Top tips on how to pass SCA

The GP SCA (Simulated Consultation Assessment): Top Tips on how to pass the SCA

The SCA examination is designed to test your skills as a GP to manage common cases you will encounter in primary care. It is not designed to catch you out or test knowledge of rare pathologies. This is not PACES for a medical speciality! Remember you are not carrying out physical examinations, going through uncertain results and dealing with multiple vague presentations. The cases will have to be standardised to numerous sittings in the year. To make the cases more complex, you will be thrown a curveball with ethical dilemmas and professional scenarios that can be easily marked via a video/telephone consult. These are used to push candidates and will also make it easier for examiners to create a benchmark. I have trained and helped numerous trainees pass the SCA on the first attempt. I want to share with you below the top tips a trainee in ST2/3 can do to give them the best chances of success and smashing this exam the first time round.

Firstly lets look at the preparation I would expect you to be doing whilst in primary care;

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If you are struggling with timing on a 20+ minute consult or finding yourself running behind each clinic, speak to your supervisor early on to address this. SCA preparation should be started ideally at the start of ST3 to give you plenty of time to perfect and hone your skills.

Next let's look at the 6/5/1 consultation model I have recommended trainees to use. This is just a guide, you can use whatever model works best for you!.

If we break down the typical case in SCA which lasts 12 minutes;

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3 minutes prior to consultation start: you will be given some text for case pre-reading. This may be brief and just include Name/Age/Past medical history for example. It can also include longer text with recent consults and test results. You can start thinking about what this case will entail but do not start getting carried away with diagnosis at this stage. Keep an open mind with differentials. This is a common pitfall with trainees. Avoid doing a spot diagnosis at this stage- this will give you information bias and you may risk missing out on the actual diagnosis if not explored sufficiently.

0-6 minutes: Data Gathering & Diagnosis

I would suggest spending maximum 6 minutes in this part of the consultation. This may not sound like a lot of time. But these are the timings you will need to aim for to avoid running out of time for the remaining consult. As mentioned before easy marks are lost by candidates in each sitting as they spend too long on the history taking and running out of time for the remaining management. This is not an ABC guide on how to take a history for a patient which I am sure all of you will do well. But key things to remember;

During the end of 5-6 minutes you should be thinking about transitioning to the next part of the consultation. The divider here will be the diagnosis. Your will need to commit to your most likely differential at this stage and make this clear. Do not keep it vague.

6-11 minutes: Clinical Management

The next 5 minutes you will be focusing on the management aspect of the above diagnosis. There is a lot to fit into this section and remember marks may be weighted more heavily here so it even more important to do this effectively and well. The key points here are to explain the reasoning behind the diagnosis and generating a share care management plan. This is the domain where most marks are lost and this could account for the difference between clear pass and a borderline fail. Remember;

11-12 minutes: Closing and safety netting/ Follow up

The last minute should be used to close the consultation, advise about follow up and discuss safety netting. If you have timed yourself well as above these are easy marks you can secure.