MRCGP SCA Consultation Skills Course
Station 14 · Weight loss
Video consultation · Children and young people · Mental health · Health disadvantage and vulnerabilities · Circuit 3 · 13:15–15:15 · 20-minute station
A sixteen-year-old attends alone about tiredness; her mother has left a message at reception asking you to check her weight — and not to say she called.
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 | Lily Turner, 16 (Year 12), attends alone |
| Reason for appointment | "Tired" (booked by patient). Reception note this morning, from mother by phone: "Please check her weight — she's stopped eating, says she's fine. Don't tell her I called." |
| PMH | Nil. Menarche 12 |
| Medication | None. Allergies: none |
| Recent entries | Weight 62 kg at 14 (height 165 cm). Today (HCA): weight 47 kg; pulse 52; BP 98/60 sitting, 86/56 standing (dizzy); temperature 35.9 |
Role-player script — tutors only
Delegates: please do not open this section until you have consulted at this station.
Open the role-player script (504 words)
Persona and manner
- Polite, guarded, large hoodie, brief answers; glances at the scales; wants a blood test and to be left alone.
- Trust builds slowly if the doctor explains confidentiality and asks without accusation; she cries only at the end.
Opening line — say this verbatim
- "I've just been really tired and cold all the time. I think it's my iron or something. Can I just have a blood test?"
Volunteer freely if given the space
- Tired; cold; 'stressed with A-levels'; periods 'irregular'.
Only if asked
- Periods absent four months.
- Eating: 'healthy — I cut out junk'; on gentle questioning: skips breakfast, salad at lunch, 'a small tea'; counts calories (about 700 a day); exercises daily; weighs herself twice a day; 'I still feel big'. No vomiting; no laxatives.
- Dizzy on standing; hair falling out; feels faint after PE; cannot concentrate; low mood, 'numb'.
- Self-harm: if asked directly and kindly — scratches her arm 'sometimes'; no suicidal thoughts.
- Friends 'worry'; a friend 'was in hospital for it'.
- She knows her mum phoned — 'she does that'. Does not want her mum 'told everything' but 'I suppose she can know I've seen you'. Her form tutor is 'safe'.
- Parents separated; lives with mother and younger brother; dance background; A-level pressure.
- If asked whether she can decide about her own care: 'I'm sixteen. Yes.'
Ideas, concerns and expectations
- Idea: iron, stress.
- Concern: 'being made to eat'; 'being sectioned'; her mum 'going mad'.
- Expectation: a blood test and 'to be left alone'.
Cues to deliver, timed
- Minute 1: the hoodie; a glance at the scales.
- Minute 3: 'I still feel big.'
- Minute 5: 'my friend was in hospital for it.'
How to respond to the doctor's plan
- If the doctor builds trust, explains confidentiality and its limits, gently explores eating and body image, recognises an eating disorder with physical red flags from the HCA readings, explains that a same-day referral to the community eating-disorder service and same-day bloods and ECG are needed and why, discusses involving her mother with her agreement (and that safety may require sharing), checks self-harm and mood, and safety-nets specifically: she cries quietly — 'will they make me eat?' and 'do you have to tell my mum?'
- If the doctor orders a blood test and reassures: 'thanks' — and she leaves; the examiner will not.
- If the doctor leads with 'your mum rang': she shuts down — 'so she's told you what to think.'
Examination findings if requested
- Use the HCA readings; add: BMI 17.3 (below 0.4th centile for age); lanugo on forearms; cool peripheries; no oedema; capillary refill 3 seconds; squat test — needs to use arms to stand.
Background you can draw on if asked
- School: predicted A grades; a teacher has 'had a word' about her looking unwell; she left PE early twice.
- Sleep: wakes at 4 a.m., cold; lies awake planning food. Mood worst in the evening.
- Her brother (12) 'teases' her about not eating; her mother 'cooks and cries'.
- She has looked at pro-recovery accounts online and 'wants to get better but not to get bigger' — say this only if the doctor asks what she wants.
Do not
- Volunteer the calorie counting, the amenorrhoea or the self-harm without direct, gentle questions.
- Refuse referral outright; agree if it is explained as help, not force.
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 = eating disorder recognised, physical risk acted on today, immediate referral, confidentiality handled, mother involved by agreement.
Teaching points
- NICE NG69: refer immediately to a community eating-disorder service; do not use single measures such as BMI as thresholds. MEED (RCPsych 2022): HR <40 (concerning <50), BP <90/60, postural drop >20 mmHg, temperature <35.5°C, rapid weight loss, electrolyte derangement — this patient has several amber-to-red markers.
- Confidentiality for a 16-year-old is the default; sharing is justified when risk is serious — say so before you need to.
- Statement 3.6: the reception note is context, not the consultation.
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 14
Revision link for this case: mdacumen.com/sca-station14-weight-loss
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.