Verbatims & Reflections
Old-school? Not a chance. A pen, a blank page, and a quiet room β still one of the sharpest teaching tools we have.
Videos are brilliant. COTs are essential. But sometimes the sharpest insight comes from a trainee slowly writing out β word for word β what was actually said. Verbatims slow the consultation down so we can see the bits that normally rush past us. This page shows you why they still matter, how to run them well, and how to use them to unlock real progress in all three SCA domains.
π₯ Downloads
Handouts, sample verbatims, and teaching extras β ready when you are. Drop them into a tutorial, edit them, or use them as a template for your own.
path: VERBATIMS & REFLECTIONS
π Web Resources
A hand-picked mix of official guidance and real-world GP training resources. Because sometimes the best pearls aren't hiding in the official documents.
β±οΈOne-Minute Recall
If you read nothing else on this page, read this.
π What it is
A verbatim is a written, word-for-word recollection of a consultation β as close as memory will allow β followed by a structured reflection. No camera. No microphone. Just the trainee, a pen, and the conversation as they remember it.
π― Why it's powerful
Writing it down forces the trainee to slow time. They notice cues they missed, phrases they regret, gaps in empathy, and moments the consultation quietly went off the rails. Video rushes past; verbatim sits still.
π When to use it
Brilliant for sensitive trainees, IMGs building confidence, intimate or distressing consultations, remote or audio cases, and any time you want to target language rather than behaviour.
π The One-Line Summary
A verbatim doesn't replace video, COT or audioCOT β it complements them. It's the one method that lets you teach the words, not just the skills.
π‘Why This Matters In GP Training
GP training is drowning in consultation feedback tools. So why bother adding verbatims into the mix?
π¬ Video shows the outside
Cameras catch body language, tone, and structure. But trainees rarely remember the exact words they said β and exact words are where patients get hurt or healed.
βοΈ Verbatim shows the inside
Writing forces the trainee to own their words. What did I actually say? How might that have landed? Would I say it again? This is the place real insight appears.
π§ It rehearses the SCA mindset
The SCA is scored on three domains that are largely about language choices. Verbatim work trains trainees to hear themselves consulting β which is exactly what the SCA is testing.
π It is gentler
Video exposes everything. Verbatim can be deliberately blurred, anonymised, and softened β helpful for nervous trainees, sensitive cases, and trainers who want to teach the skill without exposing the person.
πWhat Is A Verbatim?
A verbatim is simple to describe and surprisingly hard to do well.
A verbatim is a written recollection of a consultation, reconstructed word for word (or as close to word for word as memory allows) and then analysed by the trainee β ideally with a trainer or small group. It originates from clinical pastoral education in the 1920s and has quietly travelled across healthcare training ever since, including into palliative care fellowships where it is well evidenced as a deep reflection tool.
The key ingredients are these:
Brief demographics and setting.
The dialogue as remembered, in script form.
What the trainee was thinking and feeling.
Analysis of what happened, and what to change.
Two flavours of verbatim
Verbatims come in two useful forms. Both have their place β and they are used very differently in tutorials.
π§ Self-verbatim
The trainee writes out one of their own consultations from memory, shortly after the encounter. Uncomfortable but very illuminating.
Best for insight Best for SCA prepπ Prepared verbatim
A pre-written script of a consultation (real or composed) that the trainee has not been involved in. Used to teach skills without exposing the trainee.
Best for nervous trainees Best for group teachingπ§¬The Anatomy Of A Good Verbatim
A useful verbatim has four layers. Each layer pays back in a different way.
β οΈ The most commonly missed layer
The inner monologue is what makes a verbatim different from a transcript. Without it, you just have a script. With it, you have a window into why the trainee made the choices they made. Always ask for it.
βοΈVerbatim vs Other Consultation Teaching Methods
Each tool teaches something different. None is a substitute for the others.
| Method | What it captures | Main strength | Main limitation | Best for |
|---|---|---|---|---|
| Video / COT | Full behaviour, body language, structure, tone | Most objective β you can't argue with the tape | Exact words often slip past; camera-shy trainees freeze | Structural feedback, non-verbal skills |
| AudioCOT | Voice, pace, phrasing, silence | Closer to the SCA format (often audio) | No visual cues; still under time pressure to review | Telephone skills, voice, SCA prep |
| Sitting-in | Live moments, real-time cues, reactions | Immediate, rich, interactive | Trainee performs for the trainer; one-off | Early training, modelling, complex cases |
| CbD | Clinical reasoning, decisions, rationale | Depth of thinking, ethical reasoning | Misses interpersonal texture | Decision-making, complexity |
| βοΈ Verbatim | Exact language, inner thoughts, sequence | Teaches words, phrasing, and self-awareness | Relies on memory; trainees may sanitise themselves | Language, empathy, SCA phrasing, sensitive cases |
π§When To Use A Verbatim
Not every tutorial needs one. But there are specific moments when a verbatim beats every other tool.
β Reach for a verbatim whenβ¦
- The trainee is camera-shy or self-conscious on video.
- The consultation was emotionally heavy (breaking bad news, bereavement, mental health).
- You want to focus on language and phrasing, not behaviour.
- The case was a telephone consultation and there is no video to review.
- A specific moment in a consultation haunted the trainee and they need to process it.
- You are working with an IMG building English consultation idiom.
- You are preparing directly for the SCA β especially the Relating to Others domain.
- The trainee has had a patient complaint or significant event and needs to reconstruct what was said.
β οΈ Reach for something else whenβ¦
- You primarily need to assess examination or non-verbal skills (use video).
- The trainee is very early in training and needs modelling rather than analysis.
- You only have 10 minutes β a proper verbatim session needs space.
- The trainee is at ARCP risk β you need objective evidence, which video provides better.
- You want to assess a full competency formally β use a COT or MiniCEX.
πHow To Run A Verbatim Session
A structured walk-through. Follow the steps. You will be surprised how much comes out of it.
Before the session
During the session
π‘ The single biggest trick
Read the verbatim aloud in the tutorial β trainer as patient, trainee as doctor. Hearing their own words spoken back at them, out loud, is often when the penny drops. You cannot replicate this with silent reading.
After the session
- Ask the trainee to write a brief follow-up reflection for the 14Fish ePortfolio within 48 hours. Fresh insight fades fast.
- Agree one skill to consciously work on in the next week. Write it down.
- Revisit it in the next tutorial: "Did you try that new phrase? How did it land?"
π―SCA Domain Targeting With Verbatims
This is where verbatims genuinely shine. The SCA is marked across three domains β and a verbatim can target each one in very different ways.
The three SCA domains β quick refresher
Each SCA case is marked across Data Gathering & Diagnosis (DG), Clinical Management & Medical Complexity (CM), and Relating to Others (RTO). A verbatim lets you zoom in on whichever of these a trainee is losing marks on. Different questions unlock different domains.
π©Ί Data Gathering & Diagnosis
Systematic, targeted information gathering. Red flags. Psychosocial context. Hypothesis-testing.
π Clinical Management & Medical Complexity
Safe, patient-centred management. Co-morbidity. Prioritisation. Safety-netting.
π€ Relating To Others
Rapport, cues, ICE, shared decision-making, language, empathy.
π©Ί Using verbatims for Data Gathering (DG)
The verbatim is a gift for this domain because it lays bare the order and type of the questions the trainee asked. Most DG weaknesses are not missing questions β they are asking them in the wrong order, or asking closed before open.
What to look for in the verbatim
π΅ Facilitator moves for DG
- Highlight the first three questions. Open or closed? What does that tell us?
- Circle any patient cues. Were any left behind?
- Role-play the first 90 seconds again. Practise one open opener.
- Ask: "If you could hear yourself asking one better question here, what would it be?"
π Using verbatims for Clinical Management (CM)
CM is less about the words and more about the shape of the management. But the verbatim still reveals a lot β because the way a plan is delivered often shows whether the plan was actually safe and shared.
What to look for in the verbatim
π£ Facilitator moves for CM
- "Read me the plan back in the trainee's actual words. Would the patient be clear what to do?"
- "What would have happened if the patient had stopped listening halfway through?"
- "Where would NICE or CKS put this plan β safe, borderline, or unsafe?"
- "Write out one alternative plan that would also have been safe. Which one fits this patient better?"
π€ Using verbatims for Relating to Others (RTO)
This is where verbatims earn their keep. The RTO domain is almost entirely about language β the exact words the trainee chose. Rapport, cue exploration, ICE, shared decision-making, empathy, verbalising thinking β all of it lives in the text of the verbatim.
What to look for in the verbatim
π’ Facilitator moves for RTO
- Highlight the single most empathic line. Highlight the single most doctor-centred line. Compare.
- "Which word, if changed, would have changed the whole feel of this consultation?"
- "Where could you have said less and let the patient say more?"
- "If you replayed this moment, what phrase would you use that you've been practising?"
π Verbatim focus areas by SCA domain β at a glance
| Domain | What to highlight in the script | Example facilitator opener |
|---|---|---|
| DG Data Gathering |
Open-to-closed ratio, cue follow-up, red flag questions, psychosocial questions, hypothesis-testing out loud. | "Walk me through the first 90 seconds. What did your questions tell the patient about how you were thinking?" |
| CM Clinical Mgmt |
Plan delivery, options offered, co-morbidity, concrete safety-netting, follow-up, understanding check. | "Read me the plan back as the patient would have heard it. Was it clear, safe, and shared?" |
| RTO Relating |
Rapport, ICE, cues, empathy lines, shared language, jargon, silence, shared decisions, closing. | "Which single line here do you most wish you hadn't said? And why?" |
π£οΈFacilitator Phrases To Open Insight
These are the exact phrases that crack open reflection. Keep a small handful in your back pocket. Under pressure, a good question is more useful than any framework.
Ground rule. In verbatim work, the facilitator asks β the trainee answers. If you find yourself lecturing more than listening, stop. Your job is to make them think, not to show them you've already thought.
π± Opening the session
π Opening insight (the trainee's own view)
π Exploring inner thoughts & feelings
πͺ Surfacing blind spots (without shaming)
π§ Moving towards alternatives
π Linking to SCA domains
π― Closing the session
π‘ The facilitator's golden rule
After you ask a question, shut up. Let the silence sit. Trainees reach their best insight about seven long seconds after you think they've finished. Count to seven in your head before filling the space.
πReflection Frameworks Worth Using
You don't need a framework to reflect. But one is useful when reflection feels stuck, shallow, or forced β which, for many trainees, is often.
Gibbs' Reflective Cycle
The most widely used model in UK GP training. It fits the 14Fish ePortfolio learning log structure almost perfectly, and it translates beautifully onto a verbatim.
β How to apply Gibbs to a verbatim
The verbatim script itself covers Description. The inner monologue covers Feelings. Your facilitator questions then walk the trainee through Evaluation β Analysis β Conclusion β Action plan. It maps almost line-for-line.
Other frameworks worth knowing
Kolb's Experiential Learning Cycle
Concrete Experience β Reflective Observation β Abstract Conceptualisation β Active Experimentation. Particularly good when the trainee wants to try something different next week.
Johns' Model of Structured Reflection
More personal and emotional β asks about intentions, feelings, ethical dimensions and self-awareness. Good for difficult emotional cases.
The "What? So What? Now What?" model
Simple, robust, memorable. Great when a trainee is reflection-averse or under time pressure. You can run a mini-verbatim with just these three questions.
β οΈ A warning about forced reflection
Research with UK IMGs has highlighted that reflection can feel performative β "written for whoever might read it" β especially when tied to ARCP assessment. Verbatims are most useful when the trainee feels genuinely curious, not when they feel judged. Protect the psychological safety of the session fiercely.
π§°Feedback Models That Fit Verbatim Work
A verbatim is worthless without good feedback around it. These are the three models that pair best with verbatim teaching.
| Model | Core idea | Strengths | Watch-outs |
|---|---|---|---|
| Pendleton's Rules | Positive first, then areas to improve β trainee speaks before trainer. Structured and predictable. | Safe, familiar, easy for new trainers. Good for psychologically sensitive trainees. | Can feel formulaic; trainees often dismiss the "positives" and wait for the criticism. |
| ALOBA (Silverman) |
Start with the trainee's agenda. What do they want help with? Then work toward outcomes they care about. | Learner-centred, reduces defensiveness, beautifully suited to verbatim work. | Needs a facilitator experienced enough to keep balance; inexperienced trainers may under-praise. |
| SET-GO (part of ALOBA) |
What I Saw, what Else did you see, what do you Think, what Goal, any Offers? | Very specific and descriptive. Forces facts over opinions. Great for language-level teaching. | Takes practice; can feel stilted if read off a script. |
π΅ Our recommendation for verbatim work
Use ALOBA as the overall frame and SET-GO for the micro-level dialogue around specific lines in the script. Pendleton is a safe fallback when the trainee is anxious or when you're still building the relationship. The best trainers mix and match.
π£ The Emotional Bank Balance (Bradford VTS)
Before any feedback β verbatim or otherwise β imagine the trainee has an emotional bank account. You need deposits (genuine warmth, specific praise, noticed effort) before withdrawals (constructive criticism). Run the account into overdraft and you lose them. This holds especially true in verbatim sessions, because the trainee is exposed in a very personal way.
πA Worked Example
A short excerpt from a trainee verbatim, and the kind of facilitation that turns it into learning.
Setting: 38-year-old woman, telephone consultation, booked for "tiredness". 6 weeks of fatigue.
How a trainer might work this verbatim
β What went well
- Warm opening, identified the patient clearly.
- Asked about some red flags (weight loss, sweats, fevers).
- Acknowledged the need for investigations.
π΄ What the verbatim reveals
- RTO: Patient dropped a major cue ("stressful time at work") β trainee walked past it.
- RTO: No ICE whatsoever. Who thought this up? What is she worried about? What did she want from the call?
- DG: Closed questions took over after 30 seconds. No narrative allowed.
- DG: No mood, sleep, or psychosocial screening β on a 6-week fatigue case.
- CM: Plan was delivered as a monologue, not shared. No clear safety-netting.
- CM: "Anything else?" as a closer β functional, not inviting.
Sample facilitator dialogue
β οΈCommon Pitfalls
Verbatim sessions can go wrong in predictable ways. Knowing the traps helps you avoid them.
For trainers / facilitators
π« Turning it into an interrogation
Too many "why didn't youβ¦?" questions and the trainee clams up. Rephrase as "what made you choose toβ¦?" β curious, not accusatory.
π« Skipping the agenda
Starting with the trainer's agenda instead of the trainee's. Always ask first: "what do you want from this?"
π« Reading silently
Reading it to yourselves in your heads. Always read aloud. The insight is in the voicing.
π« Teaching, not facilitating
Taking over and explaining what should have happened. Hold back. Ask one more question.
π« Ignoring the emotion
Jumping to skills when the trainee is clearly still processing a distressing case. Sit with the feeling first.
π« No action point
A beautiful hour of reflection with nothing to try on Monday. Always agree one concrete change.
For trainees
π¬ Sanitising the script
Writing what you wished you'd said. Write what you actually said. The flaws are the learning.
π¬ Skipping the inner thoughts
Delivering a neat dialogue without your actual feelings. Don't. The inner monologue is often the whole point.
π¬ Leaving it for days
Write it up within 24 hours. Memory decays fast β and sanitises as it decays.
π¬ Picking only "good" consultations
Bring the one that unsettled you. That's where the learning is.
π«ΆUsing Verbatims For Sensitive Or Struggling Trainees
Some trainees crumble in front of a camera. Some have been badly handled in the past. Some are IMGs navigating English consultation idiom for the first time. Verbatims can be a gift to all of them β if used carefully.
π₯ The camera-shy trainee
Use prepared verbatims first β scripts of other people's consultations. Build analytical skill with no personal exposure. Progress to self-verbatim only when rapport is strong.
π The IMG building idiom
Verbatims are brilliant for teaching the idiomatic phrases of UK general practice β the small, soft, patient-centred language that doesn't always exist in other medical cultures. Go slow, build a phrase library, and celebrate small wins.
π The trainee in difficulty
For trainees at ARCP risk, verbatims can complement β but not replace β objective evidence. Use them to build insight. Combine with COT/video for formal assessment.
π After a distressing case
Verbatim after a difficult consultation (death, complaint, breaking bad news, safeguarding) can be powerfully containing. Focus on feelings first, skills second.
π§ The insightful but awkward trainee
Some trainees have sharp analytical minds but wooden delivery. Verbatim work, rehearsed aloud, bridges the gap between knowing the right thing to say and actually saying it warmly.
π The repeat SCA candidate
After a failed sitting, RCGP feedback statements name the domain weaknesses. A verbatim is then the most targeted tool β you can literally build a language library for the domain they lost marks on.
π Psychological safety checklist
- Agree confidentiality explicitly at the start.
- Make clear the session is formative β not feeding into ARCP unless you both agree.
- Lead with strengths, every time.
- Notice emotion. Name it. Don't rush past it.
- End warmly. Thank them for their courage.
πTrainer & Teaching Pearls
The bits that make the difference. Little moves that turn an ordinary verbatim session into a memorable one.
Discussion prompts for tutorials
- Which line in this verbatim are you most proud of? Why?
- Which line would you most like to take back?
- Where did the patient tell you something, and you didn't hear it?
- If the patient wrote their own verbatim of the same consultation, what would it look like?
- Where would a kind, wise senior GP have done something different?
- What assumption did you bring into the room that shaped how you listened?
π₯What Trainees Say β Real-World Wisdom From The Ground
These insights come from UK GP trainee blogs, VTS shared experience, forum threads, trainee survival guides, and passing-candidate accounts of the SCA. We have carefully checked each one against RCGP and educator guidance β anything that clashed has been left out. These are the things trainees consistently wish they had known earlier.
What trainees say makes verbatim & reflection work stick
When trainees describe the moments reflection and verbatim work actually changed their consulting, five themes come up again and again. This ring shows how often each one appears in trainee accounts β a rough picture, not a scientific study.
Real trainee voices β the things that keep coming up
These are the patterns that show up in trainee accounts, tidied into clear language. Nothing here contradicts RCGP or NICE β every point is safe advice that a good trainer would also give.
"Most of my fail marks were not about what I did. They were about what I said β and how I said it. Writing my consultations down was the first time I saw the words clearly."
"I kept saying 'okay' and 'right' after every sentence. I had no idea until I wrote the consultation out. The patient was trying to tell me she was scared and I was just ticking her along."
"The best thing my trainer did was play the patient while I read my own lines. I could hear how my explanation sounded. I don't think I would have changed anything otherwise."
"Time management looked like my problem. It wasn't. My problem was that I didn't commit to a working diagnosis out loud by minute six, so everything after that was rushed."
"As an IMG I passed when I stopped trying to sound 'more British' and started collecting real phrases from real GPs around me. I wrote them down. I practised them out loud. It changed the feel of my whole consultation."
"I thought reflection was something you wrote for the ePortfolio. When my trainer used a verbatim in a tutorial, I realised reflection was actually something you do with yourself β and the writing was just the evidence of it."
"I used to pick my best consultation for the tutorial. Waste of time. Now I bring the one that bothered me β even if it didn't 'go wrong'. That's where the learning is."
"Practise back-to-back cases, not just one at a time. Consulting is hard when you are tired. That's what SCA day actually feels like."
"Joining more than one study group helped me more than anything. Different trainees hear different things. The same line that one group loved, another group told me sounded cold."
π‘ Insider tips distilled from trainee experience
π‘ The "one word" principle
Trainees often report that a single word change lifted a whole consultation β "should" to "could", "but" to "and", "actually" to nothing at all. Verbatim work lets you find and practise these one-word swaps.
π‘ The six-minute rule
Aim to have a working diagnosis on the table by around minute six of a twelve-minute consultation. This is consistent with the RCGP SCA toolkit, and it leaves real time for management. Verbatims let you see exactly where the six-minute mark fell in your own consultations.
π‘ The "anything else?" trap
Ending with a flat "Anything else?" gets a flat "No." Try "Was there anything else on your mind you wanted to talk about today?" β an invitation, not a tickbox. Trainees frequently name this as a marks-gaining swap.
π‘ Bring the case that bothered you
A recurring theme from trainee accounts: the best verbatim is not the polished one, it is the one that left a knot in your stomach. The discomfort is the entry point to learning.
π‘ Compartmentalise and move on
If a consultation (or an SCA case) goes badly, finish it cleanly and move on. Brooding on case 3 during case 4 costs you marks twice. Verbatims after the event help you process the difficult case later, safely.
π‘ Record, then re-listen alone first
Before a tutorial, many trainees find it useful to listen back to a consultation on their own and make notes. You notice more if you have already met your own voice once.
β οΈ Common mistakes trainees name themselves
π« Jumping into closed questions too fast
Most trainees realise, on reading their verbatims, that they shut the patient down after 30 seconds. Open questions for the first 60β90 seconds is a small change that shifts the whole consultation.
π« Not verbalising clinical thinking
The RCGP specifically flags "thinking aloud" as a key skill. Trainees often write verbatims and realise the patient never heard why they were being asked a question.
π« Vague safety-netting
"Come back if it gets worse" is not safety-netting. Concrete triggers ("If this pain wakes you at night, or if you start vomiting, ring us or call 111") are what examiners reward β and what keeps patients safe.
π« Assuming empathy, not showing it
Trainees often say they felt empathy but, on reading their verbatim, cannot find a single line where they expressed it out loud. Empathy needs to be spoken, not thought.
π― What candidates say actually gets you marks
Pulled from trainees who passed, and consistent with RCGP and educator advice:
- Being warm in the first ten seconds β rapport is the ground everything else stands on.
- Eliciting ICE (ideas, concerns, expectations) in the patient's own words β not your words.
- Making one clear working diagnosis by minute six.
- Offering at least two management options where reasonable β never one.
- Specific, named safety-netting with a timeframe.
- Checking the patient's understanding with a warm open question, not a clinical tickbox.
βΆοΈInsights From UK GP Educator YouTube Channels
There is a lot of GP training content on YouTube. Most of it is either non-UK, outdated, or aimed at hospital medicine. A small group of UK-focused channels genuinely teach SCA-relevant consultation skills well. We have distilled their repeated teaching points into educational principles β checked against RCGP and NICE β and dropped anything that did not align.
How UK GP educators teach SCA consultation language β a hierarchy
Watch enough UK GP teaching videos and a pattern emerges. Good consultation language is built in layers. Master the lower layers first β the higher ones only work when the base is solid.
π’ How to use this hierarchy in a verbatim session
Highlight each layer in a different colour on the trainee's script. Most nervous trainees have Layer 1 and Layer 2 covered, but are weak or silent at Layers 3 and 4. Layer 5 is where the biggest SCA marks hide β because these moments separate a passing candidate from a clearly-passing one.
Key teaching points distilled from UK GP educator videos
Each block below summarises teaching that recurs across multiple UK-based GP training videos. All of it sits comfortably alongside RCGP and NICE guidance.
In the first minute of the consultation, stop talking. Ask one clear open question, then let the patient speak. UK educators return to this again and again β it sets the tone for the whole consultation and protects Data Gathering marks.
- Opening line: "How can I help you today?" or "Tell me what's been going on."
- Then: silence. Nods. "Mm-hmm." Let them finish.
- Only start closed questions once the patient has told their story their way.
ICE is not a tickbox. Good UK teaching shows it done as a natural, curious conversation that surfaces the patient's real agenda. Verbatims are where you catch yourself asking ICE in a way that feels tacked-on.
- "What's been going through your mind about this?" β for ideas.
- "What's worrying you most?" β for concerns.
- "What were you hoping we might do today?" β for expectations.
A cue is any moment a patient hints at something they have not yet said openly. Good UK teaching treats cues as gold β and verbatims are the best tool for spotting the ones you walked past.
- Verbal cues: "It's been a stressful yearβ¦", "My partner is worriedβ¦", "It's probably nothing butβ¦"
- The move: stop, repeat the cue back softly, and wait. "A stressful year β tell me about that."
UK educators consistently teach: signpost your explanation, chunk it, check understanding. The SCA rewards this more than it rewards a complete list of facts.
- Signpost: "I want to explain what I think is going on β I'll keep it simple."
- Chunk: one idea at a time, then pause.
- Check: "Does that make sense so far?" β warm, not clinical.
UK GP teaching places a lot of weight on analogies β they make explanations memorable, patient-centred, and SCA-friendly. A good trainee collects them like currency.
- Hypertension: "Your heart is like a pump, and your blood vessels are like hosepipes β the pressure inside has been running too high."
- IBS: "Your gut muscles are a bit over-sensitive β they squeeze harder than they need to."
- Asthma: "The airways are like garden hoses that tighten up in certain conditions."
UK teaching videos emphasise that a good plan is never a monologue. It is built with the patient. This aligns fully with NICE shared decision-making guidance.
- Offer options where they exist β never default to one.
- State pros and cons simply.
- Ask: "Which of these feels right for you?"
- Close the loop: "So the plan we've agreed isβ¦"
Several UK-focused channels run whole videos on how to handle emotionally difficult SCA moments. The core teaching is remarkably consistent.
- Name the emotion: "I can see this is really hard."
- Give time: stay quiet, don't rescue.
- Separate the emotion from the task: acknowledge first, then move on together.
- If asked for something you can't do: "I understand why that feels right β let me explain why I'd want to take a different approach."
UK trainers repeatedly say: when you practise, simulate difficult patients on purpose. Groups that only practise "nice" cases fall apart when the exam throws up a hostile, complex, or multi-issue case.
- Rotate awkwardness: angry patient, over-talkative patient, silent patient, distressed patient.
- Rehearse the phrases that keep the consultation moving.
From online wisdom to your next clinic: a simple flow
Forum posts and YouTube videos are full of tips. The trick is turning them into something you actually do differently tomorrow. Here is a simple pathway for converting that wisdom into practice.
π’ Trainer's note
The biggest mistake trainees make with online tips is trying to use all of them at once. Pick one phrase, one skill, one structural change per week. Build slowly. By the time you sit the SCA you will have quietly rebuilt your consultation style β one good week at a time.
β οΈ A word of caution about online sources
Not every YouTube video on GP consultations is good. Not every forum post is safe. Before you adopt any advice from either, run it past three questions: Is the source a UK-based GP educator? Does it match RCGP or NICE guidance? Would my own trainer be comfortable with this? If the answer to any of these is no, set it aside and find a better source.
βFrequently Asked Questions
Short, direct answers.
Aren't verbatims completely outdated?
How do verbatims count on the 14Fish ePortfolio?
How long should a verbatim be?
Do I need to remember the conversation word-for-word?
Can I use a real patient's consultation?
Which SCA domain do verbatims help most with?
Can I use a verbatim in a group setting?
What if the trainee resists writing one?
Do examiners know about verbatims?
π― Final Take-Home Points
- Verbatims teach the words. Video teaches behaviour. Use both.
- Slow the consultation down on paper and the insight arrives that never arrived in real time.
- Always include the inner monologue. Without it, it's just a transcript.
- Read the script aloud in the tutorial. Trainer as patient, trainee as doctor. This is where pennies drop.
- Start with the trainee's agenda (ALOBA). Your agenda comes second.
- Map each moment to an SCA domain β DG, CM, or RTO. Makes every insight exam-relevant.
- Facilitate, don't lecture. Ask one more question. Count to seven before filling the silence.
- Protect psychological safety. The trainee is exposing themselves in writing β treat that with respect.
- End with one concrete action. A new phrase. A new opener. A new safety-net line.
- Revisit old verbatims. Growth becomes visible in the space between readings.