Simulated Consultation Assessment(SCA)

• The Simulated Consultation Assessment (SCA) is the final clinical examination in the MRCGP (Membership of the Royal College of General Practitioners) assessment pathway. It evaluates how well a GP trainee manages real-life, remote general practice consultations. The format mimics modern GP settings, involving video or phone consultations with actor patients.

  Trainees are assessed on their ability to:

  • Gather information efficiently

  • Make safe and patient-centred clinical decisions

  • Communicate effectively and empathetically

  📦 Structure of the Exam

• • 12 simulated consultations

  • Each consultation lasts 12 minutes

  • Conducted remotely via a secure online platform

  • Mix of video and telephone scenarios

  • Cases reflect everyday general practice, covering a wide range of clinical presentations, ages, and patient backgrounds

  🧭 Domains Assessed

  Candidates are scored in three core domains during each consultation:

  1. Data Gathering, Technical & Assessment Skills

  • Appropriately explores symptoms, red flags, and underlying conditions

  • Uses medical records, test results, and medications effectively

  • Demonstrates efficient and targeted history taking

  2. Clinical Management & Medical Complexity

  • Forms accurate clinical impressions

  • Develops safe, evidence-based management plans

  • Provides appropriate safety-netting and follow-up

  • Manages uncertainty and multi-morbidity confidently

    3. Interpersonal & Communication Skills

  • Builds rapport quickly

  • Uses open-ended questions and active listening

  • Responds empathetically to concerns and beliefs

  • Involves patients in shared decision-making

  • Communicates clearly without jargon

  🔍 Examiner Feedback Insights

• Recent examiner and trainer feedback has highlighted key themes that commonly affect performance:

• ✅ What Good Candidates Do:

  • Use patient records and medication lists to personalise consultations

  • Explore the patient's agenda (ICE: ideas, concerns, expectations) early in the consultation

  • Adjust tone and approach based on the scenario (e.g., distressed patient vs. medication review)

  • Apply clinical judgement without over-investigating or over-referring

  • Manage time effectively, ensuring both history and management are completed

  • Use natural, conversational language—not scripted phrases

  • Demonstrate awareness of continuity of care and local referral pathways

  ⚠️ Common Mistakes:

  • Relying too heavily on generic consultation models or memorised checklists

  • Rushing into management without a full understanding of the patient's context

  • Missing red flags or failing to probe for underlying conditions

  • Failing to acknowledge the patient's concerns or emotions

  • Overusing screening tools when not clinically indicated

  • Weak or absent safety-netting

  📝 Preparation Strategy

• 1. Understand the Exam Blueprint

  Familiarise yourself with the full scope of presentations, including chronic disease, mental health, safeguarding, and telephone triage.

• 2. Master Consultation Timing

  Divide your time effectively:

  • ~6 minutes for data gathering

  • ~6 minutes for management, explanation, and safety-netting

  3. Practice with Structure and Feedback

  Form small study groups to simulate full consultations. Rotate roles between doctor, patient, and observer. Use structured feedback methods after each case.

• 4. Use Realistic Mock Setups

  Practice using a webcam, not just face-to-face. Familiarise yourself with screen-sharing, reading notes, and using a whiteboard—your only permitted writing tool.

• 5. Build Clinical Reasoning

  Don’t just focus on completing checklists. Reflect on why you're asking certain questions, making decisions, and choosing treatments. Make your thinking visible to the examiner.

• 6. Focus on GMC Professionalism

  Demonstrate respect, empathy, confidentiality, and patient-centred care in every scenario. Your professionalism is just as important as your clinical knowledge.

• 🧠 High-Yield Revision Areas

• • Contraception & sexual health

  • Mental health crises

  • Chronic pain, fibromyalgia

  • Multiple co-morbidities in elderly patients

  • Safeguarding (child & adult)

  • Medicolegal issues (DVLA, fit notes, complaints)

  • Remote prescribing challenges

  • Triage and risk assessment in limited time

• 📌 Key Tips for Success

  • Be warm and human—this is not a viva or OSCE, but a simulation of everyday general practice

  • Listen more than you speak in the first half of the consultation

  • Don’t rush the management—structure your explanation, involve the patient, and check understanding

  • Use ICE (Ideas, Concerns, Expectations) and SBAR or SOAP formats flexibly, not rigidly

  • Have a strategy for telephone consultations—especially managing without visual cues

  • Use the 3-minute pre-reading time wisely to scan records, meds, and red flag clues

  ✅ Final Words

• The SCA is designed to test whether you're ready for real-world independent GP practice. You are expected to be safe, patient-centred, and clinically sound—not perfect. Authenticity, empathy, and structure are your greatest tools.