The Calgary-Cambridge model: five stages, two threads, and how to use it in exams
The Calgary-Cambridge model is a consultation framework developed by Kurtz and Silverman in 1996. It has five stages, initiating the session, gathering information, physical examination, explanation and planning, and closing the session, and two threads that run through the whole consultation: providing structure and building the relationship. The RCGP says of the SCA, "There is not a preferred model", and the GMC pages we read don't name one, but Calgary-Cambridge maps closely onto how PLAB 2 and the SCA are marked.
Last checked Nov 1, 2026 against the peer-reviewed description and the GMC and RCGP pages listed under Sources.
The short version
- Five stages: initiating the session → gathering information → physical examination → explanation and planning → closing the session.
- Two threads throughout: providing structure, and building the relationship.
- It was developed by Kurtz and Silverman for doctors and is now used across many health professions, according to a 2024 peer-reviewed study in the British Paramedic Journal.
- PLAB 2 marks every scenario in three GMC domains; the SCA marks every case in three RCGP domains. Each stage of the model feeds one or more of them (table below).
- The RCGP's SCA toolkit lists "global skills", including "Structures consultation" and "Finishes data gathering by 6-7 minutes", which match the providing-structure thread.
- In an 8-minute PLAB 2 station or a 12-minute SCA case, you won't spend equal time on each stage. Our timing maps below show one way to split it.
The five stages
| Stage | What happens | Key skills |
|---|---|---|
| 1. Initiating the session | Greet, introduce yourself, confirm who the patient is, find out why they came | Open question, listen to the opening story without interrupting, agree what to cover |
| 2. Gathering information | Explore the problem from both sides: the clinical facts and the patient's own perspective | Open then closed questions, picking up cues, ideas, concerns and expectations (ICE), red flags, background, social context |
| 3. Physical examination | Examine what is relevant, with consent and explanation | Explain what you will do and why, consent, chaperone where appropriate, comfort and dignity |
| 4. Explanation and planning | Explain what you think is going on and agree a plan together | Plain language, small chunks, check understanding, link to the patient's ICE, shared decisions |
| 5. Closing the session | Summarize, agree next steps and safety-net | Summary, safety-netting, follow-up, final check for questions |
The two threads
Providing structure. Making the consultation easy to follow: signposting ("I'd like to ask some questions about your health in general now"), summarizing at key points, and moving through the stages in a logical order without repeating yourself.
Building the relationship. Rapport, empathy, appropriate body language and tone, and involving the patient in decisions. On the phone this relies on voice, pauses and spoken acknowledgment.
Mapping Calgary-Cambridge to PLAB 2 and SCA domains
The GMC marks each PLAB 2 scenario in three domains, and the RCGP marks each SCA case in three domains. Neither body maps its domains to Calgary-Cambridge; the table is our reading, using the RCGP's own toolkit wording where it fits.
| Calgary-Cambridge | PLAB 2 domain (GMC) | SCA domain (RCGP) | SCA toolkit items (RCGP wording) |
|---|---|---|---|
| Initiating the session | Interpersonal skills; data gathering | Data gathering and diagnosis | "Opens consultation and explores problem"; "Generates rapport" |
| Gathering information | Data gathering, technical and assessment skills | Data gathering and diagnosis | "Identifies cues"; "Discovers patient's ICE"; "Discovers patient's psycho-social context"; "Rules in / out a serious disease" |
| Physical examination | Data gathering, technical and assessment skills | Data gathering and diagnosis | "Interprets appropriate examination and tests" |
| Explanation and planning | Clinical management skills; interpersonal skills | Clinical management and medical complexity; relating to others | "Offers a safe patient-centred management plan"; "Shares and uses ICE in plan"; "Supports in decision-making" |
| Closing the session | Clinical management skills | Clinical management and medical complexity | "Provides follow-up / safety net" |
| Thread: providing structure | All three | All three | Global skills: "Structures consultation"; "Avoids repetition"; "Progresses through tasks" |
| Thread: building the relationship | Interpersonal skills | Relating to others | "Generates rapport"; "Listens and shows curiosity"; "Uses clear language" |
In the SCA, the clinical management and medical complexity domain "is weighted in comparison to the other two domains" (RCGP marking page), so don't let information gathering eat into your plan.
Physical examination in each exam
- SCA: consultations are by video or telephone ("In the majority of these you will be able to see the simulated patient. Others will be audio only", RCGP). The RCGP toolkit notes that "A few examinations can be done either on the telephone or during a remote video consultation, such as tests of cognitive functioning and mental health including suicidal risk assessment", and photos sent in by the patient can be interpreted. The RCGP also says physical examination "will not be assessed within the SCA, and instead will be covered within WPBA" (workplace-based assessment). In a case where examination matters, say what you would examine and why, and how you'd arrange it.
- PLAB 2: the GMC lists "physical examination" in the first domain (data gathering, technical and assessment skills). The GMC pages we read don't describe how examination stations are run. See our PLAB 2 examination stations guide.
Timing maps (our advice, not an official rule)
SCA: 12 minutes (after 3 minutes' reading time)
The RCGP gives 3 minutes' reading time at the start of each case. Its toolkit lists "Finishes data gathering by 6-7 minutes" as a global skill.
| Time | Stage | What to aim for |
|---|---|---|
| 0:00–1:00 | Initiating | Greeting, identity check if remote, open question, let them talk |
| 1:00–6:00 | Gathering information (+ examination if relevant) | History, cues, ICE, red flags, psycho-social context; say what you'd examine |
| 6:00–10:30 | Explanation and planning | Diagnosis or working analysis in plain words, options, shared decision, use their ICE |
| 10:30–12:00 | Closing | Summary, safety-netting, follow-up, any last questions |
PLAB 2: 8 minutes
The GMC says you read the instructions and patient information outside each room before entering, but the pages we read don't say how long reading time is. Plan inside the 8 minutes:
| Time | Stage | What to aim for |
|---|---|---|
| 0:00–0:45 | Initiating | Introduce yourself and your role, confirm the patient, open question |
| 0:45–4:00 | Gathering information | Focused history, ICE, red flags (or the examination, if that is the task) |
| 4:00–7:00 | Explanation and planning | Plain-language explanation, plan, check understanding |
| 7:00–8:00 | Closing | Summary, safety-netting, follow-up |
Station tasks differ. In a counseling or explanation station, gathering information may be 2 minutes and explanation 5.
Worked example: stages in one consultation
Example written by Confetto for practice (not a real exam station). A 12-minute SCA-style video consultation: Mr. Tom Hughes, 46, with heartburn for two months. Clinical content is kept general; in real practice follow current NICE/CKS guidance.
| Stage | What the candidate says (sample) |
|---|---|
| Initiating | "Hello Mr. Hughes, I'm Dr. Mensah, one of the GPs. Can you hear and see me OK? What can I help with today?" |
| Gathering, open | "Tell me more about the heartburn, from when it started." |
| Gathering, cue | "You said your dad 'had stomach trouble'. Can you tell me about that?" |
| Gathering, ICE | "What do you think might be causing it? Is anything worrying you about it? What were you hoping we'd do?" |
| Gathering, red flags | "Have you had any trouble swallowing, lost weight without trying, vomited blood, or had black stools?" |
| Signposting (structure) | "Thanks, that's really helpful. I'd like to explain what I think is going on, and then we can decide together what to do." |
| Examination | "I'd normally like to examine your tummy. As we're on video, could you come in to the surgery for that?" |
| Explanation | "This sounds like acid reflux, where stomach acid comes up into the food pipe. You were worried about your dad's illness. None of the warning signs I asked about are there, which is reassuring." |
| Planning | "There are a few options: some changes to eating and drinking, a look at your current medicines, and a treatment to reduce acid. What would suit you?" |
| Closing | "So, to sum up… If you have trouble swallowing, lose weight, vomit blood or have black stools, contact us the same day, or call 999 if you feel very unwell. Let's review in four weeks. Anything else before we finish?" |
Neighbour's five checkpoints (briefly)
Another model often taught alongside Calgary-Cambridge is Roger Neighbour's The Inner Consultation (book, 1987). It uses five checkpoints: connecting, summarizing, handing over, safety-netting and housekeeping. Many trainees combine them: Calgary-Cambridge for the structure, Neighbour's checkpoints as reminders.
Common mistakes
| Mistake | Better |
|---|---|
| Spending 7 of 8 minutes on history | Watch the clock; leave time to explain and plan |
| No signposting between stages | One sentence: "I'd like to move on to…" |
| Explaining before checking what the patient knows | Ask first, then explain from there |
| A plan made for the patient, not with them | Offer options and ask what suits them |
| Forgetting to close | Summary, safety-net, follow-up, every time |
Practice this with an AI patient
Confetto isn't affiliated with the GMC or RCGP.
Frequently asked questions
What are the stages of the Calgary-Cambridge model?
Five stages: initiating the session, gathering information, physical examination, explanation and planning, and closing the session. Two threads, providing structure and building the relationship, run through all of them.
Who developed the Calgary-Cambridge model?
Kurtz and Silverman, in 1996, as a communication tool for doctors (as described in a 2024 peer-reviewed study).
Do I need to use Calgary-Cambridge in PLAB 2 or the SCA?
No. The RCGP says "There is not a preferred model" for the SCA, and the GMC marks PLAB 2 by domains, not a named model. Calgary-Cambridge is useful because its stages line up with what those domains look for.
How long should each stage take in the SCA?
The RCGP doesn't set times per stage, but its toolkit lists "Finishes data gathering by 6-7 minutes" as a global skill. That leaves around 5 minutes for explanation, planning and closing.
What is the difference between Calgary-Cambridge and Neighbour?
Calgary-Cambridge describes the stages and skills of the whole consultation. Neighbour's Inner Consultation gives five checkpoints (connecting, summarizing, handing over, safety-netting, housekeeping). Many doctors use both.
How is physical examination handled in the SCA?
The RCGP says physical examination "will not be assessed within the SCA, and instead will be covered within WPBA". A few examinations can be done remotely, such as tests of cognitive functioning and mental health including suicidal risk. For others, say what you'd examine and how you'd arrange it.
Sources
Read on November 1, 2026.
- Hastings C. "Is the Calgary-Cambridge Model of consultation a suitable communication tool for students and newly qualified paramedics? A qualitative study." British Paramedic Journal 2024;9(1):23–33
- RCGP. "SCA toolkit: Data gathering."
- RCGP. "SCA toolkit: Clinical management."
- RCGP. "SCA toolkit: Relating to others."
- RCGP. "Introducing the SCA."
- RCGP. "Marking and results for the SCA."
- GMC. "How will you be tested in your PLAB 2 test?"
- GMC. "What is the PLAB 2 exam and how does it work?"
- Neighbour R. The Inner Consultation. 1987 (book).