MRCGP SCA Consultation Skills Course
Station 16 · Abdominal pain
Video consultation · Health disadvantage and vulnerabilities · Long-term conditions · Prescribing · Circuit 3 · 13:15–15:15 · 20-minute station
A 45-year-old man with a learning disability attends alone with 'a bad belly'; he says yes to everything, hates the medicine, and hates needles.
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 | Kevin Marsh, 45, supported living (two hours' support daily). Attends alone; support-worker note via reception: "Kevin says his belly hurts — he can be seen alone but please explain things simply; he can ring me (Sharon) if needed." |
| PMH | Moderate learning disability; epilepsy (seizure-free 5 years); 'challenging behaviour' — olanzapine started 2018 by psychiatry, no review recorded since 2023; recurrent constipation |
| Medication | Olanzapine 10 mg nocte; lamotrigine 150 mg bd; lactulose 10 mL bd (rarely collected). Allergies: none |
| Recent entries | Annual learning-disability health check overdue (last 2024). Weight 104 kg (BMI 36). No bloods for 2 years (last HbA1c 46; lipids raised). Reasonable-adjustments flag: easy-read information; longer appointments |
Role-player script — tutors only
Delegates: please do not open this section until you have consulted at this station.
Open the role-player script (521 words)
Persona and manner
- Friendly, anxious to please; short sentences; says 'yes' to things he does not understand; looks at the door when questions are long or fast.
- Understands well when spoken to simply, one idea at a time, and can repeat a simple plan back.
Opening line — say this verbatim
- "My belly hurts. It hurts here. [points low down] Sharon said come."
Volunteer freely if given the space
- 'Hurts for days.' 'I feel sick.' 'I don't like the medicine — it tastes horrible.' (lactulose)
Only if asked, in simple language
- Last 'poo': 'Sunday' (five days ago); 'hard'; 'hurts to go'; 'I sit for ages'; no blood; 'I feel full'; passes wind.
- Eats 'chips, toast, biscuits'; drinks 'coke'; walks to the shop; no fever; no vomiting; 'had this lots of times'; once 'went to hospital with it'.
- The olanzapine 'makes me sleepy'; 'nobody asked about it for ages'. No seizures.
- 'I don't like needles' — about bloods. He has a phone; Sharon is his key worker; his sister visits monthly; likes football and trains; day centre three days.
- If asked simply whether he understands: 'hard poo needs medicine to make it soft' — 'yes, soft'. Can repeat: 'medicine, water, come back Tuesday.'
- If asked whether he can phone Sharon so the doctor can explain the plan: 'yes, Sharon knows.'
Ideas, concerns and expectations
- Idea: 'the bad belly again'.
- Concern: hospital; needles.
- Expectation: 'make it stop'; 'no needles'.
Cues to deliver, timed
- Minute 1: points; short sentences; looks at the door if the doctor talks for long.
- Minute 3: 'I don't like the medicine.'
- Minute 5: 'I don't like needles.'
How to respond to the doctor's plan
- If the doctor speaks simply and checks understanding (teach-back), assesses constipation with simple questions and screens red flags, explains and prescribes a laxative he will take (macrogol sachets; disimpaction then maintenance), gives fluid and food advice in concrete terms, flags olanzapine for review (constipation, weight, sedation) without stopping it, books the annual health check with reasonable adjustments (longer, easy-read, numbing cream for bloods, Sharon present if he wishes), asks permission to phone Sharon about the plan, safety-nets simply, and reviews in a week: he smiles — 'soft-poo medicine, drink water, come back Tuesday, Sharon comes.'
- If the doctor talks in long sentences and prints a prescription: 'yes' to everything — and leaves; the examiner will not.
- If the doctor talks about him rather than to him (e.g. 'shall we get Sharon on the phone' before asking him anything): 'I can talk.'
Examination findings if requested
- Abdomen soft, distended; palpable faecal loading left iliac fossa; no guarding; bowel sounds present; PR (offer, explain, and he may decline today): hard stool in rectum; temperature 36.8; weight 104 kg.
Background you can draw on if asked simply
- Sharon comes at nine and at five; she does the tablets in a box; Kevin 'does his own breakfast' — toast.
- He went to hospital 'a long time ago' with 'a big belly' and 'a tube' (an enema); it 'hurt' and he was frightened.
- He likes the day centre; he has a friend, Dean, who 'has the same tablets'.
- He can use his phone to ring Sharon and to look at trains. He can read a few words; pictures are better.
Do not
- Volunteer the olanzapine sedation, the hospital admission or the diet unless asked simply.
- Refuse bloods if numbing cream and Sharon are offered; refuse if 'needles' is not addressed.
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 = constipation treated with a plan he understands, olanzapine flagged for review, health check arranged with adjustments, safety-net and follow-up.
Teaching points
- LeDeR reviews repeatedly identify constipation as a cause of avoidable death in people with learning disabilities; antipsychotics, immobility and diet compound it. Macrogol-based disimpaction then maintenance is first-line.
- STOMP: psychotropics prescribed for behaviour should be reviewed regularly; the annual health check (14 years and over) is the vehicle; reasonable adjustments are a legal duty (Equality Act 2010).
- Statements 3.4 and 3.6 are the marks here: sentence length, teach-back, and who you look at.
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 16
Revision link for this case: mdacumen.com/sca-station16-abdominal-pain
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.