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

🩺 SCA Preparation Handbook (Part 1)

1. Introduction

Many candidates find the Simulated Consultation Assessment (SCA) challenging. Some fail on their first or even second attempt despite strong clinical knowledge. This often happens because they underestimate the communication and consultation skills required.

The aim of this guide is to:

• Provide a clear roadmap for SCA preparation.

• Highlight common mistakes and how to avoid them.

• Explain examiner expectations.

• Share practical strategies, including whiteboard planning and use of mocks.

• Summarise insights from successful candidates who scored highly.

2. Understanding the Exam

How SCA differs from PLAB

• PLAB 2: Assesses junior-level, basic skills. Candidates are compared with other IMGs.

• SCA: Assesses GP-level consultations. Candidates are compared against UK-trained GP registrars.

  • Higher expectations for communication, empathy, and shared decision-making.

  • Management planning and interpersonal skills contribute heavily to scores.

What Examiners Are Looking For

• A GP who is:

  • Safe (manages appropriately, does not over-refer unnecessarily).

  • Supportive & empathetic (acknowledges concerns, builds rapport).

  • Patient-centred (addresses ICE, shares management options).

  • Confident (communicates as if experienced, even when uncertain).

3. Preparation Principles

How long to prepare?

• First attempt: 2–4 months (may extend to 6 months if progress is slow).

• Retakers:

  • If close to passing → 1–2 months.

  • If score <70 → take longer (3–4 months) before re-booking.

• Golden rule: Do not book or pay the £1200 fee until you’ve had honest feedback from a mock.

Key Resources

• NICE CKS Guidelines: Core reference, summarised into notes.

• Daily GP Work: Use 12-minute timers to simulate exam consultations during clinics.

• Study Partners:

  • Start with a group of 4–6 for variety of styles.

  • Later reduce to 1–2 reliable partners for daily intensive practice.

  • Choose partners who give tough, constructive feedback.

• Mock Exams:

  • Essential before booking the real exam.

  • Types include “big mock,” 1-to-1 mock, and 12-case “mega mock.”

  • Aim for your first mock 2–3 months before exam, not a week before.

Study Materials

• Structured notes that group cases by theme (e.g. Women’s Health, Paediatrics, MSK).

• SCA Revision and other case banks (practice scenarios rather than memorising all cases).

• Revise management tables at least twice in the final 4 weeks.

4. Whiteboard Strategy

The whiteboard is your roadmap in each case. If not used effectively, it can cause distraction and missed steps.

When to Prepare

• Prepare your template after the ID check (not during the 3-minute reading time).

• You may have 5–30 minutes before stations start — use this wisely.

Structure

Divide the board into two halves:

Left column (fixed for all cases):

• Opening question (HPC).

• ICE (write as three separate lines: Ideas, Concerns, Expectations).

• PMH/DHx/Allergies.

• Social Hx (alcohol, smoking, driving, OTC meds, impact on life).

• Red flags.

• “Impact” (daily life, work, family).

Right column (case-specific, wipe each time):

• Patient’s cues, key positives/negatives, differentials.

Bottom section (Management Checklist):

• De-ICE (address ICE first).

• Diagnosis explanation.

• Options:

  • Lifestyle / self-care.

  • Investigations (bloods, exams).

  • Medications (including OTC).

  • Referrals (if appropriate).

  • Leaflets, support, resources.

  • Follow-up & safety netting.

5. Common Mistakes to Avoid

🔴 History & ICE

• Forgetting to ask ICE entirely.

• Asking ICE as one word only (forgetting expectations/concerns).

• Asking ICE back-to-back in a robotic way.

• Not addressing ICE in management (e.g. patient worried about cancer → never reassured why it isn’t).

🔴 Management

• Listing management instructions instead of offering options.

• Overloading the patient with information instead of shared decision-making.

• Not verbalising safety netting or follow-up.

• Over-referring unnecessarily (“being safe” ≠ sending everyone to secondary care).

🔴 Interpersonal Skills (IPS)

• Not smiling (except during bad news or chronic condition counselling).

• Poor empathy (not reflecting concerns, missing cues).

• Overly formal, robotic language.

🔴 Exam Technique

• Booking exam before being ready.

• Taking first mock only 1–2 weeks before exam.

• Choosing study partners who only give “easy” feedback.

• 🔍 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.