Conscious Contraception Competence
While there is an SCA Feedback Statement regarding a lack of structure to the approach to data gathering, here we see a disorganised approach to management- it's a little chaotic and leaves the patient with uncertainty and potentially a lack of confidence to engage in conversations about her sexual health in future.
When a particular scenario has been experienced in real life, the structure will flow and this shows to examiners and patients alike. This is called unconscious competence, and in this example, the GP is getting the main points of EHC covered but in a clunky way.
This is where seeing as many patients as possible is an advantage in exams- the way you'll describe the evidence-based management will flow much easier the more times you do it- find the phrases that show you in flow!
SCA Feedback Statements
Safeguarding concerns were inadequately recognised or responded to
The examiner felt you did not understand and/or demonstrate principles of adult and child safeguarding. Perhaps you did not recognise or practice in a manner that sufficiently sought to reduce the risk of potential abuse, harm and neglect. Perhaps you did not take appropriate action including ensuring information is shared/referrals made appropriately.
For example, if a parent is experiencing substance dependency did you consider the risk to his children? If a woman is disclosing partner abuse, did you have sensitive patient-centred suggestions for keeping safe and signposting specialist services? If a young female patient is being taken out of the country by her relatives, might the risk of FGM be important to consider in her case? If an older adult appears frail and unkempt, might a home visit, team discussion or even safeguarding referral to explore possible self-neglect be sensible?
Suggestions
Meet with your practice Safeguarding Lead and/or attend their safeguarding meetings. Ensure your Level 3 Safeguarding training is up-to-date and implemented. Have a tutorial on local safeguarding procedures and pathways.
Ownership or responsibility for decision making was inadequate or inappropriate
The examiners felt that you did not take adequate ownership or responsibility for your decision-making. It may have appeared you were overly risk-averse, or unsure how to manage a simple situation without unnecessary input from other sources.
For example, this may involve suggesting you will ‘Run this past my colleagues’ or ‘Drop an email to Advice and Guidance from the specialist’ or arrange a physio opinion ‘just in case’ where it was not needed or warranted.
It is clearly important, safe and good practice for GPs to share decisions, refer to literature and involve others. Nevertheless, sometimes a simple decision is robust, defensible and adequate, without need for additional input. This is partly about the gate-keeping role we hold in GP, but also the message we convey to patients (including raising anxiety or expectations) when it is reasonable and safe for the GP to be the only clinician involved, because in this situation the answer is straightforward or clear.
Suggestions
Try to make decisions before debriefing a patient with your supervisor, even if you do not implement the decision until discussed. Develop confidence in recognising when your decision-making is good enough. Watch experienced GPs and notice what a good enough GP will do, too.