MRCGP SCA Consultation Skills Course
Station 1 · Tiredness
Video consultation · Undifferentiated presentations · Gender, reproductive and sexual health · Circuit 1 · 09:40–11:00 · 13-minute station
A 42-year-old woman is tired all the time and wants iron tablets; her blood count says more than she does.
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 | Hannah Reeve, 42, primary school teaching assistant |
| Reason for appointment | "Tired all the time — results" (booked by patient) |
| PMH | Two children (14 and 10). Nil else. Non-smoker |
| Medication | None. Allergies: none |
| Recent entries | Bloods two weeks ago (requested by telephone for tiredness): Hb 96 g/L, MCV 71, ferritin 6, TSH normal, HbA1c 38, U&E and LFT normal, B12/folate normal. No coeliac screen sent. Last cervical screening: overdue by 18 months. Contraception: none recorded |
Role-player script — tutors only
Delegates: please do not open this section until you have consulted at this station.
Open the role-player script (560 words)
Persona and manner
- Pleasant, self-deprecating, tired-looking; laughs off her symptoms; keen to be 'no trouble'.
- She has looked at the results on the app and seen 'anaemia' — she thinks iron tablets will fix it and wants to leave with a prescription.
- She becomes quieter and more honest when asked about her periods in a matter-of-fact way.
Opening line — say this verbatim
- "I saw my bloods on the app and it says I'm anaemic — I thought so, I'm shattered all the time. Can I just get some iron tablets?"
Volunteer freely if given the space
- Tired for 'a year or more', worse in the last few months; falls asleep on the sofa at eight; breathless carrying shopping up the stairs.
- Craves ice ('I chew it all day at work'), which she thinks is a funny habit.
- Diet is 'fine' — she eats meat.
Only if asked
- Periods: heavy for two or three years, worse this year. Bleeds seven or eight days, floods through a super tampon and a pad in an hour on the worst two days, passes clots 'like a 50p piece', has had to leave work twice. Cycle regular, 26 days.
- She has never mentioned this to a doctor — 'my mum was the same, it's just how we are'.
- No intermenstrual bleeding; no post-coital bleeding; no pelvic pain beyond period cramps; no pressure symptoms.
- Bowels normal; no blood in stools; no weight loss; no abdominal pain; no indigestion; no change in appetite. No nose bleeds or easy bruising.
- Not pregnant; husband had a vasectomy. Not trying for children.
- Mood: 'a bit flat', low energy, not sleeping well because she is anxious about work; no thoughts of self-harm; enjoys things when she has energy.
- Family history: mother had a hysterectomy at 45 for 'heavy periods'; no bowel cancer; no thyroid disease.
- Missed her smear because 'there's never time'.
- Work: a new head teacher, an Ofsted inspection coming; she does not want to be off sick.
Ideas, concerns and expectations
- Idea: 'I'm anaemic because I'm run down and busy'. She has not connected the periods to the anaemia.
- Concern: if pushed — 'is it something serious, like leukaemia? My colleague's husband had that'.
- Expectation: iron tablets; she would rather not be referred anywhere.
Cues to deliver, timed
- Minute 1: laughs — 'I chew ice all day, everyone at work thinks I'm mad'.
- Minute 3: if asked about periods, looks down: 'they're… a lot. I thought that was normal.'
- Minute 6: 'I can't be off — we've got Ofsted.'
How to respond to the doctor's plan
- If the doctor links the anaemia to heavy menstrual bleeding, explains the results plainly, starts iron and plans a repeat count, offers treatment for the bleeding (tranexamic acid now; discusses the hormonal coil or other options), arranges a pelvic examination and ultrasound if indicated, sends a coeliac screen, considers FIT if any bowel symptoms, books the overdue smear, and safety-nets: relieved, asks 'so it's the periods that's done this?' and 'will the coil stop my periods?'.
- If the doctor prescribes iron and nothing else: say thank you and leave; the examiner will not.
- If the doctor jumps to a gynaecology referral before offering anything: 'do I really need to go to the hospital?'
Examination findings if requested
- Pale conjunctivae; pulse 88 regular; BP 118/74; abdomen soft, no masses; pelvic examination (if the doctor describes what and why): normal-sized uterus, no adnexal mass — offer to arrange rather than perform today.
Do not
- Volunteer the periods, the ice craving's meaning, or the family history unless asked.
- Report bowel symptoms; there are none.
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 |
|
|
|
| Clinical Management & Medical Complexity |
|
|
|
| Relating to Others |
|
|
|
Global rating guide: Pass = anaemia interpreted, cause found in the menstrual history, iron plus a bleeding plan, GI cause excluded, safety-net and follow-up.
Teaching points
- NICE NG88 heavy menstrual bleeding: LNG-IUS first-line if no structural pathology; tranexamic acid or NSAID if hormonal treatment declined; ultrasound if the uterus is enlarged or there are pressure symptoms.
- Iron deficiency in a menstruating woman with a clear menstrual cause does not need endoscopy, but coeliac serology is routine and any bowel symptom triggers FIT/2WW thinking.
- The cue 'I thought that was normal' is the consultation: heavy periods are under-reported because women compare with their mothers.
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 Station 1
Revision link for this case: mdacumen.com/sca-station1-tiredness
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.