The exam and the mark scheme
What the SCA is, how it is marked, and the mark scheme used at every station today
The SCA in one page
- 12 cases, 12 minutes each, 3 minutes' reading before each; delivered remotely on the RCGP's Osler Online platform from your own or a nominated surgery. Most cases are video; some are audio-only. Third-party and professional conversations occur.
- Professional role-players. No physical examination — findings are supplied when you ask appropriately.
- No reference material. A whiteboard and the platform's notes are all you have.
- Marked afterwards from the recording by a different examiner for each case.
- Three domains: Data Gathering and Diagnosis · Clinical Management and Medical Complexity · Relating to Others. Each is graded Clear Pass / Pass / Fail / Clear Fail.
- Scores are reported out of 126. The RCGP states that Clinical Management is weighted relative to the other domains but does not publish the points per grade. The scheme reported from RCGP briefings — Clear Pass 3 · Pass 2 · Fail 1 · Clear Fail 0, Clinical Management ×1.5 — is the only one consistent with 126 and with the half-marks in published top scores, and gives 10.5 per case. Treat it as the working model.
- A global rating per case (Pass / Bare Pass / Bare Fail / Fail) is used to set the pass mark each diet by borderline regression; no pass mark is published. Published means are about 83–84 out of 126 — roughly 7 per case, the score of Pass–Pass–Pass.
- Blueprint: twelve clinical experience groups; nine diets a year; ST3 only.
What a Pass looks like
Data Gathering and Diagnosis
Targeted, systematic history; uses the information already in the notes; establishes the presence or absence of red flags; elicits the relevant psychosocial context; reasons aloud using probability and natural history; reaches a defensible working diagnosis even when the presentation is undifferentiated.
Clinical Management and Medical Complexity
Safe, appropriate options that reflect current practice, prioritised and shared; "wait and see" and self-care where right; prescribing, referral and investigation that a UK GP would recognise; co-morbidity and polypharmacy handled together; uncertainty managed openly; prevention where relevant; specific safety-netting, follow-up and continuity; the wider team used.
Relating to Others
Explores agenda, beliefs and preferences; responds to cues; adapts explanations; reaches a negotiated plan and checks understanding; respects autonomy and difference; non-judgemental; owns decisions; medico-legally aware (consent, capacity, confidentiality, safeguarding); works with colleagues.
The mark scheme used at every station
This generic scheme is identical at all 22 stations. Each station page adds a table of key points — the customised standard for that case.
Domain grades
| Domain | CF (0) | F (1) | P (2) | CP (3) | Points |
|---|---|---|---|---|---|
| Data Gathering and Diagnosis | ☐ | ☐ | ☐ | ☐ | /3 |
| Clinical Management and Medical Complexity (×1.5) | ☐ | ☐ | ☐ | ☐ | /4.5 |
| Relating to Others | ☐ | ☐ | ☐ | ☐ | /3 |
| Total | /10.5 |
Global rating: ☐ Fail ☐ Bare Fail ☐ Bare Pass ☐ Pass (CF Clear Fail · F Fail · P Pass · CP Clear Pass)
Feedback statement(s) — tick the one (at most two) you would attach
| Domain 1 | Domain 2 | Domain 3 |
|---|---|---|
| ☐ 1.1 Insufficient data | ☐ 2.1 Referral | ☐ 3.1 Cues / listening / formulaic |
| ☐ 1.2 Notes not used | ☐ 2.2 Prescribing | ☐ 3.2 Agenda / beliefs |
| ☐ 1.3 Psychosocial | ☐ 2.3 Investigations | ☐ 3.3 Circumstances / culture |
| ☐ 1.4 Unsystematic | ☐ 2.4 Prevention | ☐ 3.4 Explanations |
| ☐ 1.5 Prioritisation | ☐ 2.5 Risk management | ☐ 3.5 Judgemental |
| ☐ 1.6 Implications of findings | ☐ 2.6 Co-morbidity | ☐ 3.6 Respect / sensitivity |
| ☐ 1.7 Differentials | ☐ 2.7 Uncertainty | ☐ 3.7 Ownership |
| ☐ 1.8 Diagnosis / decision | ☐ 2.8 Follow-up / safety-net | ☐ 3.8 Teamwork |
| ☐ 2.9 Time management | ☐ 3.9 Safeguarding |
Timing checkpoints (Observer)
| Checkpoint (10-minute frame) | Done | Minute |
|---|---|---|
| Patient allowed to open without interruption (≈1 min) | ☐ | |
| ICE and psychosocial context elicited by 3:30 | ☐ | |
| Red flags covered; examination findings requested by 5:00 | ☐ | |
| Working diagnosis verbalised; gear change by 5:00–5:30 | ☐ | |
| Options shared; patient's preference used | ☐ | |
| Specific safety-net and follow-up by 9:30 | ☐ | |
| Understanding checked; finished inside 10:00 | ☐ |
The same checkpoints on the exam clock (Mock stations)
Multiply by 1.2: ICE and context by 4:00; findings by 6:00; gear change by 6:00–7:00; safety-net and follow-up by 11:30; finished inside 12:00.
The 26 feedback statements in plain words
| Domain 1 — Data Gathering and Diagnosis | Domain 2 — Clinical Management and Medical Complexity | Domain 3 — Relating to Others |
|---|---|---|
| 1.1 Insufficient data gathered for a safe assessment | 2.1 Referral inappropriate or not current practice | 3.1 Communication, cues and active listening insufficient (includes formulaic consulting) |
| 1.2 Existing information (the notes) insufficiently used | 2.2 Prescribing inappropriate or not current practice | 3.2 Agenda, health beliefs and preferences insufficiently explored |
| 1.3 Psychosocial information insufficiently recognised | 2.3 Investigations inappropriate or not current practice | 3.3 Circumstances, cultural differences, preferences insufficiently responded to |
| 1.4 Unsystematic or disorganised approach | 2.4 Prevention, health promotion, rehabilitation inadequate | 3.4 Explanations inadequately shared or adapted |
| 1.5 Poor prioritisation with multiple problems | 2.5 Medical management of risk inadequate | 3.5 Judgemental approach |
| 1.6 Implications of findings not recognised | 2.6 Co-morbidity insufficiently considered | 3.6 Respect and sensitivity inadequate |
| 1.7 Differentials inadequately generated or tested | 2.7 Uncertainty (own or patient's) managed ineffectively | 3.7 Ownership of decisions inadequate |
| 1.8 Decision-making or diagnosis illogical, incorrect or incomplete | 2.8 Follow-up, continuity, safety-netting inadequate | 3.8 Teamwork and others' roles inadequately used |
| 2.9 Time management ineffective | 3.9 Safeguarding inadequately recognised |
Interpreting your scores today (course heuristic, not an RCGP standard)
- ≥ 7.5 per case: strong · 6.5–7.0: pass standard · 5.5–6.0: borderline · < 5.5: below the standard.
- One Fail in Clinical Management costs 1.5 points; two Fails in a case put you below the line.
- Watch which feedback statements recur across your stations — that is your action plan.
Editorial stamp · MRCGP SCA Consultation Skills Course · Station pages v1.0 · 11 September 2026 · Prof Rajesh Varma, Course Director · MD Acumen. Formative training material; not a prediction of exam performance. Not for onward distribution.