The MRCGP SCA is a challenging exam in a simulated surgery format. In this article, Dr Zebun Nahar shares her experience of passing the exam, her preparation, resources she used, and tips to help you succeed.

Preparation time

I was pregnant and had hyperemesis pre exam, hence I started my preparation early – 6 months before my exa date. It took me about two months to go through the materials and get an idea about the exam. Then I had four months of intensive preparation.

Resources I used for SCA

I began practicing with The Complete MRCGP Casebook by Emily Blount. While going through the book, I found most cases to be relatively easy, with a few exceptions. I learned from the SCA examiners that this exam would be challenging yet standardized. As a result, I signed up for the Emedica “Pass the SCA” bundle, which included lots of different resources for the SCA including videos from the SCA Masterclass and GP 100 case crammer course, and 69 samples cases to practice. I completed the video lectures and accompanying reading material, which significantly enhanced my knowledge of various medical conditions. I also learned how to rule out red flags early. The 69 Emedica SCA cases are an absolute must for anyone sitting for the SCA exam. Each case not only breaks down what examiners are looking for but also encourages thinking outside the box and is applicable in many other scenarios.

One challenge faced, was handling confrontational patients, and resources like Emedica YouTube videos, Nigel Giam’s, and Matthew Smith’s YouTube videos proved invaluable in improving my skills.

I utilized a website called SCA revision, which greatly boosted my confidence in handling ethical or slightly unconventional situations.

I also dedicated a few hours to reading two other books which provided me with insights on how different scenarios may arise:

• MRCGP Practice Cases: Clinical Skills Assessment by Raj Thakkar.
• Get Through MRCGP: Clinical Skills Assessment 2E: MRCGP: Clinical Skills Assessment by Bruno Rushforth

Lastly, I referred to the NICE CKS guidelines. Not only did reading these guidelines assist me in explaining diagnoses using simpler terms, but it also deepened my understanding of disease outcomes and the available management options in both primary and secondary care.

On FourteenFish, there is a marking grid available. I highly recommend reviewing it as it will help one understand how the marking is done.

Practise, practise, practise!

Initially, three of us practised together. One of our study partner took the exam with the first cohort, and the feedback we received was super helpful. After that, my study partner and I slowly increased the frequency of our practice sessions. In the last three weeks, we practiced every day.

The week before the exam, we conducted a mock exam, creating 12 cases and running the mock using the exam timetable. We managed to finish each case within 10 minutes and felt confident that we would likely pass the exam.

Getting the tech ready

I ensured that I was well acquainted with the online exam platform. The GP surgery had good internet bandwidth, and the camera and audio were in working order. Initially, I considered using a USB webcam but noticed that even slight movement would disrupt the connection. To reduce stress during the exam, I switched to a room that had a monitor with a webcam attached. Additionally, I highly recommend using headphones to minimize interruptions.

MRCGP SCA exam day

On the day of the exam, I logged in at 8:30 AM, which resulted in an early check-in. I used two boards, a silent timer I purchased from Amazon, and a phone holder. I positioned the timer at eye level beside the monitor. There is a short gap between check-in and the start of the exam. I utilized that time to write down my eight-point consultation structure on the A4 board and position it accordingly.

My 8-point consultation strategy was: Golden 2 minutes, ICE, red flags, additional questions/relevant psychosocial point/driving if relevant, explanation of differential/diagnosis in a chunk and check manner, management, follow up/safety netting/driving.

I positioned the A4 board in a way that it was in my peripheral vision. The timer proved to be extremely helpful in keeping me on track with time. Thanks to practicing during the last two weeks before the exam, I finished most of my consultations within 10 minutes. It was a relief to have two minutes left where I could engage in a conversation with the patient, reiterate key points, and close the consultation in an unrushed manner. I used the A3 board to jot down important information during data gathering without taking my eyes off the patient. This information proved valuable during summarizing, making the patient feel heard, and reducing repetition.

During the exam, there will be cases where the given information is only a few lines, and some where it may span as much as three pages. During the 3min reading time, I tried to allocate two minutes for reading the station and one minute to structure my thoughts. To help memorize the information, I found it helpful to read the information out loudly and then write down the main points on the A3 board.

There may be cases where discussion of blood test results or interpretation of ECG/spirometry/palliative medication discussion will be necessary. It’s good to prepare for them. The abnormal results were usually highlighted, so no need to memorize the range.

SCA – tips to help you pass

The exam is about knowledge testing, communication skills, and one’s ability to work with patients. The exam will assess your knowledge of what is available in primary care and what happens in secondary care. Not every station required asking about smoking, alcohol, or past medical history. The examiners in the SCA course also mentioned using these questions only where relevant.

Although it may be challenging, achieving the time structure is possible, and that’s where the videos from the Emedica GP 100 case crammer course proved invaluable. Dr. Rahman asks very specific questions in his videos and offers similar suggestions in practice cases, which helps narrow down the questions and makes one highly efficient during the exam, as time is of the essence.

Lastly, getting a good night’s sleep is crucial. Please accept that there may be a station that may leave you feeling confused, but try your best, be safe, cover ICE, and work with the patient. You’ll be fine.

The exam itself is not difficult. It simulates standard daily consultations and sensible patient queries. The actors assisting you are helpful, and there were no hidden agendas in the cases I had.

I have been utilizing Emedica since PLAB, MRSA, AKT, and now have completed the circle with SCA preparation. I hope my experience and tips will be helpful if you are starting to prepare for your exam.

Best of luck to everyone taking the exam!