MRCGP SCA Consultation Skills Course
Station 4 · Early pregnancy
Video consultation · Gender, reproductive and sexual health · Urgent and unscheduled care · Circuit 1 · 09:40–11:00 · 13-minute station
A 29-year-old with spotting and one-sided pain at eight weeks is not sure she wants to be pregnant — and her partner does not know.
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 | Amara Osei, 29, hospitality manager |
| Reason for appointment | "Bleeding — pregnant" (booked online this morning) |
| PMH | Chlamydia treated at 22. One termination at 24. Nil else |
| Medication | None. Allergies: none. Contraception: condoms 'mostly' |
| Recent entries | Nil in 18 months. Positive home pregnancy test recorded by reception today at booking. LMP 8 weeks ago (regular 28-day cycle) |
Role-player script — tutors only
Delegates: please do not open this section until you have consulted at this station.
Open the role-player script (589 words)
Persona and manner
- Composed on the surface, guarded, speaks quietly; glances off-camera as if someone might come in. She is at home; her partner is at work.
- Becomes tearful only if the doctor asks how she feels about the pregnancy; otherwise keeps to the physical story.
Opening line — say this verbatim
- "I did a test two weeks ago and it was positive. I've had some brown spotting since yesterday and a sort of ache low down on the right, and I just wanted to know if that's normal."
Volunteer freely if given the space
- Spotting: brown, then a little pink this morning; a panty-liner's worth; no clots.
- Pain: a dull ache low on the right for two days, 'like a stitch', worse when she walks; a sharp twinge this morning that made her stop.
- Feels 'a bit off' — tired, nauseous in the mornings, breasts sore.
Only if asked
- Pain now 4/10; no shoulder-tip pain; no faintness; no dizziness on standing; no pain on opening her bowels; no urinary symptoms.
- No previous scan this pregnancy; she has not booked with a midwife — 'I hadn't decided'.
- The termination at 24 was straightforward; she does not regret it. Chlamydia was treated; partner at the time also treated.
- This pregnancy was not planned. Partner of 18 months, Marcus; he does not know she is pregnant. 'He'd be thrilled. That's the problem — I'm not sure I am.' They have discussed children 'in a few years'.
- She is up for a promotion to area manager; her mother is unwell in Ghana and she sends money home; she is the only one in the family in the UK.
- She has not decided whether to continue; she wanted 'to know it's a real pregnancy first'. She would want to talk to Marcus before deciding but 'not today'.
- No one else knows. Her best friend is 'religious about these things'.
- Blood group unknown. Smokes two or three a day when stressed; no alcohol since the test.
Ideas, concerns and expectations
- Idea: 'a miscarriage, or maybe just normal'.
- Concern: an ectopic — she has read about it because of the chlamydia; also that a hospital visit will mean Marcus finds out.
- Expectation: to be told whether it is serious, and a scan.
Cues to deliver, timed
- Minute 1: glances off-camera — 'sorry, I'm just checking no one's home'.
- Minute 3: 'I hadn't really decided anything yet' — quiet, looking down.
- Minute 6: 'if I have to go to the hospital, do they tell my partner?'
How to respond to the doctor's plan
- If the doctor recognises the ectopic risk (one-sided pain, bleeding, previous chlamydia), arranges same-day early pregnancy assessment unit review with a clear explanation, gives red-flag advice (999 for severe pain, shoulder-tip pain, fainting, heavy bleeding), asks about her feelings about the pregnancy without judgement, reassures about confidentiality, and offers a follow-up conversation about her options whatever the scan shows: she cries briefly, then thanks the doctor and asks 'will I be able to decide afterwards?'.
- If the doctor reassures ('spotting is common, see how it goes') without arranging assessment: 'OK… and the pain on the right?' — then accept if still dismissed; the examiner will not.
- If the doctor moves straight to antenatal booking and folic acid without asking how she feels: go quiet; answer 'I suppose' to everything.
- If the doctor asks about her partner in a way that assumes he should be told: 'that's my decision'.
Examination findings if requested
- Video: no examination possible; she looks well; she can stand and walk; pulse she counts as 84. Offer that abdominal and pelvic examination will be done at the unit.
Do not
- Volunteer the ambivalence, the partner's ignorance or the family pressures unless asked.
- Report red features; there are none today.
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 = ectopic risk acted on today, red flags given, her ambivalence heard and her confidentiality protected.
Teaching points
- NICE NG126 ectopic pregnancy and miscarriage: pain and bleeding with a positive test — refer to EPAU; the combination of pain, bleeding and a risk factor (previous PID/chlamydia, tubal surgery, IUD) warrants same-day assessment; shoulder-tip pain, syncope or haemodynamic compromise → emergency.
- Ambivalence is common; the GP's job is to keep every option open and to make the decision hers — RCGP statements 3.2 and 3.6 are scored here.
- Confidentiality with a partner is absolute in an adult patient; say so before she has to ask.
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 4
Revision link for this case: mdacumen.com/sca-station4-early-pregnancy
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.