The MRCGP Simulated Consultation Assessment (SCA) was launched in November 2023 and has replaced the MRCGP RCA. Dr Ranmini Weerasinghe was part of the first cohort of doctors to sit the new exam, and passed with flying colours after having failed her RCA by a significant margin. In this article she discussses how she prepared, the resources she used, and shares tips to help you pass the MRCGP SCA.
My RCA experience
I attempted the RCA in March 2023 and failed by 15 marks. This was a huge shock for me and it really impacted me as I lost confidence in my consulting abilities. As a result, I had an extension in to my training for 6 months. I did not want to go through the stress of recording real life consultations again and decided to go for the new SCA instead. I think it was one of the best decisions I have ever made in my career!
How I prepared for the SCA
I decided to go for the 1st diet in November and began reading about the exam around June. I read through all the materials on the RCGP website to get official information about the new exam. This inlcuded details on what they test in SCA, the exam format, their expectations from candidates and how the exam would be marked. This was something I did not do for my RCA during my preparation as I was too busy with what seemed like endless recordings. Once I was familar with the exam format, I formed a study group and started to practice cases. Initially we practised on 3 days each week and then we increased it to 4 days per week once we got closer to the exam. We practised cases via role-play, each taking turns of doctor, patient, and examiner roles and regularly gave feedback to each other. Joining a few different groups was useful rather than practising with the same people as it allowed me to experience different consultation styles and get feedback from multiple perspectives.
Resources I used
- RCGP SCA page and webinars
Since this was a new exam, I thought the SCA section of the RCGP website would be the best resource to gather official information about the exam. Since I failed RCA, I wanted to put all my efforts to pass the new exam in my 1st attempt. Their sample cases and videos were useful. Initially I felt those sample videos were perfect examples but when I re-watched them after practising, I noticed some cases could have been done better. I assume this is where I started to improve my consultations. I also attended the RCGP SCA webinars to know about the new exam.
- Emedica SCA courses, webinars, and resources
I have trusted Dr Mahibur Rahman to help me with exams since I started preparing for the MSRA, and his courses also helped me pass my AKT, so as soon as I committed to attempt the SCA in November I decided I should seek his help. Emedica have a range of courses and resources for the SCA, so I took time to decide what would suit me best. I contacted Emedica and their team was supportive in terms of discussing the different options available.
I chose the live MRCGP SCA intensive preparation course, and also booked 2 sessions of 1:1 SCA coaching which was particularly helpful for me to pick up my unique weaknesses in consultation skills and it also built up my confidence which I lost through RCA.
I found Dr Rahman was up to date with RCGP information and both the half day SCA Masterclass recording which was provided as pre-course learning and then the full day live SCA Intensive course were very useful in terms of knowing how to improve consultation skills, common mistakes that candidates do, watching other participants doing consultations and receiving feedback.
As part of the course booking for the SCA preparation course, I was given access to the Emedica online SCA cases. I used the online SCA case bank to practice with my study group and we finished all 69 SCA cases before the exam. The cases included information for role plays for the simulator in the group, a sheet for the doctor for each case, and one for the examiner. Going through these cases helped me to learn how to approach different cases in terms of data gathering and management, as they included detailed mark schemes specific to each case and areas for discussion and further learning in the examiner sheet.
- RCA/SCA videos on Fourteen Fish
Watching 14 fish videos by Dr Mark Coombe was helpful on how he explores ICE and psychosocial context of the patient in natural way. One of the best examples was the video on tension headache. Some videos also give a comment about how the consultation went well/ how it went not so well. This gave me an insight on common mistakes that most of the candidates do and I realised examiners are well aware of these. This helped to be aware of my own mistakes, bad habits and also helped me to give constructive feedback to my colleagues while we were practising.
- The complete MRCGP case book (100 cases)
Me and my study groups used this book as our bible. We started our preparation with this book system wise initially and then on random topics later on while we were practicing. It gives you an account of good phases that you could use, what you should cover on common topics during data gathering, what you should include you in the management part such as good safety netting tips at the end.
- Other resources
I used NICE guidelines to refresh my clinical knowledge. Since I have done my AKT a while ago I had to refresh my guideline knowledge again, but if the gap between the two exam is less you might save time reading nice guidance. However, after each challenging case we practiced, if the case did not go well in data gathering or in the management, we spent time together reading guidelines, Sometimes we even practised some phrases we could have used better buy re phasing questions, explanations etc.
I also subscribed to Medlighten (by Dr Beej Shah) who was helpful in showing how to explain conditions in a few seconds efficiently, and how to gather data and tips on managing the scenarios holistically and efficiently.
Here are my top 5 tips for SCA preparation:
- Start preparation early. Discuss with your supervisor when would be the best time to sit for the exam. Sitting too early can increases the chances of failing as in this exam RCGP tests your ability to consult like a newly qualified GP. Sitting too late might put you at extra strain. However, when to sit the exam might differ from person to person as we all have different scope of abilities. That is where your clinical/educational supervisor can be useful.
- Form a study group and practice at least 2-3 times per week. Without role playing and giving and receiving structured feedback it will be very hard to pass this exam specially if you are an IMG/ English is not your 1st language. I used to have joint clinics in my surgery and one of my supervisors thoroughly criticised my consultations which was very useful. Do not be discouraged or be upset to receive negative feedback. More you receive negative feedback the more you can improve yourself.
- Use the methods/ skills you used while practising in your role play in to real life consultations. Such as you may practice exploring ICE and psychosocial context, structure of consult, explaining diagnosis, next steps in the management, appropriate safety netting in your clinic while seeing the patients. With time you will start to see an improvement and sometimes even will receive compliments from the patients for being thorough.
- Know your guidelines. This exam is not all about communication, it also tests your clinical knowledge. If you are aware of the guidelines, you will be more confident in the management part so you could focus on your interpersonal skills. After sitting the exam, I found there were a good number of cases based on test results which resembled day today real life scenarios. So when filing results doing it insightfully and discussing tricky cases with supervisor could be useful.
- If you ever happen to fail (I wish you wouldn’t) use that experience as the pillar of your success. Take it as an advantage. That will make you a better more resilient GP. Learn from your mistakes. My RCA results was 128/ 234 and the pass mark was 143. My SCA results was 99/126 and the pass mark was 77.
I hope you will find these tips helpful, and I wish you good luck to complete your MRCGP exams!
Dr Ranmini Weerasinghe