MD Acumen · MRCGP SCA course · free practice resources
MRCGP SCA course · Station 9
Station 9 · Irregular pulse
A 72-year-old is telephoned about a new irregular pulse on his ECG; the drug that protects his brain is the drug his brother died on.
Reviewed and kept current
Telephone consultation · Long-term condition · Prescribing · Investigation and results · 12-minute case · 3 min reading · Last editorial review: 11 October 2026 · Next scheduled refresh: 11 April 2027 · Clinical content signed by Course Director, 11 October 2026.
Candidate instructions
Read this as you would outside the room
Read the brief as you would in the examination (RCGP: twelve consultations with simulated patients, each lasting twelve minutes, with 3 minutes' reading at the start of each). There is no reference material. Everything below the brief is folded until the consultation is over.
| Information | |
|---|---|
| Frame | You have 3 minutes to read, then 12 minutes. Telephone consultation, audio only. Everything below this brief is folded away until the consultation is over. |
| Your role | GP partner at a town practice, working the results call-back list. |
| Patient | Raymond Hurst, 72. |
| Reason for consultation | Call-back list entry: “ECG result; the nurse found an irregular pulse at his blood pressure check yesterday.” |
| Format | Telephone, audio only. You are ringing him at home; his wife is with him. You cannot examine him; the nurse's findings and the ECG report are in the record. |
Information available
The records extract, printed as it appears. Results carry units and reference ranges.
| Problem list | Hypertension. Osteoarthritis, both knees. Non-smoker. Alcohol recorded at 20 units a week. |
| Medication | Amlodipine 5 mg daily. Paracetamol when required. Allergies: none recorded. |
| Nurse, yesterday | Pulse 96, irregularly irregular. BP 152/90. Weight 84 kg. ECG: atrial fibrillation, ventricular rate 94, no acute changes (reported by the practice ECG software and checked by the nurse). |
| Bloods, today | Full blood count, urea and electrolytes, liver function, thyroid function: within range. Creatinine 88 micromol/L (60–110); eGFR 76 mL/min/1.73m². HbA1c 41 mmol/mol (below 42). |
| Other | No falls recorded. No previous stroke or TIA. Lives with his wife. Drives. |
Your task
•
Explain the ECG result and assess him by telephone.
•
Reach a working diagnosis and explain what it means for him.
•
Agree a management plan, including what he is and is not willing to take.
•
Address his concerns.
Folded away
For the role player and the observer
Open these after the consultation, or during it if you are observing. The role-player script and every marking section are public (D-76): this is practice material, not an examination.
1 · Role-player script — opening line, story, ICE, hidden facts and triggers (examination findings last)
Candidates: do not open until you have consulted.
Persona and manner
- Raymond Hurst, 72, a retired postman; steady, courteous, a little deaf (“Speak up, doctor”); your wife Jean is beside you and prompts you now and then. You become quiet and firm when warfarin is mentioned.
- You have no symptoms and do not see why a pulse you cannot feel matters.
Opening line (verbatim)
- “Hello doctor — the nurse said my heart's going irregular and you'd ring about the tracing. I feel perfectly well, I must say. Is it serious?”
The story
- “No palpitations, maybe a flutter now and then. No chest pain. No breathlessness beyond the knees. No dizziness, no blackouts.”
- “I walk the dog twice a day. I sleep well. I'm as fit as I've been.”
- If asked how long: the nurse found it; you think you have felt a flutter on and off for a few months.
- If asked: no stroke or mini-stroke; no weakness or speech trouble ever; no bleeding problems; no stomach ulcer; no falls. Four pints on a Friday and a whisky most nights, “about 20 units, maybe a bit more”.
- Your kidney function is fine; the nurse told you.
- You drive; Jean does not.
- You would take “a tablet for the rhythm” if that helps.
- Your brother Eddie had “the same heart thing”, went on warfarin, “bled into his brain and died within a week”, eight years ago, aged 70. You are convinced warfarin “thins the blood too much”. If it is raised, say firmly: “I'm not going on that stuff.”
Ideas, concerns and expectations
- Idea: “A bit of an irregular heartbeat at my age is normal.”
- Concern: Warfarin; “ending up like Eddie”. Underneath: a stroke. Jean's mother had one and lived six years unable to speak.
- Expectation: Reassurance, maybe a rhythm tablet; nothing that thins the blood.
Impact
- Driving: you drive Jean to the shops and to her sister's; losing that would matter more than anything.
- Home: Jean worries; she has read about strokes.
- Money: no concern. Work: retired.
Red flags
- Present: A stroke risk that is not trivial: age over 65, hypertension, male; a bleeding-risk factor in the alcohol; a deeply held fear of anticoagulation from a bereavement.
- Absent: No chest pain, breathlessness, syncope or heart failure symptoms; the rate is below 100; haemodynamically well.
- Absent: No previous stroke or TIA; no bleeding history; no peptic ulcer; no falls; no liver or kidney disease; no interacting drugs.
Hidden facts and their triggers
- Eddie's death on warfarin — released only only when anticoagulation is first raised; never before
- The flutter on and off for a few months — released only if asked how long this might have been going on
- The whisky most nights and the true units — released only if asked to count the drinks
- Jean's mother's stroke and what it did to her — released only if the doctor asks what worries you, or what a stroke means to you
- That driving Jean about is the thing you most fear losing — released only if asked what matters most to you
Behaviour
- Minute 1: “Speak up, doctor.” Jean's voice in the background.
- Minute 4, when anticoagulation is first raised: “My brother died on warfarin.” Flat.
- Minute 8: Jean, off the phone: “Ask him about the stroke risk, Ray.”
- If the doctor explains the rhythm and the stroke risk in plain terms with your numbers, takes Eddie's story seriously and explains how the newer tablets differ from warfarin, is honest about bleeding risk including the whisky, proposes one of the newer tablets at the right dose, explains that a rate tablet is not needed today, arranges a heart scan and a review, addresses the blood pressure, and says that driving is unaffected: listen, check with Jean, and say, “If it's not warfarin… I'll think about it. Can you send me something to read?” Agree to start.
- If the doctor says a blood thinner will be started without exploring Eddie: “No. Absolutely not.” Do not shift unless the doctor asks why.
- If the doctor accepts the refusal and offers aspirin: pleased.
- If the doctor speaks fast or in long sentences: “Sorry, you'll have to say that again.”
Examination findings, if the candidate states what they would examine and why
- None: audio-only telephone consultation. There are no examination findings to give.
- If the candidate asks what the nurse found or what you could check: pulse 96 and irregular yesterday; blood pressure 152/90; you have no monitor at home; Jean can feel your wrist if asked and says it is “all over the place”.
2 · Examiner mark sheet — generic SCA scheme plus the key facts for this case
Domain grades — with the key facts that earn a clear pass at this station
| Domain (RCGP wording) · key facts for this case | CF (0) | F (1) | P (2) | CP (3) | Score |
|---|---|---|---|---|---|
1 · Data gathering and diagnosis
| ☐ | ☐ | ☐ | ☐ | /3 |
2 · Clinical management and medical complexity (×1.5)
| ☐ (0) | ☐ (1.5) | ☐ (3) | ☐ (4.5) | /4.5 |
3 · Relating to others
| ☐ | ☐ | ☐ | ☐ | /3 |
| Case total | /10.5 |
Global rating (recorded, not added to the total): ☐ Fail ☐ Bare Fail ☐ Bare Pass ☐ Pass
The domain grades (RCGP descriptors): CP clear pass — above the standard of a newly qualified, independent GP · P pass — sufficiently demonstrated at the standard · F fail — insufficiently demonstrated at the standard · CF clear fail — clearly demonstrated below the standard.
The RCGP grades each domain CF, F, P or CP and weights clinical management and medical complexity against the other two domains; the examination's maximum is 126 over twelve cases, which is 10.5 per case. The RCGP does not publish the mark each grade carries. MD Acumen's training sheet uses CF 0 · F 1 · P 2 · CP 3, with clinical management weighted ×1.5 (0 · 1.5 · 3 · 4.5), so that a case is marked out of 10.5 and a twelve-case circuit out of 126. A P in all three domains is 7.0; MD Acumen treats that line as the training standard for a case. The examination's pass mark is set by borderline regression for each diet and is published in the RCGP's diet summary reports; it is not a fixed fraction of 126.
Weighting rationale, in the RCGP's words: “To reflect the capability coverage within the clinical management and medical complexity domain this is weighted in comparison to the other two domains.”
3 · Expanded station standard — what earns a clear pass, pass, fail and clear fail here
Written to the standard of a newly qualified independent GP; the clear-pass row describes practice above that standard. It is a debriefing aid, not a checklist: the grade is a judgement that the essentials, the italic key facts on the mark sheet, were done well, at the patient's pace and in plain language. MD Acumen training standard; the RCGP does not publish case mark sheets.
| Grade | Data gathering and diagnosis | Clinical management and medical complexity | Relating to others |
|---|---|---|---|
| CP | Checks he is well before anything else, then builds the stroke-risk picture from the record and three questions, and the bleeding-risk picture from the alcohol counted honestly and the history. Asks about mini-strokes by description. Hears “My brother died on warfarin” and stops to ask what happened, when, and what he took from it, before saying anything about treatment. Adjusts pace for his hearing from the first exchange and asks whether Jean may listen. | States his stroke risk in his own numbers and what anticoagulation does to it, recommends a direct oral anticoagulant at the correct dose for his age, weight and kidneys, and says plainly that aspirin is not a substitute. Explains why no rate tablet today and what would change that. Arranges the echocardiogram, treats the blood pressure, and makes the alcohol a bleeding-risk conversation rather than a lecture. Sends written information, involves the pharmacist, and sets the review and the safety-net. | Acknowledges Eddie's death as a loss before it is a clinical fact, and separates warfarin-then from the newer tablets-now concretely: no blood tests, a lower risk of bleeding into the brain. Uses Jean's prompt about the stroke risk as an ally without sidelining Ray. Gives the numbers in both directions and lets him weigh them. Respects “I'll think about it” as a reasonable answer, sends something to read, and agrees what happens next and who will ring whom. |
| P | Checks symptoms and stability by telephone. Establishes duration and likely persistence. Elicits the stroke-risk factors and the bleeding-risk factors (alcohol, falls, bleeding history). Explores the brother's death: what drug, what happened. Uses the record: the ECG, the bloods, the blood pressure, the weight and kidney function. Reaches a working diagnosis of atrial fibrillation with a stroke risk that warrants anticoagulation. | Recommends anticoagulation with a direct oral anticoagulant as first line at the standard dose, with warfarin only if a direct oral anticoagulant is unsuitable; states that aspirin is not used for stroke prevention in atrial fibrillation. Assesses and modifies bleeding risk: alcohol reduction, blood pressure control. No rate control today at a rate of 94 without symptoms. Arranges an echocardiogram. Steps up the blood pressure treatment. Follow-up at four weeks; safety-net for stroke symptoms, chest pain, breathlessness and bleeding. | Speaks clearly and slowly; checks his hearing; involves Jean appropriately and with his consent. Explores the brother's death before proposing treatment. Explains risk with numbers in both directions. Respects his decision-making and leaves the door open with information and a follow-up. Confirms what he will tell the pharmacist. |
| F | Reassures because he is asymptomatic and skips the stroke-risk assessment, or assesses it without the alcohol or the bleeding history. Hears “My brother died on warfarin” and moves on to the prescription. Does not ask what a stroke means to him or Jean. Does not use the normal thyroid result or the kidney function. Speaks too fast for a man who asked for the doctor to speak up. | Aspirin instead of anticoagulation. Or warfarin pushed after the brother's story. Or no anticoagulation discussion at all because he refused. A rate tablet started for a rate of 94 with no symptoms. No echocardiogram. The blood pressure left at 152/90. No written information, no review date, no safety-net for stroke symptoms. | Talks over his refusal or treats it as ignorance. Frightens him with the stroke to win the argument. Ignores Jean's presence, or talks to Jean about him without checking. Uses CHA2DS2-VASc, DOAC and anticoagulant as labels without explanation. Does not acknowledge the loss. Ends without knowing what he has decided or what happens next. |
| CF | No assessment of symptoms or stability; no stroke-risk or bleeding-risk assessment; the brother's story never heard because anticoagulation was never raised; the record not read. Or the consultation conducted at a pace and volume he cannot follow, so that nothing is gathered. | Unsafe: aspirin prescribed as stroke prevention; or warfarin insisted upon against a stated refusal with no alternative offered; or the result explained as nothing to worry about with no plan at all. He leaves with a stroke risk unaddressed and a belief about blood thinners unchanged. | Dismissive of his fear or his brother's death; argues; bullies with the stroke; speaks to Jean over his head; ends with no agreement and no door left open. No partnership, and a patient who will not pick up the phone next time. |
Where candidates lose this station
- Reassuring that an irregular heartbeat at his age is common and ending the call without the stroke-risk assessment (statement D1)
- Hearing “My brother died on warfarin” and moving straight to the prescription, so that the refusal is absolute (statement R2)
- Accepting the refusal and offering aspirin instead of anticoagulation (statement C2)
What the examiner is listening for in the last four minutes
By 8:00 the working diagnosis should have been stated: atrial fibrillation, well tolerated, with a stroke risk that warrants anticoagulation. The examiner is listening for: the direct oral anticoagulant recommended at the right dose and aspirin named as not an alternative; the difference from warfarin explained concretely; the alcohol and the blood pressure as bleeding-risk conversations; the echocardiogram and the review date; a safety-net that names face, arm and speech symptoms, chest pain, breathlessness and bleeding; the written information promised; and his own words on what he has decided and what he will tell the pharmacist.
4 · RCGP feedback statements — where underperformance was identified — with case-specific examples
The ten statements below are postulated: the feedback an examiner would most likely attach at this station, chosen from the RCGP's standardised list of 26 feedback statements that applies to every SCA case and spans the three marking domains (Data Gathering and Diagnosis; Clinical Management and Medical Complexity; Relating to Others). They are a prediction from the case content, its complexity and the marks that matter, not an examiner's record: any statement on the full list can be attached to any case, and feedback plays no part in the mark. Record the statements that applied in the practice log.
| RCGP feedback statement (postulated top ten) | Underperformance it signals (generic) | Station-specific example |
|---|---|---|
| D1 · Data gathering was insufficient to enable safe assessment of the condition/situation Data gathering and diagnosis · Data gathering and interpretation | History too thin to decide safely: the presenting problem not characterised, the essential negatives not asked. |
|
| D5 · Ineffective approach or prioritisation in data gathering, when presented with multiple or complex problems Data gathering and diagnosis · Managing medical complexity | With several problems on the table, none is prioritised; time spent on the least important. |
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| D6 · The implications of relevant findings identified during the data gathering were insufficiently recognised or understood Data gathering and diagnosis · Data gathering and interpretation | A finding or result is elicited but its meaning is not recognised or not followed up. |
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| D7 · Differential diagnoses or hypotheses were inadequately generated or tested Data gathering and diagnosis · Making diagnosis/decisions | One diagnosis assumed; alternatives not generated, or generated but not tested with a question. |
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| C2 · The management plan relating to prescribing of medication was inappropriate or not reflective of current practice Clinical management and medical complexity · Clinical management | A drug started, continued or stopped against current guidance, or without the checks it needs. |
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| C5 · The plan relating to the medical management of risk was inadequate or inappropriate Clinical management and medical complexity · Clinical management; Organisation, management and leadership | Clinical risk left unmanaged: no plan for the thing that could go wrong, or the risk not weighed. |
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| C8 · Inappropriate or inadequate arrangements for follow-up, continuity and/or safety netting Clinical management and medical complexity · Clinical management | No follow-up, continuity or safety-net, or one too vague to act on. |
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| R2 · The person's agenda, health beliefs and/or preferences were insufficiently explored Relating to others · Communication and consultation skills; Practising holistically, promoting health and safeguarding | What the person thinks is wrong, fears, or wants is not asked, or not used in the plan. |
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| R4 · Explanations were inadequately shared or adapted for the person's needs Relating to others · Communication and consultation skills | Explanation in jargon, at the wrong pace, or not adapted to the person's level and concerns. |
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| R6 · Respect and/or sensitivity shown to the person was inadequate or inappropriate Relating to others · Fitness to practise; Maintaining an ethical approach | Discourtesy, insensitivity to distress or to privacy; the person's dignity not protected. |
|
The full list of 26 statements, with the generic meaning of each, is on the exam and the mark scheme.
5 · Examiner points of fact and guidelines
Points of fact the examiner should have to hand
Each statement is drawn from the named guideline, in its current version, with the date it was checked. The examiner marks against these facts; the candidate is not expected to quote them.
- Offer anticoagulation to people with atrial fibrillation and a CHA2DS2-VASc score of 2 or above, taking bleeding risk into account; consider it for men with a score of 1; do not withhold anticoagulation solely because of a risk of falls. A 72-year-old man with hypertension scores 2 (age 65 to 74; hypertension). NICE — NG196 Atrial fibrillation: diagnosis and management, section 1.5, assessing stroke and bleeding risk; section 1.6, anticoagulation, 2021, last updated June 2021, checked 10 Oct 2026
- When offering anticoagulation, offer a direct-acting oral anticoagulant (apixaban, dabigatran, edoxaban or rivaroxaban); offer a vitamin K antagonist only if a direct-acting anticoagulant is contraindicated, not tolerated or not suitable. Do not offer aspirin monotherapy solely for stroke prevention in atrial fibrillation. NICE — NG196 Atrial fibrillation: diagnosis and management, section 1.6, anticoagulation, 2021, last updated June 2021, checked 10 Oct 2026
- Use the ORBIT bleeding risk score to assess bleeding risk, and address modifiable risk factors: uncontrolled hypertension, poor INR control on a vitamin K antagonist, concurrent medication such as aspirin or NSAIDs, harmful alcohol consumption, and reversible causes of anaemia. NICE — NG196 Atrial fibrillation: diagnosis and management, section 1.5, assessing stroke and bleeding risk, 2021, last updated June 2021, checked 10 Oct 2026
- Apixaban for stroke prevention in non-valvular atrial fibrillation: 5 mg twice daily; reduce to 2.5 mg twice daily only if at least two of age 80 or over, body weight 60 kg or less, or serum creatinine 133 micromol/L or more, or if creatinine clearance is 15 to 29 mL/min. A 72-year-old of 84 kg with a creatinine of 88 meets none of the reduction criteria. BNF (NICE) — Apixaban, indications and dose; dose adjustments, current BNF online, checked 10 Oct 2026
- In the large trials, the direct-acting anticoagulants caused about half as much intracranial haemorrhage as warfarin, do not require INR monitoring, and have fewer food and drug interactions; this is the concrete difference to explain to a person whose fear of anticoagulation comes from warfarin. NICE CKS — Anticoagulation, oral, background: direct-acting oral anticoagulants compared with warfarin, current online version, checked 10 Oct 2026
- Offer rate control as first-line treatment for most people with atrial fibrillation, with a standard beta-blocker or a rate-limiting calcium-channel blocker, when symptoms or a persistently raised ventricular rate warrant it; a person with no symptoms and a resting rate below 100 does not need rate control to be started at diagnosis. Perform echocardiography when a baseline is needed for long-term management. NICE — NG196 Atrial fibrillation: diagnosis and management, section 1.7, rate and rhythm control; section 1.2, echocardiography, 2021, last updated June 2021, checked 10 Oct 2026
- Group 1 drivers with atrial fibrillation may continue to drive and need not notify the DVLA provided there are no distracting or disabling symptoms; driving must stop if the arrhythmia has caused or is likely to cause incapacity. DVLA — Assessing fitness to drive: cardiovascular disorders, arrhythmias, 2024 edition, checked 10 Oct 2026
- The UK Chief Medical Officers' low-risk drinking guideline is not more than 14 units a week spread over three or more days; harmful alcohol consumption is a modifiable bleeding risk in people taking an anticoagulant. NICE CKS (citing the UK Chief Medical Officers' 2016 guideline) — Alcohol, problem drinking, background: the low-risk drinking guideline and unit calculation, current online version, checked 10 Oct 2026
- The 2024 ESC guideline organises care around AF-CARE: comorbidity and risk-factor management; avoidance of stroke and thromboembolism; reduction of symptoms by rate and rhythm control; and evaluation with dynamic reassessment. Stroke risk is scored with CHA2DS2-VA, which no longer counts sex: oral anticoagulation is recommended at a score of 2 or more and should be considered at a score of 1. A direct oral anticoagulant is preferred to a vitamin K antagonist except with a mechanical heart valve or moderate-to-severe mitral stenosis. A 72-year-old man with hypertension scores 2. ESC — 2024 ESC Guidelines for the management of atrial fibrillation, developed in collaboration with EACTS, the AF-CARE pathway; stroke risk assessment and oral anticoagulation, 2024, checked 10 Oct 2026
- Bleeding risk is assessed to find and correct modifiable factors, uncontrolled hypertension, excess alcohol, concomitant antiplatelet or anti-inflammatory drugs and anaemia among them, and not to decide against anticoagulation: a bleeding score is not used to withhold a direct oral anticoagulant, and antiplatelet therapy alone is not used for stroke prevention in atrial fibrillation. Where rate control is needed, a beta-blocker, diltiazem, verapamil or digoxin is first line, with an initial lenient target of a resting rate below 110 a minute. ESC — 2024 ESC Guidelines for the management of atrial fibrillation, developed in collaboration with EACTS, bleeding risk and modifiable factors; rate control, 2024, checked 10 Oct 2026
- For adults under 80 with hypertension the clinic target is below 140/90 mmHg, or a home average below 135/85. A reading of 152/90 on amlodipine 5 mg is above target: confirm adherence and that the dose is optimised, then step up by adding an ACE inhibitor, an angiotensin receptor blocker or a thiazide-like diuretic to the calcium-channel blocker. Blood pressure is rechecked when the anticoagulant is reviewed, because uncontrolled hypertension raises both stroke risk and bleeding risk. NICE — NG136 Hypertension in adults: diagnosis and management, blood pressure targets; choosing antihypertensive drug treatment, step 2, NG136, 2019, last updated November 2023, checked 10 Oct 2026
- Outside hospital, sudden neurological symptoms are screened with a validated tool such as FAST (face, arm, speech, time), and a positive screen is a 999 call for immediate admission to a stroke unit. A person whose symptoms have resolved, a suspected transient ischaemic attack, is given aspirin 300 mg immediately unless contraindicated and referred for specialist assessment within 24 hours; the symptoms are not dismissed because they have passed. NICE — NG128 Stroke and transient ischaemic attack in over 16s: diagnosis and initial management, section 1.1, rapid recognition of symptoms and diagnosis; section 1.2, initial management of suspected TIA, 2019, checked 10 Oct 2026
- The Cardiovascular health Topic Guide expects the GP to recognise atrial fibrillation on examination and ECG, to assess stroke and bleeding risk with validated tools, to prescribe and monitor anticoagulants safely, to explain absolute risk in both directions so that the patient can share the decision, to manage the comorbidities that drive the risk, hypertension and alcohol among them, and to apply the DVLA rules when a cardiovascular diagnosis is made. RCGP — GP curriculum: Cardiovascular health, Topic Guide: knowledge and skills, Being a GP, 2025 curriculum, checked 10 Oct 2026
Working references for this station
| Issuer | Document | Version | Checked |
|---|---|---|---|
| NICE | NG196 Atrial fibrillation: diagnosis and management | 2021, last updated June 2021 | 10 Oct 2026 |
| BNF (NICE) | Apixaban | current BNF online | 10 Oct 2026 |
| NICE CKS | Anticoagulation, oral | current online version | 10 Oct 2026 |
| DVLA | Assessing fitness to drive: cardiovascular disorders | 2024 edition | 10 Oct 2026 |
| NICE CKS (citing the UK Chief Medical Officers' 2016 guideline) | Alcohol, problem drinking | current online version | 10 Oct 2026 |
| ESC | 2024 ESC Guidelines for the management of atrial fibrillation, developed in collaboration with EACTS | 2024 | 10 Oct 2026 |
| NICE | NG136 Hypertension in adults: diagnosis and management | NG136, 2019, last updated November 2023 | 10 Oct 2026 |
| NICE | NG128 Stroke and transient ischaemic attack in over 16s: diagnosis and initial management | 2019 | 10 Oct 2026 |
| RCGP | GP curriculum, Topic Guides: Cardiovascular health · Older adults · Continuity and quality of care, safety and prescribing | Being a GP, 2025 curriculum | 10 Oct 2026 |
13 statements, 767 words. Every statement is signed by the Course Director before it is published; a station whose facts have changed since signature carries no signature line until it is signed again.
This case's topic and its signed Golden Triangle, for review after the station.
Golden Triangle
Atrial fibrillation
Knowledge Green · Evidence Green · Real-world Amber
Not yet at the Equinox · UK (NHS England) · as of 8 October 2026 · How the triangle works
6 · RCGP curriculum tags for this case
| RCGP curriculum (2025) | This case |
|---|---|
| Topic Guide(s) | Cardiovascular health · Older adults · Continuity and quality of care, safety and prescribing |
| Core capabilities | Data gathering and interpretation · Clinical management · Communicating and consulting · An ethical approach |
| SCA Clinical Experience Group(s) | Long-term condition, including cancer, multi-morbidity, and disability · Prescribing · Investigation / Results |
| AKT blueprint clinical area | Cardiovascular medicine (broader representation) |
| Case type | results |
| Modality | telephone |
7 · My marks and reflection — practice log form
Record your three domain grades, your case total out of 10.5, your global rating, the RCGP feedback statements that applied, and what you will keep and change. The form is already labelled with this case and its web address; a copy of your entry is emailed to you, so your practice log builds up in your inbox and can be downloaded.
Record my marks and reflection for SCA-09
Revision link for this case: mdacumen.com/sca-station9-atrial-fibrillation
Independence & scope. Formative training material from MD Acumen Ltd; not a prediction of exam performance. Not affiliated with, endorsed by, or delivered on behalf of the Royal College of General Practitioners; the marking domains and feedback statements are the RCGP's published ones, and every descriptor on this page is an Acumen training tool calibrated to them. Clinical content reflects UK guidance at the date of editorial review — always check the current guideline. All patients are fictional.
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