If you’ve sat the SCA more than once and failed marginally, this post was written for you.
For twenty years, Dr Ali was a surgeon.
She knew certainty. She knew protocols. She knew what it felt like to walk into a room, assess a problem and act confidently. Then she moved into general practice and everything she’d built her identity on stopped being the thing that worked.
“When you are not sure, or you are not supposed to be so, there is a completely different understanding of how you manage patients when you are a GP,” she told me. Twelve minutes. A patient in front of her. And a version of herself that no longer fit the room.
So she did what she’d always done. She worked harder. She finished on time, every time. She was safe. Thorough. Efficient. And she still kept failing the SCA, each one landing in the same maddening place. Not a clear fail. A marginal one. Half a mark short. A mark short. The kind of result that tells you nothing except that you weren’t quite enough, in a way you can’t see.
“I’m pass failing marginally every time,” she said. “Knowledge is there but I’m too firm… it’s a little bit less in a sense of patient understanding, standing on the other side of the consultation and just showing some empathy.”
She’d caught the shape of the problem. She just couldn’t get her hands around it.
A Different Language for Care
There was something underneath this that went deeper than exam technique. Dr Ali grew up understanding care differently to how a UK consultation asks you to perform it.
What we call empathy is a sympathy. We never go into the shoes of others, to be honest and reflect back that thing. So we are there for support, but we are not there to just verbalise them.
She had to close gap between two ways of being a caring person and no case bank was ever going to close it.
Everything She Tried
So she went looking for what would.
She bought courses. Studied the videos from tutors everyone recommends. Watched other clinicians consult, again and again, trying to absorb what she couldn’t yet name. She practised on an AI mock consultation tool. She recorded herself and reviewed the tapes. She sat one-to-one with a retired Fellow of the Royal College who worked through her language and phrasing, sentence by sentence. Her supervisors gave her everything they had to support her.
And she still failed a fourth time. By a margin so narrow it barely counted as a gap at all and it broke something in her. She had to step away from work. She describes the days before that fourth result as some of the hardest of her life outside childbirth.
If you’ve done everything you know how to do and you’re still coming up short by a mark or two, sit with that for a second. Dr Ali’s problem was that nobody had shown her, specifically, what to fix.
The Feedback No One Had Given Her
By the time we started working together, she’d absorbed the learning like a sponge. What she hadn’t had was someone watching her actual consultations and pointing, precisely, at the habits costing her marks.
Here’s one: she had a way of thinking out loud mid-consultation without looking at the patient while she did it. Her supervisors never caught it — they were watching her as a safe clinician in a real clinic, not scoring her against SCA criteria. The AI tools didn’t catch it either. They could tell her something felt off. They couldn’t tell her why, in the exact language an examiner is trained to listen for.
“That will not give me that feedback,” she said. “I need to have a feedback which is straightforward to the point and what need to be changed to improve the results.”
We found more. A habit of saying “okay” as a placeholder, when what the moment needed was a real acknowledgement, a phrase, costing her marks. And the instinct almost every conscientious IMG carries: the pull to cover everything, to prove you know it all by saying all of it. In one case, safety-netting a medication change, she felt compelled to spell out every possible side effect in full. “You don’t need to repeat it in the end,” we worked through together, “because it will time consume you… you will be more stressed about that.”
These were patterns you cannot see in yourself, and cannot fix until someone else names them out loud.
The Fifth Sitting
Her final attempt was different since she could read the actors’ expressions. She felt present, in the room, instead of running a script. In one station, a phrasing mix-up made her and the patient actor laugh together, genuinely, before she caught herself and moved on. It didn’t feel like an exam she was surviving. It felt like a conversation.
On results day, she didn’t know what to expect.
“When I go there, I keep going down and then it was a green tick that I was relieved.”
A pass with a score of 81.5. After two years, over six thousands of pounds in exam fees and strain on the people she loves. “It’s a big relief,” she told me afterwards. “Very big relief.”
What changed was identifying the obstacles standing between her and a pass and helping her fix precisely those, instead of everything at once.
Maybe Dr Ali’s story sounds familiar: the marginal fails, the real effort, the courses that helped a little but never enough, the sense that something specific is wrong and you just can’t name it, then her lesson is yours too.
Hard work was never your problem. Precision was.
I asked her what she’d say to someone with a few months left before their own sitting.
“Stay in the moment. Think about what is going on now,” she said. “You’re a GP. You are sitting in a GP exam. You’re not a specialist. You need to give them a safe assessment, listen to them, and provide them what they want in a safe manner without missing your role as a doctor.”
If you’ve done everything you know how to do and you’re still short, a mark, a domain, a sitting — maybe what you need isn’t another course. It’s someone to watch your consultation and tell you what’s actually happening.
That’s what changed it for Dr Ali. It could be what changes it for you too.
Want Support With Your Exam?
Dr Ali worked hard for four sittings and still couldn’t get over the line. What moved her score on the fifth was someone watching her consultations and naming the specific habits she couldn’t see in herself. Once we found them, we fixed them, one at a time.
If you’re in that same place after trying everything you were supposed to but still not sure exactly what’s costing you marks in IPS or Clinical Management, this is exactly the gap we close.
✅ 1:1 feedback that names the specific habit, not just “practise more”
✅ Real-time practice under exam conditions
✅ Mindset coaching for the weeks after a fail, when it’s hardest to get back on track
✅ A supportive community that gets what a resit actually feels like
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FAQ
How many times can you resit the MRCGP SCA? Candidates are permitted five attempts at the MRCGP SCA as long as their deanery support them. Each unsuccessful resit adds cost, time and pressure on training progression. This is exactly why identifying the specific, correctable reasons behind a marginal fail matters more with each attempt.
Why do experienced hospital doctors sometimes struggle more with the SCA? A career built in hospital or surgical medicine often rewards thoroughness and procedural completeness: traits that don’t map directly onto what the SCA is assessing. The exam is looking for person-centred, safe general practice, not maximal clinical coverage, which can mean unlearning habits that were previously considered strengths.
Can neurodivergence affect SCA performance and can it be accommodated? Yes. Many trainees discover a neurodivergent profile only after repeated exam attempts, as Dr Ali did following her third sitting. A formal assessment can lead to reasonable adjustments and also gives trainees language for patterns such as anxiety under observation, or a need for structured note-taking that they may have carried, unnamed, for years.
Why do trainees still fail after using courses, AI mock tools and recordings? These tools are valuable for practice volume and general pattern recognition but they rarely pinpoint the one or two specific, individual habits costing a particular candidate marks. Generic feedback tells you something is off; targeted feedback tells you exactly what to change and why it matters to the marking domain.
What is the difference between empathy and sympathy in an SCA consultation? Sympathy acknowledges a patient’s distress from the outside. Empathy involves reflecting back what the patient is feeling in a way that shows you’ve understood their perspective from the inside. Examiners are listening for the latter and for IMGs from cultures where emotional expression works differently, this can be a genuinely learnable but under-taught skill.