Bradford VTS Online Resources:
ISCEE Sessions
Group learning so good, your colleagues will actually make you better — not just watch you flounder alone.
Last updated: 18 April 2026
Web Resources
A hand-picked mix of official guidance and real-world GP training resources. Because sometimes the best pearls are not hiding in the official documents.
🏫 Bradford VTS — Core Resources
- OSCE Database — Bradford VTS Extensive database of OSCE stations — many directly convertible to ISCEE format
- Teaching & Learning — Bradford VTS The full Bradford VTS educational methodology library
- Half Day Release (HDR) — Bradford VTS Where ISCEE sessions often fit in the scheme timetable
- Presentations & Workshops — Bradford VTS How to design engaging educational sessions
📚 Educational Theory & Methodology
- RCGP GP Educator Resources Official RCGP guidance for GP trainers and educators
- NACT UK (National Association of Clinical Tutors) Resources for postgraduate medical educators
- Association for the Study of Medical Education (ASME) Research and practice in medical education
- BMC Medical Education Open-access research on medical education methods including collaborative learning
🎯 OSCE & Clinical Skills Development
- Geeky Medics OSCE Stations 1,300+ OSCE stations — useful for building or adapting ISCEE scenarios
- MRCGP Resources GP training exam resources including clinical skills
- NICE Clinical Guidelines Essential background for designing clinically accurate scenarios
- BNF Online Prescribing reference for building prescribing challenge stations
🔬 Research on Collaborative & Group Learning
- Reflection and group learning improve OSCE scores (PubMed) Research showing collaborative practice improves clinical skills performance
- Education for Primary Care Journal Peer-reviewed research specifically in primary care education
⚡ Quick Summary — If You Only Read One Thing
- An ISCEE is like an OSCE — but instead of individuals going around stations alone, small groups go around together.
- The group dynamic is the magic: learners support each other, discuss, swap places, and learn from each other, not just at each other.
- It is formative (developmental), not summative (high-stakes testing). The goal is learning — not grading.
- ISCEE stands for Intensive Structured Collaborative Educational Experience.
- It was invented at Bradford by Nick Price — a genuinely original contribution to GP training methodology.
- Many existing OSCE stations can be easily converted into ISCEE format — you don't always need to start from scratch.
- One set of 8 stations can easily accommodate 40–48 trainees at once — far more efficient than a traditional OSCE.
What Is an ISCEE?
In a traditional OSCE (Objective Structured Clinical Examination), individual trainees rotate around a circuit of stations. Each station tests specific competencies. It is primarily a tool for assessment.
An ISCEE takes the same circuit idea — and transforms it into something far more educationally powerful. Instead of individuals going around alone, small groups (sometimes called "groupettes" or a "family of learners") travel the circuit together.
Each member of the group takes a turn at each station. Crucially, while one person is "having a go", the rest of the group is watching, thinking, and ready to contribute. They can step in to demonstrate an alternative approach, offer ideas, or simply provide moral support.
👉 Click here for the OSCE Database
The questions at each station are designed to encourage thinking and exchange of ideas — not to grill or quiz individuals. The station facilitator acts as a guide, prompting discussion and bringing out learning in a "building-block" way.
The result is a session that feels active, dynamic, and genuinely enjoyable — which is not something GP trainees say about educational activities very often.
The Acronym — What ISCEE Actually Means
The name is no accident. Each letter points to a key design principle that separates ISCEE from any other teaching format.
ISCEE vs OSCE — Side by Side
🏆 ISCEE
- Small groups go around together
- Formative — learning-focused
- Collaborative, peer-to-peer learning
- Questions prompt discussion
- Safe, open, supportive environment
- Swapping roles mid-station is fine
- Accommodates large cohorts efficiently
- Station masters guide and facilitate
- Lower stress — no pass/fail stakes
- Developed in Bradford by Nick Price
📋 OSCE
- Individuals rotate alone
- Summative — assessment-focused
- Competitive, individual performance
- Examiner observes and marks
- High-pressure, evaluation context
- Fixed roles throughout
- One candidate per station at a time
- Examiners assess and score
- High stakes — pass/fail implications
- Widely used in MRCGP context
| Feature | ISCEE | OSCE |
|---|---|---|
| Primary purpose | Formative learning | Summative assessment |
| Who attends each station? | Small group (3–6 people) | One individual at a time |
| Role of "examiner" | Facilitator / guide | Examiner / assessor |
| Peer interaction | Encouraged ✓ | Not permitted ✗ |
| Capacity (8 stations) | 40–48 trainees | 8 trainees |
| Stress level | Low–moderate (safe space) | High (high-stakes) |
| Marking / grading | Not required | Central to the process |
| Can stations be swapped? | Yes ✓ | No ✗ |
Why ISCEE Matters in GP Training
GP training is, at its core, about developing doctors who can think clearly, communicate well, and make wise decisions under uncertainty. These skills are difficult to develop through lectures or passive revision alone.
ISCEE sessions create a rare and valuable thing in medical education: a safe space to fail, try again, and learn from watching others do the same. Trainees often report that watching a colleague struggle with a simulated patient — and then seeing a different approach work — is more memorable than any lecture they have attended.
🧠 Why Group Learning Works
When learners explain ideas to each other, they consolidate their own understanding. When they watch a peer make an error they almost made themselves, the lesson lands harder than feedback from a senior. Peer learning activates a different kind of attention — you are not just absorbing information, you are evaluating it.
Research on collaborative learning consistently shows that group formats improve both retention and transfer of learning to new situations — exactly what GP trainees need when they are sitting alone in a consulting room with a complex patient.
🎯 What ISCEE Develops
- Clinical reasoning and differential diagnosis
- Communication and consultation skills
- Ethical reasoning and decision-making
- Self-awareness and reflection
- Confidence in uncertainty
- Peer support and professional relationships
- Multiple Professional Capabilities (RCGP framework)
- SCA-relevant skills in a low-pressure setting
Pros, Cons & Organising Tips
Every educational format has its strengths and limitations. Understanding them helps you get more out of ISCEE and avoid the common traps.
✅ Advantages
- Creates a safe, small group environment where trainees feel comfortable being open and honest
- Peer-to-peer learning — trainees often explain things to each other more clearly than a facilitator can
- Active and dynamic — participants are doing things, not just listening
- Stations can be based on real-life GP scenarios (e.g. communication challenges, clinical dilemmas)
- Highly scalable — 8 stations can comfortably accommodate 40–48 trainees at once, compared to just 8 in an OSCE
- Reduces the isolation and anxiety of individual performance
- Generates richer discussion than individual formats
⚠️ Challenges
- Requires significant planning — you need patient simulator, facilitator, and trainee instruction sheets for every station
- Needs enough breakout rooms (one per station), or a large hall with sufficient screens and space
- Using simulated patients and trainers as facilitators can increase costs
- Dominant group members can sometimes take over — good facilitation is essential
- Harder to assess individual competency in this format
- Requires a dedicated timekeeper — without one, timing falls apart fast
💡 Organising Tips
- Diversify the groups intentionally — balance by gender, ethnicity, ST year, and experience level
- Strict timekeeping is essential — appoint a dedicated bell-ringer/timekeeper
- Brief facilitators beforehand — they need to guide discussion, not lecture
- Provide clear written instructions for each station — one set for the group, one for the facilitator
- Run a short intro session before starting: explain the format and reassure trainees it is not a test
- Build in a debrief at the end — this is where lasting learning is consolidated
- Pilot new stations with a small group before using them in a large session
How to Run an ISCEE Session — Step by Step
Whether you are a TPD planning a whole-cohort event or a trainer trying this with two or three trainees, the core structure is the same.
• 6–8 stations × 12–15 minutes each = 72–120 minutes of circuit time
• Add 10 minutes at the start (orientation) and 15–20 minutes at the end (debrief)
• Total session time: typically 2–2.5 hours for a full ISCEE event
Types of ISCEE Stations
ISCEE stations can cover almost any area of GP training. Think creatively — some of the best stations are the simplest to set up.
How to Design a Good ISCEE Station
A well-designed station almost runs itself. A poorly designed one leaves the facilitator and group staring at each other awkwardly. Here is what separates the two.
📐 Every Station Needs These Elements
- A clear learning objective — what will trainees know or be able to do after this station?
- A scenario or stimulus — a case, a patient, a data set, or a dilemma to work with
- A trainee instruction sheet — brief, clear, accessible to all backgrounds
- A facilitator guide — with progressive questions, key teaching points, and common mistakes to address
- A time plan — what happens in each phase of the station's 12–15 minutes
- Materials — any props, printouts, equipment, or patient actor instructions needed
💬 The Art of Progressive Questions
The facilitator guide should include questions that build on each other. Start simple, move to complexity.
Level 2 (Probing): "Why would you do that? What are you worried about?"
Level 3 (Deepening): "What if the patient refused? What would you do then?"
Level 4 (Synthesis): "What does this case tell us about how we approach these situations generally?"
This layered approach ensures even a short 12-minute station generates genuinely rich discussion.
Learning Objective: Trainees will practise exploring a patient's hidden concerns and demonstrate appropriate empathic responses.
Scenario: A 52-year-old woman comes in complaining of tiredness. She has been in three times in the last two months. Her bloods are normal. She seems distracted and makes no eye contact.
Trainee Instructions: One person takes the consulting role. The patient actor will play the scenario. After 5 minutes, the group pauses and discusses. Then a second person takes over to demonstrate an alternative approach.
Facilitator Questions (progressive):
- What did you notice about her body language? What might it mean?
- She has been in three times with normal tests. What might be going on that isn't being said?
- How would you ask about her social situation in a way that felt natural — not like a form?
- When the second person takes over, how does their approach differ? What is better or worse?
- What is the risk of not exploring this further today?
Key Teaching Points: ICE exploration, recognising a hidden agenda, safety-netting appropriately, the importance of returning visit patterns as a diagnostic signal.
Learning Objective: Trainees will interpret a set of blood results and identify the most clinically significant findings.
Scenario: A 68-year-old man with type 2 diabetes. You are reviewing his latest blood results. [Printed results provided at the station.]
Trainee Instructions: As a group, discuss what you see, what concerns you, and what you would do next. There is no single right answer — we want to hear your thinking.
Facilitator Questions (progressive):
- What is the first thing you notice? Why does it matter?
- Which finding is the most clinically urgent? Why?
- Is there anything here that looks normal but is actually dangerous in this context?
- If you were going to phone this patient today, what would you say?
- What would your management plan look like for the next 3 months?
Key Teaching Points: Reading results in clinical context, recognising borderline-but-significant findings, knowing when to act urgently vs. review at the next appointment.
Learning Objective: Trainees will apply ethical reasoning frameworks to a realistic GP dilemma, demonstrating balanced and justifiable decision-making.
Scenario: A 17-year-old comes in asking for contraception. She does not want her parents to know. She seems mature and understands the implications. What do you do?
Trainee Instructions: Discuss as a group. There is no single correct answer. We want to see the quality of your reasoning, not just your conclusion.
Facilitator Questions (progressive):
- What are the key ethical issues here?
- What does "Gillick competence" mean in practice for this case?
- What are the arguments for and against prescribing without parental involvement?
- What would you document in the notes, and why?
- If she were 15 rather than 17, would your answer be the same?
Key Teaching Points: Gillick competence, Fraser guidelines, balancing autonomy vs. safeguarding, documentation in sensitive cases, confidentiality.
✅ ISCEE Organiser Checklist
- Learning objectives defined for each station
- Scenarios written and reviewed for clinical accuracy
- Trainee instruction sheets printed (clear, IMG-friendly language)
- Facilitator guides produced with progressive questions
- Groups formed — diverse by ST year, gender, background
- Rooms allocated — one per station, or clearly marked areas in a hall
- Simulated patients briefed (if applicable)
- Timekeeper appointed and bell / buzzer ready
- Brief orientation session planned (5–10 min)
- Plenary debrief planned for end of session
- Trainees reminded to log the experience in their 14Fish ePortfolio
From the Trenches — What Trainees & Educators Actually Say
These insights come from UK GP trainees, training scheme guidance, GP educators, and published deanery resources. Everything here aligns with RCGP and NHS England guidance. Nothing here is rumour — these are recurring patterns from real training experience across the UK.
🔍 Where These Insights Come From
All insights have been cross-checked against RCGP, GMC, and NHS England guidance. Anything that conflicts with official advice has been excluded.
The Group Size Sweet Spot
One of the most consistent findings across UK training schemes, published research, and trainee experience is this: group size matters enormously. Get it wrong and the ISCEE either becomes a lecture or turns into chaos.
Why 4–5 Is the Magic Number
- Every person gets a turn at each station — nobody just watches
- There are always enough observers to generate a real discussion
- No single person can dominate — everyone is heard
- The group is small enough to feel safe
- Large enough to bring genuinely different perspectives
The Peer Role-Play Advantage — What Research & Trainees Say
Published research from UK GP training contexts consistently shows that practising with peers — rather than always using professional simulated patients — has some unique advantages. Here is what the evidence and trainee experience both point to.
🔬 What the Research Shows
Studies comparing peer role-play with standardised patient (SP) training found that peer role-play produced higher empathy scores and better performance in the domain of understanding the patient's perspective. When you play the patient yourself, you genuinely understand what it feels like to be on the receiving end of a consultation.
A UK study of GP trainees as peer role-players in formative CSA sessions found that the experience "clarified a lot" — trainees reported that playing the patient role gave them insight into examination technique, reinforced knowledge, and developed professional attributes in ways that purely observing did not.
🗣️ What Trainees Report
- Playing the patient role makes you realise how much you miss when you are in the doctor role — cues you walk past completely
- Watching a peer consult is different from watching a video — you know them, you can imagine doing it yourself, and the feedback feels real
- Rotating roles — doctor, patient, observer — in a single session gives you three completely different learning experiences from one scenario
- Hearing a peer give feedback is sometimes more memorable than hearing the same point from a trainer — you think "they spotted that because they would have done the same thing"
- The low-stakes environment of peer practice lets you try things you would never risk in a real consultation — and find out what actually works
🔄 The Three-Role Model — One Scenario, Three Learning Perspectives
The Observer Effect — Why Watching Is an Active Skill
Most trainees arrive at their first ISCEE session thinking: "I hope I'm not the one who has to go first." What they discover is that the observer role is just as demanding — and just as educational — as the doctor role. Here is how to make the most of it.
😬 What Trainees Get Wrong About Observing
- Passive watching. Sitting back and simply watching the consultation without active mental engagement. You might as well be watching a TV programme.
- Only watching the doctor. The patient's reactions are equally important — and often more revealing.
- Saving feedback for the end. By then you have forgotten the specific moment you wanted to mention. Note it down as it happens.
- Only noticing what went wrong. Identifying what worked — and why it worked — is just as important, and much harder to do well.
- Generic feedback. "Good rapport" helps nobody. "You leaned forward when she mentioned her daughter — that was the moment she relaxed" is useful feedback.
✅ How to Observe Actively
Use a structured observation framework as you watch. Deanery resources from the North West, Bristol, and Severn suggest dividing your attention across four areas:
Giving Great Peer Feedback — The Skill Nobody Teaches You
Peer feedback is the engine of a good ISCEE session. Bad feedback wastes the experience. Good feedback transforms it. Here is a practical guide — drawn from UK GP training guidance — to giving feedback that actually helps.
📊 The Feedback Quality Spectrum
- "That was really good overall."
- "I thought your rapport was nice."
- "Maybe you could have been a bit more empathic."
- "I would have done it differently, but…"
These say nothing the trainee can act on. They feel nice to receive and are useless for learning.
- "When she mentioned her son, you kept going. That was the moment she wanted you to pause."
- "You explained the diagnosis clearly, but you never checked if she understood it. She looked confused from about minute 7."
- "Your safety-netting was: 'come back if worse.' She had no idea what 'worse' meant. Be specific next time."
These are specific, observable, kind, and immediately actionable.
This structure is adapted from Pendleton's feedback model, which has been used in GP training in the UK for decades. It works well in ISCEE sessions because it keeps feedback constructive and prevents the group from becoming critical.
Always start with the person who just consulted. They often spot their own strengths and weaknesses more accurately than the observers — and giving them first voice builds psychological safety.
Observers add specific positive observations. The facilitator redirects generic comments toward specificity: "Can you tell us exactly which moment you're describing?"
The trainee names their own learning points first. This prevents feedback feeling like an attack, and develops self-awareness — one of the most important skills in GP.
The observer group adds specific, actionable suggestions. The facilitator ensures feedback stays about behaviours, not personality: "What did they do?" not "Who they are."
Common ISCEE Pitfalls — What Goes Wrong & How to Fix It
These are the patterns that appear repeatedly across UK training schemes when ISCEE sessions do not deliver their full potential. Most of them are easy to fix once you know to look for them.
The Online Dimension — Running ISCEEs Remotely
Since the SCA is a remote online examination, training schemes across the UK now run ISCEE-style sessions online as well as face to face. Deanery guidance from multiple schemes emphasises that trainees should practise remote consulting from early in their training — not just in the weeks before the SCA.
🖥️ What Works Well Online
- Breakout rooms on Teams or Zoom mirror the ISCEE group structure perfectly — each breakout room becomes one station
- Remote format is better for practising SCA-specific skills because the exam itself is remote
- Screen sharing allows a group to look at blood results, ECGs, or scenarios together — a natural fit for data interpretation stations
- Geography stops being a barrier — trainees spread across a region can join the same ISCEE circuit without travelling
- Recording a practice consultation (with consent) and watching it back as a group is one of the most powerful learning activities available
⚠️ What to Watch Out For Online
- Camera off = camera off practice. Some trainees practise with cameras off throughout. In the SCA telephone stations (3 of 12) this is appropriate — but for video stations, always keep cameras on.
- Technical problems (poor connection, frozen screen) can derail a station. Have a backup plan — WhatsApp group or phone call if Teams fails.
- Online facilitation requires more active effort to draw quiet members in — silence online can easily become invisibility.
- It is harder to read body language online. Explicitly ask for the patient's perspective: "How are you feeling about this?" rather than relying on visual cues.
- Time your sessions carefully — video fatigue is real, and a 2-hour online ISCEE needs a comfort break built in.
| Feature | In-Person ISCEE | Online ISCEE |
|---|---|---|
| SCA exam relevance | Good general consultation skills | Higher — mirrors exam format ✓ |
| Body language practice | Richer — full visual cues ✓ | Limited — camera-based only |
| Accessibility | Needs a room, travel, scheduling | Flexible — any location ✓ |
| Telephone consultation practice | Awkward to simulate | Natural — just turn camera off ✓ |
| Group energy | Higher — physical presence ✓ | Requires more facilitation effort |
| Recording for review | Requires equipment setup | Easy — built-in recording ✓ |
The PEAS Group Model — Peer Support Built Into the Week
Some UK training schemes have formalised peer learning into the weekly HDR structure. The York GP Training Scheme's PEAS (Peer Education And Support) group model is a good example of how ISCEE principles can become a regular habit rather than a one-off event.
🌿 What PEAS Groups Do
In schemes that run PEAS groups, the first 45 minutes of every HDR session is a structured small-group discussion. Trainees bring anything — a difficult consultation from the week, a clinical question they could not answer, a challenging patient interaction, an ethical dilemma. The group discusses it together.
This is ISCEE thinking applied at the smallest scale. No formal stations, no patient actors, no elaborate planning. Just a small group of trainees, a structure, and the understanding that learning together is more powerful than learning alone.
The "Near Miss" Effect — Why Getting It Wrong in the Group Is Golden
One of the most consistent findings from GP trainee experience — and from educational research — is that the most memorable learning moments in ISCEE sessions happen when something goes wrong. Not catastrophically wrong. Just wrong enough that everyone watching thinks: "I would have done exactly the same thing."
Why the Near-Miss Sticks
e.g. misses the patient's hidden concern, rushes to management before exploring ICE, gives a vague safety-net
"I was thinking exactly that — I didn't spot the cue either until she paused"
The group watches a different way of handling the same moment — and sees it work
"I still remember the exact moment she flinched. I never rush past a pause like that any more."
What RCGP Examiners & Senior Educators Actually Say
These insights come from RCGP examiners, the North West SOX (Support on Exams) programme, and deanery-published consultation guidance. They tell you exactly what separates trainees who pass from those who don't — and they are directly relevant to designing and running good ISCEE sessions.
Building Your Personal Phrase Bank — A Trainee Favourite
One of the most universally praised activities across UK GP training communities is the group phrase bank — where trainees generate, test, and refine their own natural consultation language together. Here is how to make it work in your ISCEE.
Why Your Own Phrases Beat Anyone Else's Phrases
There is a big difference between a phrase that you would actually say and a phrase that sounds right in a textbook. When trainees generate language together — under mild scrutiny from peers who know them — the result is a personalised phrase bank that feels genuinely natural under pressure.
Multiple UK deanery resources and experienced GP trainers recommend keeping a physical notebook (or Notes app) specifically for consultation phrases collected from peers, trainers, and real clinical encounters. The best phrases are usually the ones you heard someone else say and thought: "I would never have thought of that — and it was perfect."
💬 Group-Tested Phrases — Collected From UK Trainees & Training Schemes
These phrases have been tested in UK GP training groups and described by trainees as natural-sounding and clinically effective. They are starting points — adapt them to your own voice.
These open the consultation without boxing the patient into a specific presenting complaint before they have told you what is really going on.
- "What would be most helpful to focus on today?"
- "You mentioned a few things when you booked — where would you like to start?"
- "How have things been since we last spoke?"
- "Is there something particular on your mind today?"
Every experienced GP has moments of not knowing what to do next. The skill is handling that moment gracefully.
- "That is really helpful — let me just think about this for a second."
- "I want to make sure I give you the right answer on that, so I am going to check and come back to you today."
- "That is not a question I can answer with certainty right now — and I would rather be honest with you than guess."
- "Can I just summarise what you've told me, to make sure I've understood correctly?"
One of the scenarios most commonly flagged by UK trainees as the hardest to handle. The key is validating the request before declining it.
- "I completely understand why you feel that would help, and I want to make sure we find something that does. Let me explain my concern with that option."
- "I hear you — and I really do want to help. But I need to be honest with you about why I don't think that particular approach would be in your best interests."
- "I can't prescribe that, but I don't want to just leave you without a plan. Let's think about what else might help."
- "I'm not going to be able to do that today — but can I explain why, so it makes sense rather than just feeling like a no?"
Research from RCGP examiner guidance consistently shows that vague safety-netting ("come back if worse") scores poorly. Specific safety-netting scores well and protects patients.
- "If you develop a fever above 38°C, or if the pain gets worse rather than better over the next 24 hours, I want you to call us straight away."
- "If you feel short of breath, have chest pain, or notice any swelling in your leg — do not wait. That is a reason to call 999."
- "I expect things to settle within 3 or 4 days. If they haven't, book in again. We can re-examine and think again at that point."
- "Is there a particular symptom you are worried about? Because I want to make sure you know exactly when to come back."
⭐ The Single Most Important Insight — From Every Source We Consulted
Every GP educator, deanery resource, published study, and experienced trainee points to the same conclusion: the quality of your consultation skills depends almost entirely on how much you practise them — and whether you get honest, specific, timely feedback when you do.
An ISCEE session, done well, gives you all three things: deliberate practice, honest feedback from people who know exactly what the task feels like, and the perspective of watching others struggle with — and solve — the same challenges you face. No book, no lecture, and no video can replicate that combination.
The trainees who progress fastest are rarely the most knowledgeable. They are the ones who put themselves in the room, get it wrong, accept the feedback, and try again. ISCEE is the room. Use it.
Suggested ISCEE Session: Improving AKT Performance
The AKT tests applied knowledge — not just recall. A well-designed ISCEE session helps trainees understand why the right answer is right, and why the wrong answers are almost right. That discussion is where the real learning lives.
ISCEE Session Design — AKT Preparation
A 2-hour circuit for groups of 4–5 trainees across 6 stations
🩺 The Clinical Reasoning Station
Format: 3 AKT-style clinical vignettes (Single Best Answer format). The group reads each question, discusses the options, and agrees on an answer — but more importantly, must explain why the other options are wrong.
Facilitator focus: Push the group past "I'd choose A" to "Here's why B is a distractor designed to catch people who confuse X with Y." Learning the anatomy of a wrong answer is as valuable as knowing the right one.
Topics suited to this station: Diagnosis of common GP presentations, management algorithms (e.g. hypertension, depression), first-line vs second-line choices.
📏 The Numbers and Thresholds Station
Format: A set of 10–12 clinical "number flashcards" — each showing a threshold, target, or guideline figure with a clinical context. The group discusses: Is this right? What's the real number? What happens if you get this wrong in practice?
Examples: Hypertension thresholds, HbA1c targets, eGFR stages, PSA age-adjusted values, hypothyroidism TSH ranges, warfarin INR targets, antibiotic duration, QTc prolongation cut-offs.
Facilitator focus: Connect each number to a clinical decision. "If the NICE threshold changed from X to Y last year, how many patients in your practice would that affect?"
📸 The Interpretation Station
Format: A printed set of investigations — an ECG, a blood result table, a spirometry graph, a urine dipstick result, or an X-ray image. The group interprets each one as a team, discussing what they see, what it means, and what they would do next.
Facilitator focus: The AKT frequently asks trainees to interpret data, not just recall facts. This station builds that skill in a low-stakes environment. Ask the group to rank findings by clinical urgency.
Useful investigations to include: AF on ECG, spirometry showing obstructive vs restrictive pattern, mildly deranged LFTs in a patient on statins, haematuria dipstick.
⚖️ The Evidence & Statistics Station
Format: A short printed abstract or data summary (2–3 sentences). The group answers questions about it: What type of study is this? What does NNT mean here? Is this result clinically significant as well as statistically significant?
Facilitator focus: The AKT tests research methods and critical appraisal. Many trainees lose marks here not because they lack knowledge but because they freeze at unfamiliar terminology. Group discussion demystifies it.
Topics to cover: Sensitivity vs specificity, NNT vs NNH, RCT vs cohort design, meta-analysis interpretation, p-value meaning, absolute vs relative risk.
🗂️ The "Spot the Guideline Update" Station
Format: A set of 5 brief clinical scenarios. For each one, the group is asked: "What was the old guidance? What has changed? How does it affect this patient?" Pre-prepared reference cards with the updated guidelines can be provided.
Facilitator focus: The AKT consistently tests the most recent guideline updates. This station trains trainees to think about whether their knowledge is current — a skill that serves them in clinical practice too.
Example topics: Recent NICE hypertension updates, antibiotic prescribing changes (Therapeutic Review guidance), diabetes management updates (SGLT2 inhibitors), depression treatment thresholds.
🎲 The "Wild Card" Station — Extended Matching Questions
Format: A printed set of 6–8 Extended Matching Questions (EMQs) in two linked categories (e.g. "Match each presentation to the most likely diagnosis" + "Match each diagnosis to the most appropriate first-line treatment"). Groups work through them together, discussing each option.
Facilitator focus: EMQs reward pattern recognition and systematic elimination. The group format allows trainees to hear each other's reasoning — which is often more illuminating than just checking the answer key.
Topics suited to EMQs: Pharmacology (drug mechanisms, interactions, contraindications), dermatology diagnoses, psychiatric presentations, laboratory interpretation.
🎓 Plenary Debrief — AKT ISCEE
Bring all groups together for a 20-minute debrief. Suggested structure:
- Each group shares their most surprising learning point from the circuit (2–3 min)
- Facilitators collect the questions where groups disagreed — discuss these with the whole cohort (5–8 min)
- Highlight the top 3 "knowledge gaps" that appeared across multiple groups (3 min)
- Signpost resources for each gap — e.g. specific NICE CKS pages, BNF chapters (2 min)
- Ask: "What will you do differently in your revision as a result of today?" (2 min)
Suggested ISCEE Session: Improving SCA Performance
The SCA is fundamentally about how you consult — your communication, your empathy, your clinical reasoning in real time. There is only one way to improve at these things: practice them, receive feedback, and practice again. ISCEE creates the perfect environment for exactly that.
ISCEE Session Design — SCA Preparation
A 2-hour circuit for groups of 4–5 trainees across 6 stations
👀 The Observation Guide — What to Watch For
Give each observer a simple card at each station. They watch and note:
- Did the doctor open warmly and invite the story?
- Did they explore ICE (Ideas, Concerns, Expectations)?
- Did they demonstrate genuine empathy — not just phrases?
- Was the explanation clear and jargon-free?
- Was shared decision-making used?
- Was safety-netting done clearly and specifically?
- Did the doctor handle any "difficult moment" well?
- Was the patient left feeling heard and respected?
🎭 The Hidden Agenda Consultation
Scenario: A patient presents with a minor, easily managed complaint (e.g. a rash, a repeat prescription request). The real reason they are there is something they haven't said yet — relationship breakdown, fear of cancer, anxiety about a family member.
Patient actor instruction: Only reveal the real agenda if the doctor directly creates a safe opening — e.g. uses open questions, notices hesitation, or asks "Is there anything else going on?" The patient should not volunteer the hidden concern unprompted.
Facilitator discussion questions: At what point did the group suspect there was a hidden agenda? What cues did they notice — verbal, non-verbal? What question or phrase opened the space for the patient to share?
💬 The Explanation and Negotiation Station
Scenario: A patient has been given a diagnosis (already established before this consultation). They are confused about what it means, worried about the implications, and uncertain about the treatment options. The doctor's task is to explain clearly, address concerns, and agree a shared plan.
Suggested diagnoses: New diagnosis of type 2 diabetes, hypertension, atrial fibrillation, or mild depression.
Facilitator discussion questions: Was the explanation in plain language? Did the doctor check understanding? Were the patient's specific concerns addressed — or just assumed? Was the final plan one the patient genuinely agreed to?
😤 The Angry or Frustrated Patient
Scenario: A patient arrives already upset — perhaps a delayed referral, a medication error, or a previous consultation they felt dismissed them. They are not aggressive, but they are clearly frustrated and feel they have not been heard.
Patient actor instruction: Start frustrated. Respond positively (and gradually de-escalate) if the doctor acknowledges your feelings without defensiveness. Escalate slightly if they become dismissive or immediately launch into problem-solving.
Facilitator discussion questions: What was the first thing the doctor said — and did it help or hinder? Did they acknowledge the emotion before addressing the content? Did they avoid defensiveness?
🔴 The Urgent Presentation with a Worried Patient
Scenario: A patient presents with symptoms that require urgent action — but they are minimising their symptoms and reluctant to go to hospital. The doctor needs to balance being honest about urgency with maintaining the therapeutic relationship and avoiding panic.
Suggested presentations: Chest pain (possible ACS), stroke symptoms (FAST), severe abdominal pain, sudden visual loss.
Facilitator discussion questions: How did the doctor convey urgency without causing panic? Did they use clear safety-netting language? Did they check the patient understood why immediate action was needed?
🧩 The Multimorbidity & Prioritisation Station
Scenario: A patient comes in for one reason but has three or four active problems that could all be addressed. They also have a long medication list, some of which may be contributing to their presenting complaint. The doctor has 10 minutes.
Facilitator discussion questions: How did the doctor open a negotiation about what to cover today? Did they acknowledge the other problems without trying to solve all of them? Did they close the consultation with a clear shared plan?
Suggested presentations: Elderly patient with fatigue, pain, possible medication side effects, and social concerns.
🗣️ The Phrase Bank Station — No Patient Required
Format: A purely discussion-based station. No simulated patient. The group is given a list of 8–10 common SCA consultation challenges (e.g. "How do you say no to a patient who wants antibiotics?" "How do you ask about suicidal ideation naturally?"). The group discusses and generates their own bank of natural phrases for each one.
Facilitator focus: The goal is not to produce a script — it is to find language that feels genuinely natural to each individual in the room. Encourage the group to challenge each other: "Does that actually sound like something you'd say?"
Challenges to include: Declining an inappropriate request, discussing mental health sensitively, explaining risk, admitting uncertainty, handling a tearful patient, safety-netting without being dismissive.
🎓 Plenary Debrief — SCA ISCEE
Bring all groups together for a structured 20-minute debrief.
- Each group shares "the phrase or moment that worked best" from their circuit (2–3 min)
- Share across the room: "What was the hardest station? Why?" (3–4 min)
- Facilitator highlights 3–4 common patterns seen across groups — e.g. rushing to problem-solve, forgetting to safety-net (5 min)
- Revisit one consultation together as a whole group — discuss what a "top-mark" response would look like (5 min)
- Each trainee names one specific behaviour they will change in their next clinic (2 min)
Trainer & Educator Pearls
These observations come from running ISCEE sessions in GP training schemes. They are the things that make the difference between a session that people remember fondly and one that quietly descends into chaos.
🧠 What Makes a Great Facilitator
- Guide, don't lecture. If you find yourself talking for more than 2 minutes continuously at a station, stop. Ask a question instead.
- Welcome silence. When a group goes quiet after a difficult question, that is thinking — not failure. Let it breathe.
- Name what you notice. "I noticed that both times someone tried to explore her concerns, they moved away quite quickly. Why do you think that happened?"
- Use the group. When one person answers, don't immediately respond — ask the group: "What do others think?"
- Value the wrong answer. A confident wrong answer, unpacked gently, teaches more than three correct ones.
📋 Common Facilitation Mistakes
- Revealing the "answer" too early — kills the discussion before it starts
- Allowing one dominant group member to take over all the talking
- Going too fast — 15 minutes feels short but it is enough if you don't rush the first 3
- Making it feel like an assessment — "you all did well" repeatedly removes the honesty
- Forgetting to tie the station's learning back to a real clinical context
- Not debriefing at the end — this is where learning consolidates
💡 Tutorial Ideas Using ISCEE Concepts
Even without a full ISCEE circuit, you can bring the same principles into one-to-one tutorials:
- Present a case and ask: "Walk me through your thinking" — then sit with any silences before commenting
- Ask the trainee to analyse a consultation they felt went badly — guide them to identify the precise moment things shifted
- Role-play a difficult consultation, then swap roles so the trainee plays the patient — perspective shifts are powerful
- Use a printed AKT-style question together — not to test them, but to hear their reasoning process aloud
- Ask: "If you were designing an ISCEE station on this topic, what question would you want the group to struggle with?"
🎓 Reflective Questions for Trainees
These questions can be used to prompt ePortfolio entries after an ISCEE session:
- What did you do in the consultation that you were pleased with?
- What was the moment you found hardest, and why?
- What did you learn from watching a colleague that you would never have noticed in your own performance?
- What will you do differently in clinic this week as a direct result of today?
- Which of the 13 Professional Capabilities do you feel this session most helped you develop?
Real-World Wisdom — What Trainees Often Say
Watching a colleague consult with a simulated patient and thinking "I would have done exactly the same thing — and it's clearly going wrong" is one of the most powerful learning experiences GP training can offer. The penny drops fast when it's not your penny.
A recurring trainee observation: the group format reveals shared knowledge gaps that individuals were too embarrassed to admit on their own. There is genuine relief in discovering that your confusion is widely shared — and then fixing it together.
ISCEEs are particularly valuable for International Medical Graduates who are adapting to UK consultation styles. Hearing how UK-trained peers approach a patient's concerns, handle uncertainty, and use natural language — in a safe group setting — accelerates the cultural and communication adjustment far more than books alone.
Trainees who have done the Phrase Bank station (Station 6 of the SCA ISCEE above) consistently report that having generated their own natural language with their peers feels different from reading someone else's phrases in a textbook. Ownership of the language makes it stick.
Frequently Asked Questions
⭐ Final Take-Home Points
- ISCEE = OSCE infrastructure + group learning dynamic = something far more educationally powerful than either alone
- The collaborative element is the magic: trainees learn most from watching each other, not just from performing
- It is formative and safe — the absence of pass/fail pressure creates the conditions for honest, open learning
- One set of 8 stations can teach 40–48 trainees at once — an astonishing return on educational investment
- Great ISCEE facilitation means guiding, not lecturing — the best sessions are mostly the group talking to each other
- Many OSCE stations can be converted to ISCEE format without starting from scratch — use the Bradford VTS OSCE Database
- Both AKT and SCA preparation benefit enormously from well-designed ISCEE sessions — use the example circuits above as your starting point
- Trainees should log their ISCEE experience in the 14Fish ePortfolio — it is excellent evidence for multiple Professional Capabilities
- Always debrief at the end — this is where the dispersed learning from six different stations gets consolidated into something lasting
- Developed at Bradford by Nick Price — and still one of the best educational ideas in UK GP training