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Tick the indicators you would have demonstrated

Grading: Clear pass = 3 · Marginal pass = 2 · Marginal fail = 1 · Clear fail = 0 

Case Title: Difficult Follow-up – Suspected Colorectal Cancer with Resistant Patient (RCGP SCA Blueprint Group: Cancer Recognition and Urgent Referral in Adults) 

Data-gathering, technical and assessment skills

Score: 0/3

  • Positive indicators
  • Clarifies nature and duration of bleeding
  • Quantifies weight loss and explores anaemia symptoms
  • Reviews FBC findings
  • Assesses bowel habit change
  • Explores family history
  • Differentiates haemorrhoids from malignancy; explores reasons for non-attendance
  • Assesses psychological barriers
  • Summarises clearly
  • Recognises high-risk features
  • Negative indicators
  • Fails to explore red flag symptoms
  • Ignores existing anaemia findings
  • Reassures solely on previous haemorrhoid history
  • Does not assess weight loss or systemic features
  • Neglects reasons for non-attendance
  • Demonstrates poor consultation structure
  • Fails to provide a clear summary
  • Performs inadequate cancer risk assessment
Clinical Management Skills

Score: 0/3

  • Positive indicators
  • Recognises urgent need for suspected cancer pathway referral
  • Explains rationale clearly and appropriately
  • Addresses colonoscopy fears empathetically
  • Discusses risks associated with further delay
  • Provides safety-netting regarding worsening bleeding or symptoms
  • Considers iron supplementation appropriately
  • Arranges prompt repeat referral
  • Documents refusal clearly if non-attendance persists
  • Demonstrates shared decision-making while maintaining clinical urgency
  • Adopts a holistic approach addressing anxiety and concerns
  • Negative indicators
  • Accepts refusal without clear documentation or safety-netting
  • Delays appropriate referral
  • Provides reassurance without adequate investigation
  • Prescribes only haemorrhoid treatment despite concerning features
  • Fails to address existing anaemia
  • Does not establish a follow-up plan
  • Demonstrates poor communication of clinical risk
Interpersonal skills

Score: 0/3

  • Positive indicators
  • Maintains a calm and non-judgemental tone
  • Acknowledges fear and embarrassment sensitively
  • Explores barriers to investigation appropriately
  • Avoids confrontation or dismissive language
  • Provides a clear explanation of seriousness without causing alarm
  • Demonstrates a supportive yet firm approach
  • Checks patient understanding throughout the consultation
  • Uses a collaborative but appropriately assertive communication style
  • Negative indicators
  • Demonstrates a dismissive or confrontational manner
  • Minimises potential cancer risk
  • Fails to acknowledge patient fear or embarrassment
  • Appears rushed during the consultation
  • Provides unclear or inadequate explanations
  • Does not check patient understanding
  • Escalates tension or conflict unnecessarily
  • Shows limited empathy or reassurance
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