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Introduction
The MRCGP Simulated Consultation Assessment (SCA) is the new exam that has replaced both the RCA and the CSA as part of the final stages of GP training in the UK.
As a GPST3 who has recently sat and passed the exam, I’ve thought of a few top tips to help you prepare for the SCA. This is not an exhaustive list, but hopefully, it will help you feel more prepared to sit the SCA and pass!
Preparing for exams, especially whilst working, can be tough. These tips will guide you in the right direction – you might also find our bank of SCA cases helpful for your revision.
Choosing when to do the exam
This exam can be sat at any point in ST3, but that doesn’t mean you can’t start practising beforehand!
The RCGP suggest trying to do your AKT and SCA relatively close together so that your knowledge does not slip – however, don’t rush this. I did my AKT in April 2023 and the SCA in November 2023. I think this time frame worked well for me.
The experience of working in General Practice cannot be underestimated to be ready to sit this exam. A lot of “on the job” learning is picked up by simply going to work in the surgery, which is more difficult to learn from studying.
Discuss this with your trainer, have an idea at the start of ST3 of when you plan to do the exam and make sure your trainer supports this.
ST3 is a busy year. There are many things to do as well as the SCA. Being organised by setting out a clear timeline for exams and workplace-based assessments can help this go more smoothly.
Start preparing early
The more practice you do, the more exposure you have, and hopefully, the less likely you’ll be caught off guard on the SCA exam day.
You cannot cram revision for the SCA!
Give yourself plenty of time. Regular practice around three months before the exam is a good starting point. Once a week for a few hours, slowly building up to maybe 3-4 times a week in the weeks leading up to the exam. Of course, tailor this to suit your individual objectives.
Pick your study group
This can be done in many different ways, but the best way to be consistent is to try to coordinate with your friends/colleagues who are planning on sitting the exam at the same time and make a study group.
There is no perfect number of people, but I found three to work well. When practising, you can be the patient, the doctor, and the examiner (ideally rotating after each case).
Be honest with feedback
Once you’ve got a group of people to revise with, you’ve hit the ground running! One of the most important tips I can give you is to be honest with your feedback.
You will not improve if you do not receive constructive criticism. There is no point in being told by your colleagues that you performed the perfect consultation on day one of revising.
Ensure you are comfortable with your group and allow yourself to be challenged to improve your skills.
Giving constructive feedback
One method for giving constructive feedback is by using Pendleton’s rules:
- Start with the individual playing the doctor and ask them to highlight the positive aspects of their performance (“What went well?”)
- Next, the examiner(s) and patient offer their perspectives on what the doctor did well
- Ask the doctor to reflect on areas for improvement in their approach or technique (“What would you do differently next time?”)
- The examiner and patient contribute their observations on aspects the doctor could improve.
Feedback should be specific, focusing on behaviours observed during the roleplay. Suggestions for improvement should be practical and achievable.
Mimic the exam environment
The SCA is an online examination, and with this comes some nuances to get used to the exam conditions, such as ensuring you are looking at the patient rather than yourself on screen!
To try to get used to this from an early stage, practice in your group using an online video platform. This also makes things more accessible if you don’t live close to your peer group.
Some of your consultations in the exam are telephone consultations, which can easily be recreated by switching your camera off – something that is harder to recreate if practising face-to-face.
Recording consultations and joint surgeries
You are expected to record consultations through the Consultation Observation Tool assessment (COT) and audio COTs during your GP training. Your trainer will either watch you consult via a joint surgery or watch a consultation you have recorded.
Your trainer is an experienced GP, and although this exam is new, consultation assessments are not. They will be able to provide valuable feedback about your consultation and explanation skills and give you tips on improving.
It is also important to remember that real patients in your surgery will not behave quite like the actors.
It may also be useful to get your trainer to listen to a recording of a consultation you’ve done with your peers during revision, as this may be more like the case in the exam.
Half day release
As part of your GP training programme, you will have half day release (HDR). Try to speak to your Training Programme Directors (TPDs) early about organising sessions for SCA practice – whether in person or using breakout rooms on online video platforms.
Your TPDs are experienced GPs, and education and training are part of their role. Getting feedback from the TPDs on your consultation skills is another great resource.
This may also be an opportunity to practise outside your revision group, get other peoples’ perspectives, and maybe even learn some new phrases/skills from your colleagues.
Learn from others
By working with your peers and listening to advice from your trainer or colleagues, you’ll pick up good phrases to use consultations and ways to ask tricky questions.
Have a notebook where you write these phrases down, and practise using them in your consultations.
These can be as simple as asking about home or work life that sounds organic and conversational instead of a tick box exercise.
Develop a good consultation structure
Consultation structure is a topic in itself, but generally, it is important to develop a structure that works for you and stick to it.
This can be done by trial and error at the start of your revision, following tutorials and joint surgeries with your trainer.
Being consistent with this structure allows things to flow and gives you scaffolding to use, even when faced with challenging cases.
Timing
Twelve minutes goes quickly, especially in an exam setting. From the start of your revision, practise with a timer. The exam starts at twelve minutes and counts down – get familiar with this.
Splitting your consultation into two six minute sections is a good start:
- Six minutes for data gathering and diagnosis
- Six minutes for clinical management and complexity
The relating to others marks will be picked up throughout both sections.
Having enough time to discuss your management is so very important, as this is where you demonstrate that you have listened to the patient and can discuss a shared management plan.
Resources
The SCA is a new exam but not too different from the previous CSA, so previous casebooks are still useful for exam practice.
Remembering there is no physical examination element in the SCA is something to be aware of when looking at these cases and trying to work these findings into the brief some way if needed (e.g. examination findings of an ECG or BP measurement).
