For many international medical graduates (IMGs) training to become GPs in the UK, one assessment stands between them and the end of training: the Simulated Consultation Assessment (SCA). In 2023-24, 51.56% of IMGs passed the SCA at their first attempt, compared with 94.28% of UK graduates. It is the same exam and the same standard, with very different outcomes. This gap is called differential attainment. For the registrars behind these numbers, it can mean further attempts, extended training and months of uncertainty.
The SCA asks for more than knowledge. In twelve minutes you have to manage complexity and risk, work through uncertainty and stay warm with the patient, all at once. Those are skills, and skills can be learned.
In October 2026, Dr Erwin Kwun presented his work on this at the Royal College of General Practitioners (RCGP) Annual Conference in Glasgow, showing how structured coaching may help close the gap. This guide sets out what he found and how you can start practising this week.
Quick answer: what Dr Erwin Kwun presented at RCGP 2026
Dr Erwin Kwun presented his work on reducing differential attainment in the MRCGP Simulated Consultation Assessment (SCA) at the RCGP Annual Conference 2026 in Glasgow, as an oral presentation and a poster. Differential attainment means capable doctors sitting the same exam and reaching different outcomes.
Among the 112 international medical graduate (IMG) registrars in the work, the success rate was 80.36%, which is nearly 29 percentage points above the national IMG first-time pass rate for 2023-24. Coaching appears to drive improvement, because it shows registrars the blind spots they cannot see alone.
If you are preparing for the SCA, the message is encouraging: structured guidance and calibrated feedback give you something concrete to work on, starting this week. Dr Kwun is a GP, the author of Consultation Blueprint, and a coach to GP registrars preparing for the SCA.
What is differential attainment in the SCA?
Differential attainment is the systematic difference in exam outcomes between groups of candidates, linked to protected characteristics and socioeconomic background. The RCGP describes it as multifactorial, with no single identifiable cause (RCGP annual report 2023-24).
In the SCA, the widest published gap is by place of primary medical qualification. In 2023-24, 94.28% of UK graduates passed at their first attempt, against 51.56% of international medical graduates (IMGs). The RCGP also notes that place of qualification is not the same as nationality, because UK nationals who studied abroad sit in the IMG group.
That gap invites a practical question: what do capable candidates need in order to show what they can do in this format?
The SCA at a glance
- Format: twelve consultations with simulated roleplayers, each lasting twelve minutes, with three minutes of reading time per case
- Setting: sat in a local GP surgery, usually your own, through an online platform
- Marking: recorded, then marked later by examiners, with a different examiner for each case
- Domains: data gathering and diagnosis, clinical management and medical complexity, and relating to others
- Examination skills: assessed in workplace-based assessment (WPBA) rather than in the SCA
Source: Introducing the SCA, RCGP.
Why this work went to the RCGP Annual Conference
Dr Kwun took this work to the RCGP Annual Conference because every registrar deserves the same chance to reach MRCGP. He presented it on Thursday 29 October 2026 at the SEC Glasgow. The journey from Swansea took 7.5 hours.
The question behind the work is a hopeful one: can structured guidance and coaching help every registrar show the doctor they already are?
The cause is personal. At 17, he was voted the shyest student in his sixth form, and speaking up made his heart race. Volunteering as an international mentor led to an invitation to speak on stage. He said yes, enrolled in a public speaking course, and has since spoken at conferences. Confidence grew from action, one small step at a time, and he now brings that same belief to coaching registrars.
What the work found
Among 112 IMG registrars, the success rate was 80.36%, nearly 29 percentage points above the national IMG figure for 2023-24.
| Group | SCA pass rate | Source |
|---|---|---|
| IMG registrars who received coaching (n = 112) | 80.36% | RCGP Annual Conference 2026 poster and oral |
| National IMG first-time takers, 2023-24 | 51.56% | RCGP annual report 2023-24 |
| National UK graduate first-time takers, 2023-24 | 94.28% | RCGP annual report 2023-24 |
Coaching appears to drive improvement. Practice builds familiarity, and calibrated feedback builds insight. Coaching helps registrars see the blind spots they cannot see alone.
This is an observational result from one group of registrars, so it shows an association and invites more testing. That is why continuing and widening the work matters.
Support programmes elsewhere point in the same direction. In the North West, a targeted programme with early consultation analysis, tutorials, educational planning and the SCA consultation tool reported an IMG first-time pass rate of 81% in February 2024, across the deanery (Pulse). Single-sitting results need careful reading, and they are encouraging.
What registrars said afterwards
Registrars who had struggled with the SCA came to share what the work meant to them. For several, the exam had become a barrier on the path to MRCGP.
One trainee reflected that they had not realised they needed to offer options and ask what the patient thought (Pulse). Many IMGs already listen well and manage patients safely, and the SCA asks them to make person-centred care explicit.
If that sounds familiar, you are in good company, and the work points to a hopeful route: make the expectations visible, then practise them with calibrated feedback.
The principles behind the coaching
The SCA rewards structure, prioritisation and person-centred communication, and examiner feedback shows how much of that sits in the patient’s story. The RCGP’s 2023-24 annual report lists the feedback examiners gave all candidates. Four areas close to the patient’s story each appear in feedback to roughly half of them.
| Feedback area | Candidates given this feedback at least once, 2023-24 |
|---|---|
| Exploring the person’s agenda, health beliefs and preferences | 53.80% |
| Sharing and adapting explanations | 50.92% |
| Recognising psychological and social information | 47.38% |
| Responding to cues and listening actively | 47.06% |
Source: RCGP annual report 2023-24. Clinical management feedback is also frequent, so the story and the clinical plan work together.
Consultation Blueprint coaching, drawn from the book Consultation Blueprint: Pass the MRCGP SCA with Confidence builds five habits.
- Close the calibration gap. Registrars often feel a station went well and then see a different result. Recording a consultation, reviewing it with a trainer and reflecting on it closes the gap between what you think happened and what did.
- Open the story before the checklist. A question such as “How did it all start?” invites the patient’s story, which saves many closed questions later. In one recorded consultation about transient visual loss, the patient mentioned being a taxi driver. The registrar, focused on her question list, did not return to driving, and a safe plan depends on it.
- Tell an idea from a concern. An idea is the patient’s own explanation. A concern is a worry with emotion behind it. When a patient says they fear cancer, acknowledge it first, for example “I hear you. What makes you think it’s cancer?” Patients remember how you made them feel.
- Negotiate with HEART. Hear, Educate, offer an Alternative, Reach agreement, then Trust and follow up. It helps you say no with compassion. Wording matters here: “What did you think a scan would show?” invites more than “Why do you want a scan?”
- Look after your own state. Emotions are contagious in a consultation. Breathe out, name the feeling, and set an intention before the next patient. Naming it gives you back some control.
Red flags enable you to make a safe assessment. The story tells you what matters.
How to prepare for the SCA: what to practise this week
You can start today with one recorded consultation. These steps suit first-time candidates and resitters, and they help IMGs make the skills they already have visible to examiners.
- Record one timed consultation. Use twelve minutes, with a colleague, trainer or role-player.
- Watch it back before anyone comments. Note one thing that went well and one thing you would change.
- Review it with your trainer or a mentor. Use the three RCGP marking domains: data gathering and diagnosis, clinical management and medical complexity, and relating to others.
- Acknowledge worries before the next question. Then explore them: “I hear you. What makes you think that?”
- Make shared decision-making audible. Offer appropriate options and ask what the patient thinks.
- Pick one 1% improvement for tomorrow. One per cent a day compounds to nearly 38 times better over a year.
If you are resitting, use the feedback statements from your RCGP result to choose which habit to practise first.
Frequently asked questions about the SCA and differential attainment
What is the MRCGP SCA?
The Simulated Consultation Assessment is the RCGP’s practical exam for GP registrars and one of the three MRCGP components, alongside the Applied Knowledge Test and workplace-based assessment. It assesses your ability to integrate and apply clinical, professional and communication skills in simulated consultations delivered online.
How is the SCA structured?
There are twelve consultations of twelve minutes each, with three minutes of reading time per case. You sit it in a local GP surgery, usually your own. The sessions are recorded and marked later, with a different examiner for each case.
What is differential attainment in the SCA?
It is the systematic difference in exam outcomes between groups of candidates, linked to protected characteristics and socioeconomic background. The RCGP describes it as multifactorial, with no single cause.
What is the SCA pass rate for IMGs?
In 2023-24, the RCGP reported a first-time pass rate of 51.56% for IMGs and 94.28% for UK graduates, with 74.57% across all first-time takers. Dr Kwun’s Pulse article cites 53.64% for IMGs and 93.73% for UK graduates from the RCGP’s most recent annual report at the time of writing.
Why do IMGs have lower first-time SCA pass rates?
Thhere are different factors that may explain lower success rate among IMGs. The SCA rewards making person-centred skills explicit: empathy, ideas, concerns and expectations, spoken reasoning and shared management. Many IMGs were trained to show care differently, so this is a technique to learn rather than a gap in interpersonal skill.
Does coaching help you pass the SCA?
In Dr Kwun’s work with 112 IMG registrars, the success rate was 80.36%, and coaching appears to drive improvement. The result is observational and comes from one group, so it shows an association and cannot promise an individual outcome.
Is practice alone enough to pass the SCA?
Practice builds familiarity, and calibrated feedback builds insight. Practising without recalibration can strengthen existing habits, so pair practice with review by a trainer or coach who knows the marking domains.
How should I prepare for the SCA as an IMG?
Record timed consultations, review them with a calibrated reviewer, and rehearse specific behaviours: acknowledging worries, exploring ideas, shared-decision making and safety-netting. The steps above give you a week-one plan.
What is a good opening question in an SCA consultation?
“How did it all start?” invites the patient’s own story and shows you which cues to follow. It also saves many closed questions later.
How can I work with Dr Erwin Kwun?
Dr Kwun offers personalised SCA coaching for GP registrars, including IMGs and resitters, and works with training programme directors (TPDs) on sessions for their cohorts. The next section explains how to start.
About Dr Erwin Kwun
Dr Erwin Kwun MRCGP PGCert APPCP is a portfolio GP based in Swansea, the author of Consultation Blueprint: Pass the MRCGP SCA with Confidence and the host of the SCA Preparation Podcast. He coaches GP registrars, including IMGs and resitters, towards passing the SCA, and he writes on differential attainment for publications such as Pulse.
His approach turns what examiners look for into habits you can practise. What registrars and TPDs can see for themselves:
- Results: a success rate of 80.36% among 112 IMG registrars, shared as an observational result
- Visibility: an oral presentation and a poster at the RCGP Annual Conference 2026
- Voice: a Pulse article on why capable IMGs struggle with the SCA and what training programmes can do
- Resources: the book Consultation Blueprint: Pass the MRCGP SCA with Confidence and the SCA Preparation Podcast
- Teaching: sessions for registrars and TPDs, including the Southend VTS half-day release on the psychology of the consultation
If you are a registrar
If you are preparing for the SCA or planning a resit, a clarity call is a good first step. You talk through your situation, identify what is holding your marks back, and map your next step.
If you are a TPD or educator
Dr Kwun runs sessions on the psychology of the consultation for registrar cohorts, fitted around your teaching calendar.
Your next step can be small. Record one consultation this week, and get in touch when you would like a second pair of eyes on it.
Sources
- Introducing the SCA, RCGP, format, setting and marking of the SCA
- MRCGP Annual Report covering 2023-24, RCGP, first-time pass rates, differential attainment definition and examiner feedback
- Are we failing international medical graduates in GP training?, Dr Erwin Kwun, Pulse, the preparation gap, the North West programme and the most recent annual report figures