Watch how most registrars practise and you will notice a pattern. They sit down, do two or three cases, feel they have worked hard, and stop. That is a perfectly reasonable session. But it quietly misses something the exam, and your working life, will demand of you: the ability to consult well not just once, but again and again, when you are already tired.

The skill nobody practises

Your first consultation of any session is rarely the problem. You are fresh, focused, and the structure comes easily. It is the fifth, the eighth, the tenth where things slip. Your data gathering gets lazier. You stop exploring ideas and concerns properly. Your safety-netting becomes a rushed afterthought. The clinical reasoning is still in your head, but the consultation craft erodes under fatigue.

This is cognitive load, and it is real. Each consultation asks you to hold a lot in mind at once — the clinical picture, the person’s agenda, the time, the management plan, the relationship. Do that repeatedly and your mental reserves deplete. The registrars who perform consistently are not the ones who never tire. They are the ones who have trained themselves to consult well despite being tired.

Why this matters beyond the exam

The SCA is demanding partly because it is a run of cases back to back, with no real recovery between them. If you have only ever practised in short bursts, the exam will be the first time you have had to sustain quality across a full sequence — and that is a hard place to discover the gap.

But the more important point is what comes after. A normal surgery is exactly this: case after case, often more complex than the exam, with interruptions and admin in between. The stamina to consult well at the end of a long list is not an exam trick. It is the core of being a good GP. Practising it now serves you for the next thirty years, not just the next assessment.

How to build it

The principle is simple: gradually increase how many cases you do in one sitting. If you normally do three, push to five. Once five feels manageable, try seven. You are deliberately training the endurance, not just the technique.

Pay attention to where in the run your quality drops. For most people there is a point, often around case four or five, where the consultation craft starts to fray even though the clinical knowledge is intact. That fraying point is the thing to extend. Each time you push past it, you move it further out, until a full exam run sits comfortably inside your range.

This is hard to do in peer groups, because organising several people for a long run of cases is logistically awkward and you spend half the time waiting your turn. It is one of the things solo practice on a platform does well: you can sit down and do a genuine, uninterrupted run whenever you have the time, building the stamina at your own pace.

A challenge for your next session

Next time you practise, decide in advance to do two more cases than you normally would, and notice honestly where your quality starts to slip. That point is your current stamina ceiling. The whole game is raising it, week by week, until consulting well across a full run feels ordinary rather than exhausting.