How I Passed the MRCGP SCA Exam in my first attempt – Dr Melissa Morton

It is important to remember that any GP trainee in primary care – regardless of level of training – has started to prepare for the SCA already, simply by seeing patients. It sounds obvious but a great way to prepare for the exam is to see as many patients as possible in your own clinic. Not only does this expose you to a plethora of scenarios but it helps to build stamina when seeing lots of different cases. 

The SCA is a long assessment, comprising 12 scenarios back-to-back with a short 10-minute break in the middle. It can feel like a real challenge at times, and it is so important that you are comfortable seeing lots of patients in your surgery. You need to have the mental endurance to be comfortable going from one scenario to another without being easily fatigued by challenging patients or difficult conversations. Before my exam, I would see a minimum of twenty patients per day (10 in the morning and 10 in the afternoon) and I felt that this prepared me well. In the months leading up to your SCA, it is worth discussing clinic capacity with your educational supervisor and increasing this if appropriate. I would recommend monitoring how long it takes to see each patient as you will only get 12 minutes in the SCA per scenario, and it is vital that you use your time well. As the RCGP have already stated, the exam is marked in three separate domains: data gathering and diagnosis, clinical management and medical complexity and relating to others. When I was practicing for the exam, I noticed that I spent too much time data gathering. It was therefore important for me to work on taking a more focused history and increasing time devoted to clinical management to improve my performance. I assessed this by reflecting on scenarios in my clinics and receiving feedback from colleagues regarding my management of clinical cases. 

Ensure that you are familiar with the format of the exam and the curriculum coverage. The RCGP has a lot of useful information on their website regarding the exam and there are some scenarios that you can watch with GP supervisors or other trainees, to ultimately discuss the cases and reflect upon how candidates performed and areas for improvement. 

Use your GP colleagues and educational supervisors when possible and ask them to help with your preparation. This can be done in several different ways. I am very fortunate to have an extremely supportive practice and my colleagues would encourage exam practice through joint clinics, workplace-based assessments (COTs/CBDs) and mock consultations. Record yourself interacting with patients and watch the recordings back with a supervisor as part of a tutorial to gain feedback. I was advised to offer video appointments to some of my patients to gain experience in consulting remotely, which reflects the format of the exam. If you work in a practice like mine where long term conditions are primarily managed by the nursing team, ask if you can sit in with the nurses in their clinics. 

If you are not already doing on-call days as the duty doctor at your practice, ask if you can have the opportunity to do this. You will often find that the more challenging and unusual cases come through when you are on call. By doing more of these shifts you can become more competent at managing urgent and unscheduled situations which will stand you in good stead for the exam. I have found that some of the most interesting cases that I have seen occur at the end of a long shift as duty doctor.  I also found that during my time as duty doctor, I received a variety of calls from other healthcare professionals (such as district nurses, paramedics, social workers, etc.). Through dealing with these requests, you can develop your ability to work with other members of the wider healthcare team to provide efficient patient care. A discussion with a fellow healthcare professional can come up in my exam and it is much easier to work through this kind of scenario if you have experience doing this in your surgery. 

If your practice is willing to organise a mock exam take the opportunity to participate in this. My practice organised a mock exam using patients from the PPG as simulated patients. It was a great opportunity to practise in a familiar setting and it was invaluable to get the feedback of the GP partners which made me feel much more confident for the real exam. 

The VTS scheme in my area ran SCA preparation afternoons where trainees could opt to do a mock scenario online with feedback from TPDs and communication experts. It is well worth giving this a go if it is an option in your area as you can get specific feedback on your performance which can be hugely helpful and provide tips for self-development. Through these sessions, you also have the opportunity to observe other trainees in their mock scenarios and this can be an educational and supportive experience. 

I would advise any trainee preparing for this exam to speak with other trainees in your cluster/VTS group and see who else is preparing for the exam. Establish a small study group if you can and practise scenarios (preferably remotely) to enhance your skills in consulting remotely and to get feedback from one another. Remember that your colleagues in training are the only ones who know exactly how you feel and are facing the same challenges as you. If another trainee in your VTS group has already done the exam ask them if they can give you any advice and perhaps discuss more challenging cases that they encountered.