confined to any one section.