SCA Advice from Examiners:

Confessions of an Examiner

Reproduced with the kind permission of Jonathan Holdsworth and Angela Kerr.

The SCA:

  • Triangulation with AKT, WPBA and SCA
  • RCA was Non Standardized. SCA is Standardised
  • 12 cases of up to 12 minutes with 3 minutes reading time.
  • Physical examination no longer assessed in SCA – part of WPBA
  • Each case marked remotely by a different examiner and scored 0-9 points
  • Sum of all points counts – not pass/fail on individual cases.

SCA Design:

  • Discussion with over 3000 stakeholders
  • Less preparatory burden than RCA
  • Results available earlier
  • Exam delivery closer to home
  • More frequent sittings – 10 times a year
  • Cases represent the prevalence of conditions seen in UK general practice
  • ST3s need to do room prep and IT walkthrough with Osler

What does an examiner do?

  • Exam occurs in real time in ST3 own surgery with roleplayers on Osler Online Platform
  • 2 hour examiner Standardisation Meeting occurs online several days later
  • Lead examiner and 3 others looking at several cases to calibrate marking and improve consistency
  • Then mark 60 examples of the same case over the next 7 days

Video vs Audio Consultations

  • There are 9 video consultations and 3 phone consultations
  • Not true video consultations – more like talking to someone over Zoom / Teams
  • Phone consultations will be the same , video will remain on for the invigilator but not seen by role player or examiner
  • Body language and demeanour may have some relevance
  • No expectation of remote physical examination

Blueprint of Clinical Experience Groups

  • Children and Young People
  • Gender/ Sexual Health/ LGBTQ/gynae/men’s health
  • Long Term Conditions including cancer and disability
  • Older Adults including End of Life
  • Mental Health including Substance Misuse, Smoking, Alcohol
  • Urgent and Unscheduled Care
  • Health disadvantage & vulnerabilities including safeguarding and capacity
  • Ethnicity, diversity, inclusivity
  • New presentation of undifferentiated disease.
  • Prescribing.
  • Investigations and Results.
  • Professional Conversations and Dilemmas.

SCA Aim

The aim of the SCA is to test a doctor’s ability to gather information and apply learned understanding of disease processes and person-centred care appropriately in a standardised context, make evidence-based DECISIONS, and communicate effectively with patients and colleagues. Being able to integrate these skills effectively is a key element of this assessment.

Marking Scheme

Candidates are marked according to each domain and will receive a score of 0-3 for each. Domains are linked to the capabilities listed below.

Data Gathering and Diagnosis
Data Gathering
Making a diagnosis

Clinical Managment
Clinical Management
Medical Complexity

Relating to Others
Fitness to Practice
Maintaining Ethical Approach
Communication and Consultation Skills
Working with Colleagues
Practising Holistically and Safeguarding

Clinical Management: Marks in this domain are weighted in comparison to the other two domains to reflect their capability coverage.

What skills do you need?

  • Efficient and focused history taking.
  • Ability to deal with uncertainty e.g. when diagnosis is not clear.
  • Understand and share the probability of different options
  • Share management options with patients
  • Agree a plan and MAKE A DECISION
  • Sensible follow up and safety netting

What annoys the examiners?

  • Doctor not listening or responding to the patient
  • Clunky non focused ICE assessment
  • Stock phrases
  • Too much history  – not enough management
  • Devolving management to other members of primary care / ARRS team
  • Inappropriate safety netting
  • Asking history which is already part of the text

How will you acquire these skills?

  • See lots of patients !
  • Get familiar with clinical presentations from real life encounters not books or courses.
  • Get your consulting time to 12 minutes for single problems.
  • Genuinely listen to and respond to patients (don’t just move onto your next question)
  • See complex patients.
  • See patients across the full range of the curriculum.
  • Consider a practice swap to broaden your experience.
  • Take risks
  • Look at consultations/joint surgery with your trainers.
  • These are not easy skills but can be learnt with lots of practice!

How can I help my ST3 prepare?

  • Help them develop higher level consultation skills: negotiation / adapting to patient concerns.
  • Help them listen to patients and RESPOND to what has been said.
  • The exam is quite long with the breaks added. Candidates need to be used to seeing 12 patients in one session.
  • Watch them consult – in person or on video.
  • Help them make decisions based on probability when all the facts may not be known.
  • Avoid lectures to the patient– the examiner does not want to hear the full NICE guidance SCA in not primarily a knowledge test (covered in AKT)

Practical tips for helping my ST3

  • Trainers should consider the case-mix that the trainee is seeing and ensure they are exposed to on-call situations e.g. abnormal test results from the lab, complex patients with co-morbidity and familiarity with home visits to know how to handle requests – ensuring appropriate supervision and guidance
  • Whilst many practices are not doing many video consultations with patients, this should not have a detrimental impact on the trainee’s preparation for the SCA. The video consultation cases could be dealt with face to face and so face to face consultations provide good preparation.
  • Trainees should be preparing with by undertaking complex telephone consultations with appropriate supervision • It would be beneficial for trainees to be regularly videoing/recording their consultations and bringing these for feedback and teaching to their trainer in tutorials, giving the opportunity to pause, playback and re-run aspects through role-play
  • Joint surgeries remain an excellent opportunity to provide rapid feedback and teaching
  • Consider practice systems for booking patients in with trainees and how they can be allocated complex patients with co-morbidity and urgent cases
  • Consider trainee exposure to safeguarding issues and discussion about complex cases and their attendance at useful meetings regarding these
  • Consider the mechanism of appointment allocation within the surgery such as pre[1]triage or care navigation to help ensure an appropriate case-mix – this will be different from those previously needed for the RCA! This is not one problem done well within 12 minutes – the SCA includes comorbidity
  • Consider the types of consultations the trainee is doing (video/telephone/face-to-face)
  • A good number of patients new to the trainee are likely to be helpful

How do I know if they are ready?

  • Good medical knowledge and being up to date with guidelines is vital for this exam – the assessment can test any area of the curriculum.
  • Help your trainee to identify knowledge gaps and develop a strategy to address these.
  • Ensure they are addressing PUNs and DENs on an ongoing basis and you could ask them to self-rate against the curriculum clinical topic areas
  • Ensure that your trainee has read the SCA section of the RCGP website in detail and keeps referring back to it for updates. There are trainee webinars accessible on the RCGP website on the exam.
  • Address any issues with your trainee’s organisational skills and ensure they have clear strategy for preparation for the SCA
  • There are training and preparation courses available (although high demand and many booked up already)