The MRCGP: Simulated Consultation Assessment (SCA) is a challenging exam that may cause anxiety among trainees. This article will give you 10 actionable tips to help you prepare for your exam.
1. Develop a growth mindset
Your mindset plays a key role in your success. Some trainees don’t handle the stress and pressure of a high-stakes assessment very well. A lack of confidence can negatively impact your performance. It is important to believe in yourself and develop a can-do attitude. As you develop your consultation skills, your confidence will grow.
2. Understand the format and marking
The SCA consists of twelve consultations with simulated patients. The assessment is conducted remotely at a local GP surgery. You will have a 3-minute gap between stations. There are 12 cases performed by professional role-players who are trained, calibrated and standardised.
GP trainees can expect 9 video and 3 telephone consultations. The twelve simulated consultations are recorded remotely and marked at a later date by examiners. Trainees will not be assessed on physical examinations.
Each case will be marked in three domains:
- Data gathering and diagnosis (DG&D)
- Clinical management and medical complexity (CM&C)
- Relating to others (RTO)
Clinical management is the most heavily weighted domain with a score of 54. The maximum score is 126.
Each domain is graded as clear pass, pass, fail or clear fail. Trainees’ marks are determined based on their performance across all twelve cases. Trainees do not need to pass a certain number of cases in order to pass.
A poor performance in one domain or case can be compensated by doing well in others. There is no fixed pass mark for a station. The pass mark varies based on the performance of the candidates on the day.
3. Prepare early
It is vital that you plan for the SCA early. Every trainee will approach the exam differently. One trainee might need four months, while another might need six months, particularly if the latter works less than full time. To increase your chance of passing the SCA, aim to sit the exam when you are at your peak. Some trainees might never feel ready, but having at least six months of experience in general practice might help. If you’re planning to sit for the exam six months from now, start preparing early. Give yourself ample time to embed consultation skills so that they are internalised and become automatic for the exam.
4. Start a study group
Starting a study group can be helpful to prepare for the SCA. It allows you to practice your consultation and communication skills. A study group works well with three people in it: one to be the doctor, one to be the simulated patient, and one to observe, keep track of time, and provide feedback.
The role of the observer is far from passive. Embrace being an observer, put yourself in the shoes of an examiner and analyse the doctor’s performance. It can be insightful to develop your own consultations.
It is useful to form a study group with trainees who are planning to take the SCA in the same sitting as you. This ensures everyone in the group works together to pass. As the exam date approaches, you can decide to increase the intensity and frequency of the study sessions. It is important to practice with colleagues from various backgrounds so you can gain new perspectives and insights.
5. Seek constructive feedback
Constructive feedback is a gift to the trainee who wants to excel. Without feedback, it’s difficult to identify your blind spots and shortcomings. Use the Consultation Observation Tool (COT) and audio-COT to record challenging consultations. Watch or listen to your recorded consultations and pick up on the patient’s verbal and non-verbal cues. Evaluate the performance as if you were observing a colleague and reflect on what you might do differently. Share your recorded consultations with your trainer regularly and seek constructive feedback. Have an honest discussion with your trainer about any areas of weakness that you need to work on.
6. Manage your time effectively
Many trainees struggle to keep their consultations within 12 minutes. If a trainee regularly needs 18 minutes per case in surgery, the latter is likely to struggle with the SCA. It is vital to manage time effectively. Identify the reasons for poor use of time. It could be due to a lack of structure, not being willing to commit to a diagnosis or excessive use of summary.
There is a tendency among trainees to dwell on data gathering beyond 7-8 minutes due to a fear of missing important information. As a result, trainees don’t leave sufficient time to tackle clinical management. Trainees may have to rush and not be able to adequately discuss treatment plans, arrange follow-up or provide safety netting advice. It can be helpful to challenge yourself to consult within 10 minutes so you can increase your pace.
Priming a case prior to the start of the consultation is vital. Use the golden three minutes to prepare how you are going to approach the station. Write down key questions you shouldn’t miss to make a safe assessment.
7. Readdress idea, concern and expectation (ICE)
A common pitfall among trainees is not returning to the ICE gathered in the first half of the consultation. It is not good practice to explore ICE and then not address it. In general practice, we don’t merely treat diseases. Patients have worries, concerns and a health agenda. We ought to consider the psychology of our patient. It’s crucial to address the patient’s ICE. You ought to integrate ICE into the discussion when you explain your working diagnosis and formulate a shared treatment plan. Readdressing the patient’s ICE will allow you to take a patient-centered approach.
Preparing for the MRCGP SCA can be daunting but with the right preparation, GP registrars can pass this challenging exam with confidence.
We understand the anxiety you may have while preparing for your exam. After collaborating with trainers, examiners and trainees, Dr Erwin Kwun developed a Blueprint to help you pass SCA and CCT with confidence.
8. You need to demonstrate your skills and knowledge
The examiners can’t read your thoughts. If a behaviour is not observed, examiners cannot mark what has not happened in the consultation. You might be a great doctor, but you need to demonstrate your knowledge and skills to pass the SCA. For example, if you suspect migraine, but don’t verbalise your thoughts out loud, the examiner can’t assume you are managing the right condition.
9. Be genuinely empathetic
It is common for trainees to say, “I’m sorry to hear that”, just for the sake of appearing empathetic then jump to a completely different topic. Trainees often use stock phrases in an attempt to show empathy. By doing so, they may come across as formulaic.
Empathy is showing you understand and can feel the pain of another person. How you say something is as important as the words. You have to genuinely empathise. A useful technique to demonstrate empathy is giving a receipt.
For example, a patient might say, “I’m having an awful headache.” The doctor replies, “I hear you. This headache seems very bad.”
10. Learn to manage medical complexity
The SCA will assess candidates’ ability to manage complexity, uncertainty and risks encountered in general practice. It might be helpful to learn how your trainer manages challenging cases. Experienced GPs often use time as a tool to manage uncertainty. It is crucial to identify areas in the SCA Blueprint that you find challenging or to which you don’t have much exposure. For example, genetic diseases, ethical dilemmas, and angry patients
The SCA is challenging, but if you plan and put in the necessary work to embed good consultation practice, you can pass this exam with confidence. I hope you find the 10 tips helpful in your preparation.
Bonus Tip
Seek support from colleagues who have passed or are also sitting the SCA. Talking with other colleagues who have faced similar challenges can be incredibly helpful. If you would like support from a community of GP and GPSTs, join our Facebook Support Group
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If you wish to work with me 1 on 1 and receive constructive feedback go to SCA Blueprint Coaching.
How Dr Lawrence passed SCA?
After a failed SCA attempt with a score of 69, Dr Lawrence’s confidence was crushed. Check out how Dr Lawrence conquered SCA after this major setback.
