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The Ultimate guide to the Simulated Consultation Assessment (SCA) for GP trainees

Published on: 8 May 2024

The Royal College of General Practitioners (RCGP) has introduced a new way of examining clinical competence. This guide answers the most common questions about the new exam and explains what it involves.

 

What is the new assessment?

The Simulated Consultation Assessment (SCA) is one of three assessments that are required to gain a Certificate of Completion of Training (CCT) to become a fully trained GP (MRCGP). The other components are an applied knowledge test and a work-based assessment. 

It replaces the Clinical Skills Assessment that all trainee GPs had to sit at an exam centre in London.

What is the format of the SCA?

It’s entirely online. Trainees log in to an online portal to do the exam which lasts just over three hours. During this time they have to conduct 12 virtual consultations (a mix of telephone and video based). 

For each one, they are given 3 minutes to read the case notes of a simulated patient before they move on to a virtual consultation where a trained actor plays a patient or their relative/carer. Candidates have 12 minutes to conduct the consultation and decide on appropriate management. 

Candidates need to be online prior to the starting time to complete registration.

Where will I take the exam?

It must be taken at a trainee’s usual workplace or another local practice.

You will need a suitable space in your surgery, where you will be undisturbed for the duration of the examination. You will receive the date and time of the exam at least four weeks before the exam date. The room must be cleared of leaflets and posters. You can bring a British National Formulary (BNF) and child BNF, plus water to drink.

What will happen when I take the exam?

When you register for the exam, you will be sent a unique exam link, username and password. Enter these to log in to the platform and some checks will be made on your microphone, camera and internet connection. You’ll have an opportunity to walk through on-screen functionality before an invigilator connects with you to carry out an ID check and 360 degree inspection of the room. Once you proceed to the exam, you’ll be able to message them with any problems. 

You’ll get a countdown to reading time for each case and you’ll get the option to write notes to help you with your decision making (not marked). During consultations with the role player, you can switch back to notes. Your invigilator will monitor you throughout the exam.

What kind of patient scenarios are included?

Cases are based on everyday consultations that could be undertaken by any GP in any setting in the UK cover the following domains:

  • Patient <19 years old
  • Gender and sexual health, including women’s, men’s, and LBTQ
  • Long term conditions, including cancer, multi-morbidity, and disability
  • Older adults, including frailty and end of life care
  • Mental health, including addition, alcohol and substance misuse
  • Urgent and unscheduled care
  • Health disadvantages and vulnerabilities, including veterans, mental capacity, safeguarding, and communication difficulties 
  • Ethnics, culture, diversity, and inclusivity
  • New presentation of undifferentiated disease
  • Prescribing
  • Investigations and results
  • Professional conversations and dilemmas

All candidates taking the exam on a specific date will be assessed on the same 12 cases. 

Are any physical examinations required? 

No. If you think examining the patient would be useful, check the case notes as there may be findings there. Also there may be pictures in the briefing notes. You will have enough information to complete each case. 

At what time of year are the exam sittings?

There are 9 exam sittings every year, taking place every month except July, August and December. Each one has a 12 month reservation period, so you can reserve your place up to a year in advance, allowing plenty of time to prepare. 

What digital platform does the exam use? 

Osler Online, which is a platform designed specifically for clinical exams and also used by other Royal Medical Colleges.

What if the internet connection is lost during the exam?

No candidates will be disadvantaged if the internet connection drops out, and 45 minutes is allocated at the end to allow for any reruns of any cases that are required.

Can I take the exam on a mobile phone or tablet? 

No. It must be taken on a PC or laptop with a Windows or mac operating system (Windows 10, Sierra 10.12). An internet download speed of 10Mbs and an upload speed of 4Mbs is required. Osler Online is only compatible with Google Chrome and Microsoft Edge browsers.

Can I check the set-up works before the exam day?

Yes. You will be sent a link to attend an onboarding session four weeks before your examination date. This consists of a device check and basic troubleshooting (log in, video and sound checks) plus a walkthrough. You must use the same device and same location when you take the exam. Further information can be found at: https://www.rcgp.org.uk/mrcgp-exams/simulated-consultation-assessment/sitting

Can I request more time or adjustments? 

Reasonable adjustments can be made for evidenced disadvantages, eg, providing extra reading or consultation time, giving extra breaks, enlarging instructions, colour contrasting the screen or providing help with keyboard navigation. You need to apply in advance for this. 

How is the exam marked?

Candidates will be assessed by different examiners for every case. Capabilities will be assessed and marked according to three domains:

  • Gathering information and making a diagnosis (eg, ability to gather relevant information, making use of existing information, noting red flags, generating a reasonable working diagnosis, prioritising issues).
  • Clinical management and medical complexity (eg, effective and evidence-based treatment, appropriate follow up, managing uncertainty).
  • Relating to others (eg., responds to cues, uses understandable language).

Examiners will mark candidates after the exam, not during it. 

How are exam results graded?

Clear Pass, Pass, Fail, Clear Fail.

When will I get my results?

Within a month of taking the exam.

What if I fail? 

GPs entering Speciality training for the first time on or after 2 August 2023 are permitted to make a maximum of six attempts.

When was the new exam format introduced? 

November 2023.

Why has the new exam format been introduced?

Travel restrictions introduced during the Covid-19 pandemic triggered the need for remote examinations. It also triggered demand for remote consultations in general practice, so now both telephone and video consultations have become routine.The new exam format therefore mirrors everyday practice.
 
What are the benefits of the new format?

It’s fairer and more reliable. Since all candidates have the same cases and are provided with the same information about them, they are all tested against the same competencies. 

Candidates also save money on travel to London and any possible overnight expenses. They also sit the exam in a familiar environment, which is less stressful.

How much does the exam cost?
£1180

How do I reserve a space?

You can reserve a space via the RCGP website on the e-portfolio screen at: https://www.rcgp.org.uk/mrcgp-exams/mrcgp-exam-applications 

Where can I get extra information?

Go to: https://www.rcgp.org.uk/mrcgp-exams/simulated-consultation-assessment