Posts about improving your consulting skills ready for the SCA from the Clinitalk team of experienced RCGP examiners and tutors.
Why is SMI care a hot topic?
People with SMI can die up to 20 years younger than the general population due to preventable physical health issues like cardiovascular disease and diabetes. SMI cases are an opportunity to show you understand the issues and how to intervene.
Core checks:
• alcohol
• HbA1c
• blood pressure
• body mass index
• lipid profile
• smoking status
🌟Tips🌟
Demonstrate Empathy & Understanding 🧠❤
o Start with Compassion: To get engagement you need trust. Start off well by listening and acknowledging the psychological and physical health challenges. Messages of empathy should be personal and genuine, "I am sorry to hear the anxiety has been bad… ,
o Emphasise Holistic Care: Highlight your commitment to looking at the whole picture. " …and you’ve been struggling with your landlord. I might be able to help you with those issues”
Screen and Intervene! 📄🔍
o Integrate Risk Management: Raise awareness . "Its my job to help keep you healthy by looking after your heart and preventing diabetes." And collect the data you need for Qrisk and diabetes assessment (weight, lipids, HBA1c, family history).
o Personalised Plans: “We need to figure out what will work best for you” Help the patient to make a plan they can enact: Can they exercise?, what exercise do they enjoy?, Can they join an exercise program specifically for those with mental illness e.g. the SHAPE program?, Would they engage with dietary support (dietetics).
Communicate Clearly and Effectively 📣✍
o Teach and Educate: Help the patient understand medication impacts and preventive measures. Give clear, messages in digestible chunks. "Antipsychotics can lead to weight changes, so it’s important we make a plan so you can eat well and keep active"
o Smoking: It is important to keep the patient onside. A non-confrontational technique taken from motivational interviewing is to start the conversation by asking about feelings. “How do you feel about your smoking”
Show Proactive Follow-Up 📅📝
o Interventions & Support: Critical to being effective is continuity and follow up. So, remember to agree a target goal and a follow up date to see them again.It often takes a few goes to get your phrasing and timing right so don't let SCA be your first try.
Why not do a role play a case and listen back on Clinitalk with your role play buddies.
How about Julie a 22 year old with Schizophrenia, smoker, BMI 32 on olanzapine.
Ref: NICE CG178 / NHS England
Relating to others 23%,
Data gathering and diagnosis 23%
Clinical management and medical complexity 43%
So make sure you give yourself time for management.
Try using a management menu to summarise options at the start of management.
Give: Choice (options), Control (ask what they want to know more about) and Guidance (the pros and cons of the options)
Direct link to the Clinitalk explainer video: https://www.clinitalk.co.uk/explainer
In the case of the exam, you might get a scenario about an emergency case.
Think about;
Rapid Assessment and recognition of emergency
Consider need for speed in assessment and treatment. Revise patterns of emergency presentation and treatment algorithms.
Doctor centered approach
Consider a doctor centered approach where life is at risk to protect health
Immediate treatment
Explain and provide any immediately necessary treatment before transfer e.g. chest pain.
Communicate risk clearly promoting safety
Consider safety of patient and those around them e.g. in transfer to hospital.
Eliciting the pattern of presentation, using open questions as much as possible, conveying the differential diagnosis (and how likely each differential is) and then taking a safe action will get you a long way to a clear pass.
Make it clear and shared.
Last week, I had a great teaching session in practice with three of our ST3s—we were all practising how to explain AIR (Anti-Inflammatory Reliever) and MART (Maintenance and Reliever Therapy) therapy clearly and simply to patients. It was a helpful reminder that while we might be familiar with these terms, patients often aren’t.
When you’re discussing asthma options, this is a section where you’ll be doing more of the talking—but not all at once. Leave space for questions, check understanding, and keep it a conversation. 🗣❓
Top tips from our session:
- Avoid jargon 🚫
- Use natural pauses ⏸
- Keep it shared and patient-centred 🤝
- Ask questions like “How does that sound to you?” or “Does that make sense?” ✅
- Explore the patient's understanding before diving into treatment options—what do they know about their asthma care so far? 🧐
- Encourage shared decision-making—ask for the patient’s thoughts on the plan. 📝
When we practised last week, it took each of us three or four attempts to get to an explanation we were happy with. This is a normal part of refining your approach, and it shows the value of making the conversation as clear and patient-centred as possible. 💬✨
Check your % talking data—yes, clinical management means more input from you, but it should still feel like a dialogue. Remember, the Clinical Management domain carries more weight than Data Gathering or Relating to Others—so this bit really matters. 📊📈
Need a refresher on AIR & MART?
There’s a recent eLearning module on Asthma: Updates to Diagnosis and Treatment published in April 2025 on the RCGP website. It’s a great resource to stay up-to-date with the latest asthma management guidelines.
