We’re both GP trainers, and we’ve watched hundreds of registrars develop their consultation skills over the years. Some arrive as naturals. Most don’t — they build the skill gradually, through practice, feedback, and reflection. This guide is what we’d say to any registrar who asked us “how do I actually get better at consulting?”
The consultation is the core skill of general practice. Everything else — prescribing, referrals, investigations, clinical knowledge — flows through it. A GP who consults well gets better outcomes, fewer complaints, more satisfied patients, and frankly, enjoys the job more. A GP who doesn’t consult well works harder, runs late, and generates follow-up appointments that didn’t need to happen.
And yet most of us were never explicitly taught how to consult. We learned by doing it, absorbing habits from trainers and colleagues, some good and some not. Structured consultation practice — where you deliberately work on the skill with feedback — is still surprisingly uncommon outside of exam preparation.
It shouldn’t be. Whether you’re an ST1 doing your first surgery or an experienced GP wanting to sharpen up, the same principles apply.
What “consulting well” actually means
You can break it down into three areas that overlap constantly during a real consultation:
Gathering information effectively. Asking the right questions in a focused way, building a differential, exploring what the patient thinks is going on and what worries them about it. Not just taking a history — understanding the person sitting in front of you.
Managing the problem safely. Forming an appropriate plan based on current evidence, discussing it with the patient rather than dictating it, and safety-netting in a way that’s specific enough to be useful. “Come back if it gets worse” is not safety-netting. “If you develop X, Y, or Z, I’d want you to do A” is.
Communicating like a human being. Building rapport, listening properly, adapting your language to the patient, creating space for them to talk, and involving them in decisions about their own care. This isn’t a soft skill bolted on to the clinical work — it’s the medium through which all the clinical work happens.
These three areas map to the SCA marking domains if you’re approaching the exam, but they’re not exam constructs. They’re the things that make consultations work, regardless of whether anyone is assessing you.
How to actually practise
Talk, don’t read. This sounds obvious but most registrars default to reading cases and mentally rehearsing their approach. That builds knowledge, not skill. Consulting is a spoken, interactive activity — you need to practise it out loud, with someone (or something) responding to you.
Use a timer. In surgery you have 10 minutes. In the SCA you have 12. Either way, you need to develop an internal clock — a sense of when to transition from gathering information to discussing management. Without timed practice, you won’t know that you habitually spend 9 minutes on history until you’re doing it in an exam or running 40 minutes late in clinic.
Get structured feedback. “That was good” isn’t feedback. You need to know specifically what you did well and what you didn’t, broken down by the three areas above. Did you explore the patient’s concerns? Was your safety-netting specific? Did you involve them in the management decision? Without this level of detail, you can practise for months and never identify your actual weaknesses.
Review across multiple consultations. One case tells you how you did on that case. Ten cases tell you how you consult. Maybe you always rush the closing. Maybe you’re strong on rapport but weak on safety-netting. Maybe your data gathering is thorough with medical cases but superficial with mental health. These patterns only emerge over time, and they’re the most valuable thing to know because they tell you where to focus.
The options
A study partner is brilliant when you can arrange it. One of you plays the patient from a proper briefing, the other consults, you debrief afterwards. The emotional reality of a human response — someone who’s genuinely worried, or frustrated, or tearful — teaches you things that no other method can. The challenge is logistics. Coordinating diaries across different rotas and placements is difficult, and when sessions fall through, your practice week has a hole in it.
AI voice-based platforms solve the availability problem. You speak to an AI patient that responds to your questions in real time, and you get structured feedback afterwards. The technology has improved significantly in the last couple of years — the interactions feel reasonably natural and the feedback is domain-specific. The main advantage is that you can practise whenever you have 20 minutes free. The main limitation is that emotionally complex cases still feel different from practising with a real person.
Recording yourself — whether with a study partner or on an AI platform — and listening back is underused and very effective. You notice things in playback that you completely missed in the moment. Verbal tics, interrupting patients, rushing through safety-netting, spending too long on one area. It’s uncomfortable to listen to yourself, which is exactly why it works.
Your own surgeries are consultation practice happening every day, whether you treat them that way or not. Debriefing a real consultation with your trainer — “what went well, what would I do differently” — is free, available, and builds reflection into your clinical work. The limitation is that your trainer can only observe a small fraction of your consultations.
How often and for how long
There’s no magic number, but here’s what we’d suggest as a framework:
If you’re building skills during ST1–ST2, one or two structured practice consultations per week alongside your clinical work is enough to build steady improvement. The emphasis should be on developing good habits rather than intensive cramming — you have time.
If you’re approaching the SCA in ST3, increase to two or three per week for the 8–12 weeks before your sitting. Consistency matters more than volume. Three well-reviewed consultations per week beats ten rushed ones with no reflection.
After the exam, don’t stop entirely. Even one structured practice session per month keeps your skills sharp and prevents the gradual drift toward autopilot that happens to most GPs once formal assessment ends.
In all cases, the review after each session is at least as important as the session itself. Five minutes of genuine reflection on what you’d do differently is worth more than ploughing through another case without pausing.
Common traps
Only practising what you’re good at. Respiratory, MSK, cardio — the comfortable presentations. But the consultations that challenge you most are the ones where practice makes the biggest difference. Mental health, breaking bad news, paediatrics, safeguarding. If you’re avoiding a topic in practice, that’s a sign you need to prioritise it.
Practising without structure. Doing a consultation and moving straight to the next one without reviewing how it went. The learning is in the reflection, not just the doing.
Treating it as exam prep rather than skill development. If you only practise consultations when an exam is approaching, you’re rebuilding skills each time rather than maintaining them. The registrars who do best in the SCA are usually the ones who’ve been practising throughout training — the exam is just a checkpoint.
We built ConsultMentor because we wanted our own registrars to have access to structured consultation practice whenever they needed it — not just in exam season. Try a free case and see whether the feedback tells you something useful about your consulting.
