MRCGP SCA Consultation Skills Course
Station 15 · Poor sleep
Video consultation · Health disadvantage and vulnerabilities · Safeguarding · Mental health · Circuit 3 · 13:15–15:15 · 20-minute station
A 29-year-old with headaches and poor sleep 'can't be long'; her sleeves are pulled over her hands, and her partner checks her phone.
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 | Jade Morrison, 29, part-time cleaner |
| Reason for appointment | Headaches, poor sleep (booked by patient) |
| PMH | Two children (4 and 2). Postnatal low mood 2024 (self-resolved) |
| Medication | None. Allergies: none |
| Recent entries | 4 months ago: 'Fell down stairs — bruised ribs.' 9 months ago: 'Anxiety — declined referral.' Missed cervical screening ×2. Partner not registered here. Health visitor (2-year check): 'Mum seemed low; partner present throughout, answered for her.' |
Role-player script — tutors only
Delegates: please do not open this section until you have consulted at this station.
Open the role-player script (544 words)
Persona and manner
- Quiet, watchful, sleeves over hands; checks her phone twice; flinches at sudden movement; must be home by three.
- Discloses only when privacy is established and the question is direct and kind.
Opening line — say this verbatim
- "I've been getting headaches and I can't sleep. Can you give me something for it? I can't be long, I've got to get back."
Volunteer freely if given the space
- Headaches most days, 'like a band'; sleep broken; 'stressed'.
Only if asked, and only once privacy and gentleness are established
- The wrist bruise: 'I banged it on the door.' Then, if the doctor asks how things are at home: her partner 'doesn't like me going out'; checks her phone; 'gets angry'; has pushed her and grabbed her wrist — 'never hit me properly'; 'the stairs was him'.
- The children have seen him shout; he controls the money; universal credit is in his name; she has no friends left; her mother is in Scotland; no car.
- She is frightened to leave — 'he'd take the kids'. No weapons. He drinks at weekends. He has never strangled her (ask directly). She is not pregnant.
- Thoughts of 'what's the point' — no plan; the children keep her going.
- She does not want the police. She would talk to 'a woman who knows about this stuff'. She cannot have anything on paper at home; her phone is checked.
Ideas, concerns and expectations
- Idea: 'stress'.
- Concern: that he finds out she talked; the children being taken away.
- Expectation: sleeping tablets and to leave quickly.
Cues to deliver, timed
- Minute 1: sleeves; phone; 'can't be long'.
- Minute 2: the wrist bruise shows when she gestures.
- Minute 4: 'he doesn't like me going out' — only if asked something open about home.
How to respond to the doctor's plan
- If the doctor notices, makes privacy explicit, asks directly and without judgement, believes her, assesses immediate risk (escalation, strangulation, weapons, pregnancy, children, suicidality), explains confidentiality and its limits regarding the children, offers options without pressure (IDVA / local domestic-abuse service referral with consent; the national helpline given verbally or in a safe form; MARAC if high risk), documents carefully, addresses the children honestly (early help / children's social care discussion), offers a follow-up on a safe pretext, and treats the headaches and sleep proportionately: she is tearful — 'you won't tell him?' and 'what happens to the kids?'
- If the doctor prescribes for sleep and lets her go: she leaves quickly; the examiner will not.
- If the doctor tells her she must leave him or must go to the police: 'I can't' — and shuts down.
Examination findings if requested
- Fingertip bruising around the right wrist; old yellowing bruise on the upper arm; no other visible injury; blood pressure 118/76; she declines further examination today.
Background you can draw on if asked
- He is Ryan, 33, unemployed since a warehouse job ended last year; drinks Friday and Saturday; 'worse after football'.
- The children: Mia (4) has started wetting the bed again; Alfie (2) 'cries when Ryan shouts'. The health visitor is 'nice' but Ryan sits in on visits.
- She has one friend at the school gate she still talks to; a neighbour once asked if she was OK and she said yes.
- She once rang a helpline from a supermarket phone and hung up. She knows the number exists.
Do not
- Disclose if the doctor asks with the door open, in a hurry, or in a way that assumes she is at fault.
- Accept police involvement; accept a specialist referral if it is explained and safe.
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 = abuse asked about and heard, risk assessed, safe options offered, children addressed, follow-up secured.
Teaching points
- NICE PH50 and the Domestic Abuse Act 2021 (children who see, hear or experience abuse are victims in their own right): ask when alone, believe, assess with DASH, refer to IDVA/local services with consent, MARAC for high risk, and act for children — information sharing without consent is justified where a child is at risk.
- 'Can't be long' is a safety constraint, not an obstacle: respect it, and plan the next contact.
- Document injuries and her words verbatim; the record may become evidence.
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 15
Revision link for this case: mdacumen.com/sca-station15-poor-sleep
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.