By Dr S AhmedThe SCA at a glance
The Simulated Consultation Assessment is the RCGP's licensing exam for consultation skills. It tests one thing above all: whether you can consult at the level of a safe, independent GP. Not a perfect one. Not a consultant. A GP who can handle the breadth and complexity of real primary care.
The exam is conducted entirely remotely — every case is delivered by video or telephone, with no face-to-face scenarios. That matters in practice, because the skills you need to show (reading cues, signposting, managing uncertainty) all have to land through a screen or down a phone line.
Most trainees sit the SCA during their ST3 year, though the RCGP allows eligible trainees to sit earlier in certain circumstances. Check the current RCGP guidance on eligibility and applications to confirm your window.
The Simulated Consultation Assessment, at a glance
What happens on the day
You sit twelve consecutive cases. Each one runs for twelve minutes. A trained role player acts as the patient — occasionally a relative or a colleague — while an examiner observes and scores your consultation in real time.
You are not assessed on whether you reach the "right" diagnosis. You are assessed on how you consult. For most candidates, that is a fundamental shift from every clinical exam they have sat before.
Between cases you get a short break to read the next patient vignette. There is no long rest mid-exam — twelve cases, back to back. Stamina and consistency matter far more than most candidates realise.
The three marking domains
Every case is scored across three domains. Understanding them is not optional — they are the framework your entire preparation should be built around.
Data Gathering & Diagnosis
How you take a history, use the patient's narrative and reason your way to a working diagnosis — including when the picture is incomplete.
Clinical Management & Medical Complexity
Your plan, prescribing, safety-netting and ability to hold uncertainty. The heaviest domain — and the one that trips up the most candidates.
Relating to Others
Communication, shared decisions, responding to cues and professional manner. Not "being nice" — being genuinely responsive.
A quick word on weighting. Clinical Management & Medical Complexity carries 4.5 marks — more than either of the other two combined per half-domain — and a weak plan will cost you here even after a strong history. It is the domain that most often separates a pass from a fail. Relating to Others, meanwhile, is the one candidates most often underestimate: treat it as an afterthought and it tends to become your lowest-scoring domain.
How the marks add up
Each case carries a maximum of 10.5 marks — 3.0 + 4.5 + 3.0. Across twelve cases, the total available is 126 marks.
| Domain | Max / case | Max / exam |
|---|---|---|
| Data Gathering & Diagnosis | 3.0 | 36 |
| Clinical Management & Medical Complexity | 4.5 | 54 |
| Relating to Others | 3.0 | 36 |
| Total available | 10.5 | 126 |
The SCA is reported in four grades:
- CP — Clear Pass
- P — Pass
- F — Fail
- CF — Clear Fail
The mark required to pass changes between sittings, because the RCGP uses standard-setting to account for variation in case difficulty. There is no fixed pass mark to memorise — for the current methodology and any updated grade boundaries, always verify against RCGP guidance.
What this means in practice: aim to consult well in every case, not to hit a number. You can't know which cases are harder or easier for the cohort you sit with — so consistency beats chasing marks.
For a deeper explanation of how standard-setting works and what it means for your preparation, read our article on how the SCA pass mark works.
What the SCA is actually testing
This is where a lot of trainees get the framing wrong. The SCA is not a knowledge test — the AKT handles that.
The SCA tests your clinical judgement, your consultation skills and your ability to function as a GP, all at once, under time pressure, with a patient who may not tell you everything up front.
The cases are built to reflect real general practice. You will see undifferentiated presentations, patients with hidden agendas, complex social situations, mental health presentations, and scenarios that ask you to manage uncertainty rather than resolve it cleanly. That is general practice. That is the job.
The RCGP is explicit that the SCA is based on the GP curriculum. Grounding your preparation in real consultation skills — rather than scripted "SCA techniques" — is the right approach.
The remote format: what it changes
Every case is by video or telephone. No in-person consultations.
In video cases you can see the role player, which gives you access to non-verbal cues. In telephone cases you cannot. Both formats appear in the exam, and you need to be comfortable with each.
The remote format has real implications for how you demonstrate your skills. Signposting matters more. Checking understanding matters more. A moment of silence lands differently on a call than it does in a room. If you have not practised consulting remotely — deliberately, as a preparation strategy — start now.
Who sits the SCA
The SCA is a requirement for all trainees seeking the MRCGP. A trainee must be in ST3 to be eligible to sit.
If you are an international medical graduate, it is worth knowing that the communication and language demands of the exam can catch candidates out even when clinical knowledge is strong. The Relating to Others domain in particular asks for fluency with nuanced, patient-centred language — a register that benefits from deliberate practice. It is exactly what GP Trainer's cases are built to develop.
Where to go from here
If you are at the beginning of your SCA preparation, the most useful next steps are:
- Understand the marking domains in detail — not just their names.
- Start practising full cases under time pressure, rather than only reading about consultation models.
- Get feedback that maps to the three domains. Vague feedback ("good rapport") tells you nothing useful.
For what comes after the basics, read our pieces on how to pass the SCA first time and the most common reasons trainees fail.
“GP Trainer gave me everything I needed to pass first time. The cases mimic the actual exam, and the examiner feedback is really specific and useful.”
Dr AZ · GP trainee, passed the SCA
Frequently asked questions
The SCA (Simulated Consultation Assessment) is a remote clinical exam that forms part of the MRCGP. It consists of twelve simulated consultations, each marked across three domains — Data Gathering & Diagnosis, Clinical Management & Medical Complexity, and Relating to Others. It is conducted entirely by video or telephone.
There are twelve cases in the SCA. Each runs for twelve minutes, with a short reading period before each one.
The three marking domains are Data Gathering & Diagnosis (max 3.0 marks), Clinical Management & Medical Complexity (max 4.5 marks) and Relating to Others (max 3.0 marks). Each case carries a maximum of 10.5 marks; across twelve cases, the total available is 126 marks.
You sit the SCA from your usual GP practice. The one you are working at during your ST3. You connect remotely by video or telephone from a private consulting room, exactly as you would for a normal remote surgery. No travel, no exam hall. That means the environment is familiar, but you still need to prepare deliberately for the remote format: signposting, checking understanding, and managing silence all work differently on a call than in a room.
The RCGP uses standard-setting, which means the pass mark is not fixed — it varies between sittings based on case difficulty. Always check current RCGP guidance for the most up-to-date information on grade boundaries.
You must be in your ST3 year to sit the SCA. The RCGP publishes examination windows well in advance — reserve your place as soon as your window opens. Spaces can be limited and late registration is not an option. Check the RCGP website for the current schedule and any eligibility requirements specific to your deanery.
The AKT (Applied Knowledge Test) is a written, knowledge-based exam. The SCA tests clinical consultation skills, judgement and communication — it is not a knowledge test. Both are required for the MRCGP.