SCA guide
The GP SCA (Simulated Consultation Assessment): A Comprehensive Guide to Success
General Overview
The ST3 SCA exam for GP trainees is the final hurdle in the GP training journey. This exam has undergone a few changes away from the traditional in person exam- CSA ( consultation skills assessment ) to RCA- Recorded Consultation Assessment in 2020 and now finally the SCA. This is expected to be the format for the foreseeable future. Successful completion of the SCA together with the training portfolio gives you the final sign off for MRCGP. Hopefully this guide will give you a good summary on this exam and tips to boost your chances for success.
Exam Format
- Online exam carried out in candidate’s GP surgery
- 12 simulated patient scenarios each lasting 12 minutes
- 3 minutes in-between each case with info/case material to read in preparation for the next case
- The majority usually >2/3 of the cases will usually involve a patient on video ( as if you are speaking to someone on Zoom for example). The remaining will be a telephone consultation.
These cases are delivered by professional actors, who may adapt their consults according to candidate’s approach to each case. There is no physical examination involved in this exam. You will have to obtain the key points in the history, come up with most likely differential and manage the case within this time frame. This highlights the biggest skill of this exam which is communication skills.
Exam Dates and Fees / Booking
- Exam fee for the SCA is £1,180
- The fee will rise to £1,207 for candidates booking their exam from September 2025 onwards (please check RCGP website for latest prices)
- Nine sittings of the SCA will be available each year.
- You can reserve your place up to 12 months in advance of your intended sitting.
- Candidates in ST2/ ST3 will see the option to reserve an SCA examination from their trainee portfolio- e.g fourteen fish.
Don’t rush into the SCA: This exam should only be attempted when you are fully prepared. It’s crucial to take the time needed to practice rather than rushing into the exam before you’re ready. Your key skills are all developed by seeing real patients in general practice and your educational supervisor can also advise you on your progress.
How to Best Prepare for the SCA
The SCA tests both your clinical knowledge and interpersonal skills. To figure out how to best prepare for this exam you need to be aware of the syllabus/ what kind of cases you may get on the day. Be aware also how the examiners mark each case using key domains; listed below.
Data Gathering & Diagnosis
You will be assessed on taking a focused history and generating appropriate differentials. Remember to include systems review as appropriate and rule out red flags in each case. The cases are not designed not to catch you out however some candidates drop marks in this domain by not utilising all the relevant information related to the case or rushing into the diagnosis with limited data gathering.
Clinical Management & Medical Complexity
Here you are tested on your safe management skills within your scope of practice. Key points in this domain is to follow current practice, address uncertainty and safety net/arrange follow up as appropriate. The cases will vary in complexities. Areas where candidates lose marks on are; not allocating enough time in the consult to go through this safely and not reaching a shared decision management plans with patients .
Relating to Others
Communication skills and are tested in this domain. You may feel these are easy marks in the exam however candidates lose marks by; not addressing patient cues/concerns and ensuring consultation is patient centred.
Each case is marked by a different examiner, meaning you will have 12 different examiners for your SCA. Up to 3 marks are given for each domain (clear pass, pass, fail, clear fail). It is important to note the weighting of each domain may vary case to case. Clinical Management and Medical Complexity domain will usually carry increased weighting to reflect the number of capabilities it will cover.
Syllabus/ Clinical experience groups
The RCGP has released a list/ blueprint of clinical groups that may be tested in the SCA as below;
- Children and Young People (<19yrs old)
- Gender/ Sexual Health/ LGBTQ/gynae/men’s health
- Long Term Conditions including cancer and disability
- Older Adults including End of Life
- Mental Health including Substance Misuse, Smoking, Alcohol
- Urgent and Unscheduled Care
- Health disadvantage & vulnerabilities including safeguarding and capacity
- Ethnicity, diversity, inclusivity
- New presentation of undifferentiated disease.
- Prescribing.
- Investigations and Results.
- Professional Conversations and Dilemmas.
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To prepare for the SCA you will need to focus on all of the above clinical groups, however groups highlighted in bold above very likely to be tested in each sitting. As physical examinations are not tested, cases such as mental health, speaking to parents of a child are easily brought out in the SCA. Find out more tips on how to prepare for the SCA on my next blog where I go into more detail.