Video and telephone cases in the SCA: how to prepare for remote consultations

It is easy to prepare for the SCA as though it were a face-to-face consultation with a timer attached. It is not. Every case is delivered remotely, so treat the format itself — video or telephone — as part of what you are practising, not just the medicine inside it. Consulting well without being in the same room as the patient is a distinct skill, and it is worth building deliberately rather than discovering the gaps for the first time on exam day.

Two remote formats, not one

SCA cases are delivered remotely: most as a video consultation, and some as a telephone call with no video at all, exactly as they do on the day. The format is set by the case, not chosen by you — so both need to feel equally familiar going in, not just the one you find more comfortable.

What changes when you cannot see the patient

On a telephone case, every cue you would normally read from a face — discomfort, confusion, hesitation, relief — has to be picked up from voice alone, or asked for directly. Silence reads differently too: a pause that would be obviously thoughtful in person can sound like a dropped line on a call. And you lose the visual confirmation that the patient is following you, so you cannot simply nod along and assume understanding has landed. Most of what goes wrong on a remote case is a habit that works fine in person and quietly stops working over a screen or a phone line.

• You cannot see hesitation, discomfort or confusion — listen for it in tone and pacing, or ask directly, rather than assuming the tone tells you everything.
• A silence on the line reads as a dropped connection more than as a thoughtful pause, so it is worth filling it with words rather than letting it sit.
• There is no visual confirmation that an explanation or a safety-net has landed — check both explicitly rather than relying on a nod that will never come.
• Rapport has to be carried entirely through voice: warmth, pacing and acknowledgement do the work that facial expression would normally share.

Generic technique for consulting remotely

None of this is clinical advice — it is generic communication technique that applies to any remote consultation, adapted for a timed exam setting.

• Signpost more than you would face to face: say what you are about to do before you do it — “I would like to ask a few more questions about that, and then move on to your medication.”
• Make safety-netting fully explicit and spoken, rather than implied by tone or a shared look, since there is no visual cue to reinforce it.
• Summarise and close the loop out loud — “So, to make sure I have understood you correctly…” — because you cannot check understanding any other way.
• Narrate your reasoning briefly where you would otherwise convey it silently through expression, so the patient is not left wondering what you are thinking.
• Slow your pace deliberately. A telephone conversation strips out the natural pauses a face-to-face consultation has, and rushing is easy to do without noticing.

The clock does not change with the format

Whichever format a case arrives in, the timing is identical: 3 minutes to read the case, then 12 minutes to consult. Because the extra verbal checking a remote consultation needs — explicit summarising, spoken safety-netting — takes real time, it is worth rehearsing both formats against the actual clock rather than assuming the technique above is free. Practising it until it is fluent is what keeps it from eating into time you need elsewhere in the consultation, including the management plan that carries the most weight of the three marking domains.

How to practise deliberately

• Practise video and telephone cases as two distinct skills, not one blended one — book sessions of each rather than letting the format be whatever comes up.
• Run some sessions with your own camera off entirely, so you are forced to rely on voice alone rather than falling back on visual habits.
• Record yourself and listen back to your explanations and safety-netting — check they would land clearly for someone who cannot see you.
• Rehearse a specific opening line for both formats so you are not composing your first sentence while the clock is already running.

ZWIP presents cases in both formats — video and telephone, with no video — against the exam’s own 3-minute reading and 12-minute consulting clock, so you can build comfort with both before you meet one for real. Register free to try a case in either format and see your marks and feedback afterwards.