“Oh my god, I can’t even describe it. It was such a relief. I cried on that day.”
That’s Dr Thiha, describing the moment he finally saw a pass on his screen on his third attempt at the MRCGP SCA.
Two attempts before that, the story looked very different. 66. Then 61. Worse the second time, not better. And in the two weeks after that second result, Thiha was wondering whether this was the end of his GP training altogether.
If you’ve just opened a fail result, read his story slowly. Almost every mistake he made is one I see IMG trainees make every single week and every fix he found is one you can start using in your next practice case.
The Second Attempt: When Working Harder Made Things Worse
Most people assume a second attempt should go better than the first. Thiha assumed the same thing.
He’d read extensively. He was confident his clinical knowledge was solid and it was. So he walked into his second sitting believing that consultation skills would “just come naturally without even practising.”
His score fell from 66 to 61.5. He failed nine IPS (Interpersonal Skills) stations and eight Clinical Management stations. For a doctor who had never failed an exam like this before, the result triggered a genuine identity crisis. He even paid for an official RCGP review, certain there must have been a scoring error. There wasn’t. The score came back exactly the same.
This is the part of resit preparation nobody warns you about: the exam can expose a gap between how you consult in your own clinic and how you perform under 12-minute exam conditions.
Why “I Practised 150–200 Stations” Wasn’t Enough
Between his first and second attempts, Thiha practised extensively, somewhere between 150 and 200 stations.
He still failed.
As he put it afterwards: “That means that quality is not there.” Volume of practice was never the problem. The problem was that he was rehearsing the same instincts over and over, instincts that hadn’t been corrected. Practising 100 cases without structured feedback reinforces the old ones.
The Turning Point: Changing the Strategy
After the second fail, Thiha described a genuine low point, questioning whether to abandon GP training and go back to hospital medicine, wondering if he simply didn’t have “the instinctive consultation skills” needed to pass.
The shift came when he stopped asking “how do I try harder?” and started asking “what exactly am I doing wrong?”
For his third and final attempt within his extension window, he changed his approach:
- One dedicated study partner, working through Consultation Blueprint case bank (around 35 cases) rather than hundreds of scattered ones
- Weekly, single-skill focus, one week on addressing ICE, the next on safety-netting, the next on explaining diagnoses concisely
- Modelling language directly, he listened to consultation recordings as podcasts during his commute, at one point learning phrasing “word for word” and using it successfully in a breaking bad news station on exam day
- External, trainer-level feedback, instead of relying only on peer feedback, he actively sought input from his educational supervisor, other GPs in practice and structured coaching
The Three Specific Fixes That Moved His Score
1. Time Management: Finishing History-Taking in 5 Minutes
Thiha describes himself as someone who was “always trying to be thorough” — and that instinct was costing him marks in Clinical Management domain, because it left almost no time to negotiate a plan.
The fix was concrete: aim to finish data gathering by minute 5–6, not minute 7 or 8. In practice, that meant trading long, specific questions for broader ones. Instead of asking separately whether a headache affected work, sleep and relationships, he learned to ask one open question: “Is there anything you’ve had to change in your life because of this?” — and let the patient tell him what mattered.
Less time in data gathering. More time to actually manage the case.
2. Addressing ICE
This is the distinction that changed his interpersonal skills scores more than anything else.
Thiha had never struggled to ask ICE questions. His problem was that he asked them with a formulaic intention and then forgot to address them once he moved into management.
| What most trainees do | What actually scores |
|---|---|
| Ask ICE, then never return to it | Ask ICE, then explicitly link management back to it |
| Treat ICE as a box to tick in data gathering | Treat ICE as the thread that runs through the whole consultation |
| Park a patient’s cue and hope to remember it | Address the cue immediately, or write it down and return to it deliberately |
His fix was simple: he wrote “Addressing ICE” at the top of the management side of his whiteboard, during his three minutes of reading time so it was physically impossible to forget once he reached the management phase of the case.
3. Concise, Jargon-Free Explanations
Overexplaining showed up as heavy medical terminology and detailed pathophysiology dropped into patient explanations which slowed him down and, more importantly, didn’t land with the patient in front of him.
His fix was to listen back to consultation demonstrations until concise, plain-language explanations became his default rather than something he had to consciously think under pressure.
The Whiteboard: A Tool, Not a Crutch
Many trainees avoid using the whiteboard because they worry it breaks rapport. Thiha had the opposite problem: without it, he had “no framework” and would default to old, disorganised habits under pressure.
His solution was a middle ground worth modelling:
- During reading time, sketch the skeleton of the consultation: presenting complaint, ICE, differentials, safety-netting cues
- During the consultation, keep eye contact as the default and only glance down to jot a single word
- Before moving into management, take one quick look at the board as a prompt, not a script to read from
The Result: 61.5 to 86
The before-and-after speaks for itself:
| Second attempt | Third attempt | |
|---|---|---|
| Overall score | 61 | 86 |
| IPS stations failed | 9 | 1 |
| Management stations failed | 8 | 2 |
| IPS clear passes | — | 5 |
| Management clear passes | — | 3 |
| Time between attempts | — | ~2 months |
A 25-mark jump in two months achieved by correcting three specific, identifiable habits — time management, addressing (not just asking) ICE and concise explanation, one at a time, with constructive feedback.
What Dr Thiha Would Tell You If You’ve Just Failed
In his own words, distilled into the advice he now gives other resitting trainees:
- Change the strategy, not just the effort. Repeating the same approach with more intensity rarely produces a different result.
- Identify your specific weaknesses and work on one at a time, until it becomes instinctive rather than something you have to consciously remember under pressure.
- Accept the feedback, even when it’s uncomfortable. Thiha admits he was initially in denial about how his consultations were coming across.
- Prioritise quality of practice over quantity. 35 well-reviewed cases beat 200 unreviewed ones.
- Keep track of time, it was the hardest habit to break.
Frequently Asked Questions
Why did Dr Thiha’s SCA score get worse on his second attempt? He attributes it to overconfidence combined with unaddressed habits. He believed strong clinical knowledge would carry his consultation skills and he hadn’t identified the specific behavioural patterns in time management and addressing ICE.
What’s the importance of addressing ICE in the SCA? Addressing ICE during the management discussion allows the patient’s own agenda to shape the plan. Failing to address ICE after asking it is a common, gap, even for trainees who feel confident about their communication skills.
How much practice is actually needed to pass the MRCGP SCA? There’s no fixed number. Dr Thiha practised 150–200 stations before his second attempt and still failed; on his third attempt he worked through roughly 35 cases with structured, external feedback and scored 86. The evidence from his experience points to quality of feedback and correction mattering more than sheer volume of practice.
Is it normal to feel like giving up after failing the SCA twice? Yes. Dr Thiha describes considering whether to leave GP training after his second fail. This kind of reaction is common among trainees who have never previously failed an exam, and it doesn’t reflect your actual clinical competence — it reflects the disorientation of a result that doesn’t match your day-to-day performance in clinic.
Can changing time management alone improve an SCA score? For Dr Thiha, tightening data gathering to around 5–6 minutes was one of three specific changes, not a standalone fix. It created the space needed to properly negotiate management and address ICE and it worked in combination with more concise explanations and deliberately returning to the patient’s concerns during management.
Want Support With Your Exam?
Dr Thiha practised 150–200 stations on his own and still failed. What actually moved his score was someone pointing out that he was asking ICE but never addressing it, that his history-taking was eating the minutes he needed for management and that his explanations were still too dense for the patient in front of him. He couldn’t see those patterns in himself. Once we worked together, we fixed each one of them.
If you’re stuck practising more but not sure exactly what’s costing you marks in IPS or Clinical Management, we can help.
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