SCA Info
Welcome to the most supportive online resource for your Simulated Consultation Assessment (SCA) preparation. With the transition from the traditional CSA (Clinical Skills Assessment) to the SCA, both the format and expectations have shifted notably.
Here is some info about the SCA exam that you should be familiar with before sitting. The SCA was launched in 2023 to replace the RCA exam (Recorded Consultation Assessment)
What is the SCA?
The SCA (Simulated Consultation Assessment) is the final step to becoming a fully qualified GP.
Following this, you will gain your MRCGP (Member of the Royal College of General Practitioners) certificate and CCT (Certificate of Completion of Training) certificate, which means you are now a fully qualified General Practitioner!
The assessment method has evolved over time, particularly influenced by the necessity for remote assessment methods during the COVID-19 pandemic. The RCA exam was in place as the original replacement for the CSA due to the COVID-19 precautions in place at the time.
Unlike its now more ancient predecessor, the CSA, which was conducted face-to-face, the SCA utilizes a format where the consultations are simulated through remote communication platforms. This is seen as a future-proof examination, also reflecting the modern telemedicine practices.
What does the sCA entail?
The SCA consists of 12 separate video or audio consultation sessions. Each consultation lasts for 12 minutes. Before each consultation, you will have 3 minutes of reading time where you can read through the case notes, and make notes on your whiteboard.
The exam sittings could be either in the morning or afternoon and the cases on a particular day will be the same in both sittings. This means that those in the morning session have to be quarantined after finishing the exam until the afternoon session starts. This could mean waiting up to an hour at the end of your exam in silence until your invigilator says that you can leave the consultation room!
There will usually be a mix of 9 video consultations and 3 audio during the exam (+/- 1).
The case will assess entirely your history taking, diagnosis skills, management and how you relate to others. The physical examination will not be assessed (however, if you think the patient does need to be examined, then you should say so and this would count towards your management).
Exam format
8:45: Deadline for logging into the examination platform. ID Check starts. The assigned invigilator will check your ID in between now and the exam start time. This usually takes 45 minutes. One invigilator usually looks after 4 students
9:30: Exam start
9:30 – 11:00. Cases 1 to 6. Each case lasts 15 minutes in total comprising of 3 minutes reading time and 12 minutes of consultation time.
11:00 – 11:10. 10 minutes break to have a drink, snack, and to use the bathroom. This is the only assigned break you will get in this exam. You have to message the invigilator using the chat function before leaving the room.
11:10 – 12:40. Cases 7 to 12 (1h 30 minutes total).
12:40 – 13:25. Your invigilator will contact you, congratulate you for doing the exam and ask you to remain in the room until approximately 13:25 when the afternoon session starts. When this happens, your screen will automatically change to also let you know that you can leave. You can then close the browser.
What case types will I get?
The RCGP has said that the examination will cover cases from 12 clinical experience groups, which we should already be familiar with from Fourteen Fish.
| Clinical Experience Groups | Description and Key Points |
|---|---|
| Patient less than 19 years old | Focuses on paediatric cases, requiring knowledge of age-appropriate communication, diagnosis, and management strategies. |
| Gender, Reproductive and Sexual Health | Covers a wide range of issues from gender-specific diseases to sexual health concerns across different gender identities, including LGBTQ+ health. |
| Long-term Condition | Includes management of chronic illnesses such as cancer, diabetes, and heart disease, with attention to multi-morbidity and disability. |
| Older Adults | Concerns the care of elderly patients, focusing on issues like frailty, dementia, and end-of-life care considerations. |
| Mental Health | Encompasses addiction, depression, anxiety, and other psychiatric conditions along with related behaviours like smoking and substance misuse. |
| Urgent and Unscheduled Care | Involves the management of acute illnesses or injuries that require immediate attention, often tested through emergency simulation cases. |
| Health Disadvantage and Vulnerabilities | Deals with patients who may face barriers to health due to socioeconomic factors, including veterans, those with limited mental capacity, and individuals requiring safeguarding. |
| Ethnicity, Culture, Diversity, Inclusivity | Tests the ability to provide culturally competent care, acknowledging and respecting the varied cultural, ethnic, and religious backgrounds of patients. |
| New Presentation of Undifferentiated Disease | Focuses on the initial management and diagnostic reasoning for patients presenting with symptoms that do not immediately suggest a specific diagnosis. |
| Prescribing | Tests knowledge of pharmacology and the safe prescription of medications, including considerations for side effects, interactions, and patient-specific factors. |
| Investigation / Results | Involves interpreting clinical tests and investigations, understanding their implications, and communicating results to patients effectively. |
| Professional Conversation / Professional Dilemma | Addresses ethical and professional issues that may arise in clinical practice, requiring sound judgment and effective communication skills. |
How will each case be assessed?
Each of the 12 cases will be marked according to three different domains:
- Data Gathering and Diagnosis
- Clinical Management and Clinical Complexity
- Relating to Others
Instead of having numerical marks, the three different domains will be awarded one of the following four grades. These do in fact equate to a numerical mark when adding up the grades at the end and to decide whether you have passed or failed, but more on this later.
RCGP says that a Pass mark will be awarded if the examiner believes you have performed at the level of a newly qualified GP. The other grades will derive from this.
Clear Pass
The domain has been demonstrated by the trainee at a level ABOVE the standard of a newly qualified GP.
Pass
The domain has been demonstrated at the level expected of a newly qualified GP.
Fail
The domain has not been sufficiently demonstrated at the level expected of a newly qualified GP.
Clear Fail
The domain has been demonstrated at a level below that expected of a newly qualified GP. They can apply if there isn’t enough evidence presented in the consultation about your levels of skill or if you are putting the patient at risk (for example with inappropriate advice, safety netting or not excluding red flags).
How will each domain be marked?
Here is some info from RCGP on how they envision each domain will be marked.
The marking is done by examiners after the exams, as they watch the video replays.
RCGP says that one examiner will mark the same case all day and all markings are calibrated to the standard expected of a newly qualified GP.
Here is a summary of the standardised descriptors, or you can read the full description on the RCGP website.
| Domain | Description |
|---|---|
| Data Gathering and Diagnosis | Systematic Information Gathering: Focuses on collecting relevant information methodically, ensuring patient safety. Diagnosis Making: Utilizes a structured and evidence-based approach for diagnostic reasoning, revising hypotheses based on new information, and addressing undifferentiated presentations effectively. |
| Clinical Management and Medical Complexity | Management Planning: Involves formulating safe and appropriate management options, prioritizing effectively under various circumstances and according to current NICE CKS guidelines. Handling Medical Complexity: Manages multiple health conditions simultaneously, applies risk management, and adapts care for multi-morbidity and polypharmacy. |
| Relating to Others | Communication Skills: Demonstrates respect and non-judgmental treatment of patients, using effective verbal and non-verbal communication skills. Ethical Awareness: Maintains an ethical approach, recognizing and respecting cultural and personal differences, and acting in the patient’s best interests. Collaborative Work: Engages with colleagues respectfully and values their contributions, enhancing patient care through teamwork. Holistic Practice: Addresses broader impacts on the patient and their environment, promoting overall health and safeguarding. |
In terms of domain weighting, RCGP has said in a recent webinar that this is determined separately for each exam. However, all exam sittings (Nov ’23 and Jan, Feb ’24) have so far had a higher weighting for the Clinical Management and Medical Complexity domain than the other two. This could however change in future sittings.
How do I book the SCA exam?
The booking has to be done via the Fourteen Fish website.
Once you are in ST3 and have passed your AKT, you will be able to reserve a slot for the diet when you want to sit the exam.
The booking period usually opens about 6-8 weeks before the exam and this is when you have to make the payment to confirm the booking.
How much does the SCA exam cost?
The SCA exam costs £1,180.
One of the unique aspects of the SCA is that it does not require the physical presence of the candidates in a testing center. Instead, candidates can take the exam from their own practice or another approved location, using their own computer systems. This not only reduces the stress associated with travel but also minimizes environmental impact and overall exam costs. The latter point about the reduced travel costs, which in some cases can amount to hundreds of pounds for those far away from London.
What are the SCA setup requirements?
Technical Setup Requirements
Due to the remote nature of the SCA, ensuring that the technical setup is adequate is paramount. Candidates must have a reliable internet connection to prevent disruptions during the exam. Additionally, the following technical aspects must be considered:
- Webcam and Microphone: A functioning webcam and microphone are essential. These are the primary means through which the interaction with the role player is conducted. Having a headset available can also help. Even if you don’t have to use it, I would recommend it as a backup just in case there are technical problems with the speaker sound e.g. echo or problems hearing the actors.
- Software Requirements: The SCA is conducted on a specific platform provided by the RCGP. Candidates need to familiarize themselves with this software in advance to ensure smooth navigation during the exam. Luckily the RCGP does provide a walkthrough and tutorial of how to use the software before the exam.
- Environment: The physical environment from where the exam is taken should be quiet and free from interruptions. It’s recommended to inform colleagues and staff to ensure privacy and silence during the exam duration. A “do not disturb” sign and a quiet consultation room are paramount to ensure a interruption free exam.
What is the pass rate for the SCA?
As it’s a new exam, there is limited data available on the pass rates. However, this is what we know so far:
| Examination Period | Total Candidates | Successful Candidates | Overall Pass Rate (%) | First-time Candidates (%) | Pass Rate for First-time Candidates (%) | Mean Score | Highest Score |
|---|---|---|---|---|---|---|---|
| November 2023 – First Week | 508 | 337 | 66.34 | 72.6 | 70.55 | 83/126 | 116.5 |
| November 2023 – Second Week | 607 | 405 | 66.72 | 86.8 | 70.78 | 84/126 | 116.5 |
| January 2024 | 613 | 419 | 68.35 | 81.4 | 73.15 | 83/126 | 117.5 |
| February 2024 | 795 | 552 | 69.43 | 85.0 | 75.1 | 84/126 | 123 |
From the table above, we can calculate the SCA overall pass rate to be about 67%.
We do not yet have individual data on pass rate discrepancies between UK Graduates or International Medical Graduates (IMGs).
The bad news here is that the pass rate of 67% is significantly lower than previous RCA pass rate which was around 75% over the past three years. It is also worse than the pass rates for the CSA (Clinical Skills Assessment) which were around 79%.
The good news is that the SCA pass rate has so far been increasing, as we have more clarity about what is expected in the exam and as we have more SCA cases to practice. Let’s hope this will continue to increase to 75% in the coming sittings.
