MRCGP SCA Consultation Skills Course
Starter Station A · Indigestion
Video consultation · Undifferentiated presentations · Starter demonstration 09:00–09:40 — exemplary run
A 38-year-old man with six weeks of indigestion wants a scan.
Candidate brief
Read this as you would in the exam. One to two minutes' reading, then ten minutes. You may ask the patient for examination findings; there is no reference material.
| Patient | Daniel Okafor, 38, IT project manager |
| Reason for appointment | "Indigestion — wants a scan" (booked online) |
| PMH | Nil significant |
| Medication | None on repeat. Buys omeprazole 20 mg over the counter (two months) |
| Allergies | None known |
| Recent entries | Nurse: BMI 29. No blood tests on record for five years |
Role-player script — tutors only
Delegates: please do not open this section until you have consulted at this station.
Open the role-player script (532 words)
Persona and manner
- Pleasant, articulate, slightly impatient; has 'done his research' online and arrives with a conclusion.
- Sits forward, makes good eye contact, checks his watch once at minute 4 — he has a meeting after this.
- Not hostile. If the doctor listens, he softens quickly and becomes collaborative.
Opening line — say this verbatim
- "I've had this burning in my chest and stomach for about six weeks, the omeprazole from the chemist helps a bit, and I really think I need a scan to be safe."
Volunteer freely if given the space
- Burning pain high in the stomach and behind the breastbone, worse after meals and when he lies down at night.
- Bloating and belching after eating; 'feels like a brick in there'.
- Omeprazole from the chemist takes the edge off but it comes back.
Only if asked
- No difficulty swallowing; food does not stick. No vomiting. No weight loss — 'if anything I've gained'. No black stools; no blood.
- Takes ibuprofen most days for a gym shoulder injury — about eight weeks, two or three tablets a day, bought in a big pack.
- Alcohol: four or five pints on Friday and Saturday, wine with dinner two or three nights in the week — around 25 units. He under-estimates at first ('a few pints') and corrects if the doctor asks him to count.
- Coffee: five cups a day, mostly before lunch. Smokes 'socially', perhaps five a week.
- Sleep poor, waking at 3 a.m. Work has been 'brutal' — a project deadline and two colleagues off sick.
- Father 'had stomach problems'; on gentle questioning, a duodenal ulcer at 60, treated with tablets, no cancer.
- No previous endoscopy. No previous H. pylori test. Not taking aspirin or steroids.
Ideas, concerns and expectations
- Idea: 'an ulcer like my dad's, or something worse'.
- Concern: cancer — 'you read things'. He will say the word only if asked what worries him most.
- Expectation: a scan 'or the camera' so he can stop worrying. He does not know which; he wants the reassurance a test would give.
Psychosocial
- Lives with his partner; no children. Big gym user — the shoulder injury is a real frustration.
- Project manager under deadline pressure; describes himself as 'running on caffeine and adrenaline'.
Cues to deliver, timed
- Minute 2: '…and I'm just knackered all the time, to be honest.' Said as an aside; do not repeat unless the doctor picks it up.
- Minute 5: rub the right shoulder and mention the gym injury — this opens the ibuprofen line if the doctor is curious.
How to respond to the doctor's plan
- If the doctor explains that there are no red flags, proposes a test for H. pylori, a course of a stronger stomach tablet, stopping ibuprofen and cutting alcohol and caffeine, and explains why a scope is not needed now and what would change that: accept with visible relief and ask 'and if it doesn't work?'.
- If the doctor refers for endoscopy without any discussion: accept quickly and say 'great, thanks' — the examiner will note it.
- If the doctor refuses a scan without explaining why: push back once — 'so you're saying it's definitely nothing?' — then subside.
- If asked about stopping ibuprofen, ask what he can use for the shoulder instead.
Do not
- Volunteer the ibuprofen, the alcohol total or the father's ulcer without being asked.
- Argue beyond one push-back. Raise more than the one problem.
Mark scheme
Delegates: open after your consultation. Examiner-observers: open during it.
Generic mark scheme — identical at every station
Domain grades
| Domain | CF (0) | F (1) | P (2) | CP (3) | Points |
|---|---|---|---|---|---|
| Data Gathering and Diagnosis | ☐ | ☐ | ☐ | ☐ | /3 |
| Clinical Management and Medical Complexity (×1.5) | ☐ | ☐ | ☐ | ☐ | /4.5 |
| Relating to Others | ☐ | ☐ | ☐ | ☐ | /3 |
| Total | /10.5 |
Global rating: ☐ Fail ☐ Bare Fail ☐ Bare Pass ☐ Pass (CF Clear Fail · F Fail · P Pass · CP Clear Pass)
Feedback statement(s) — tick the one (at most two) you would attach
| Domain 1 | Domain 2 | Domain 3 |
|---|---|---|
| ☐ 1.1 Insufficient data | ☐ 2.1 Referral | ☐ 3.1 Cues / listening / formulaic |
| ☐ 1.2 Notes not used | ☐ 2.2 Prescribing | ☐ 3.2 Agenda / beliefs |
| ☐ 1.3 Psychosocial | ☐ 2.3 Investigations | ☐ 3.3 Circumstances / culture |
| ☐ 1.4 Unsystematic | ☐ 2.4 Prevention | ☐ 3.4 Explanations |
| ☐ 1.5 Prioritisation | ☐ 2.5 Risk management | ☐ 3.5 Judgemental |
| ☐ 1.6 Implications of findings | ☐ 2.6 Co-morbidity | ☐ 3.6 Respect / sensitivity |
| ☐ 1.7 Differentials | ☐ 2.7 Uncertainty | ☐ 3.7 Ownership |
| ☐ 1.8 Diagnosis / decision | ☐ 2.8 Follow-up / safety-net | ☐ 3.8 Teamwork |
| ☐ 2.9 Time management | ☐ 3.9 Safeguarding |
Timing checkpoints (Observer)
| Checkpoint (10-minute frame) | Done | Minute |
|---|---|---|
| Patient allowed to open without interruption (≈1 min) | ☐ | |
| ICE and psychosocial context elicited by 3:30 | ☐ | |
| Red flags covered; examination findings requested by 5:00 | ☐ | |
| Working diagnosis verbalised; gear change by 5:00–5:30 | ☐ | |
| Options shared; patient's preference used | ☐ | |
| Specific safety-net and follow-up by 9:30 | ☐ | |
| Understanding checked; finished inside 10:00 | ☐ |
Key points for this station — customised standard
Key points for this station
| Domain | Pass requires | Clear Pass adds | Fail if |
|---|---|---|---|
| Data Gathering & Diagnosis |
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| Clinical Management & Medical Complexity |
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| Relating to Others |
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Global rating guide: Pass = no red flags established, test-and-treat and NSAID/alcohol plan, scan request answered with reasoning, safety-net. The flawed demonstration is built to trigger 1.1, 1.3, 1.7, 2.1, 2.3, 2.8, 3.1, 3.2 and 3.7.
Teaching points
- NICE CG184: uninvestigated dyspepsia under 55 without alarm features — test and treat for H. pylori; endoscopy is for alarm features or per NG12 criteria.
- The request for a test is a belief to explore, not a demand to grant or refuse: 'What would a scan tell you that would help?'
- Two cues in one case — 'knackered' and the shoulder — each unlocks a management line (sleep and stress; NSAID). The examiner watches whether you follow them.
Guidelines for this station
Your reflection
Record your grades, the statement attached, what you will keep and change, and your own reflection. Your entry is emailed to you as a record of this station; this page stays live so you can revisit the full case during revision.
Write my reflection for Starter Station A
Revision link for this case: mdacumen.com/sca-startera-indigestion
Editorial stamp · MRCGP SCA Consultation Skills Course · Station pages v1.0 · 11 September 2026 · Prof Rajesh Varma, Course Director · MD Acumen. Formative training material; not a prediction of exam performance. Not for onward distribution.