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Marking and results for the SCA

Each case will be marked in three domains:

  • Data gathering and diagnosis (DG&D)
  • Clinical management and medical complexity (CM&C)
  • Relating to others (RTO)

Each of these three domains will be awarded one of the following grades, listed here with their associated definition relative to the standard of the MRCGP:

  • CP (clear pass): This domain is demonstrated above the standard of a newly qualified, independent GP
  • P (pass): This domain is sufficiently demonstrated at the standard of a newly qualified, independent GP
  • F (fail): This domain is insufficiently demonstrated at the standard of a newly qualified, independent GP
  • CF (clear fail): This domain is clearly demonstrated below the standard of a newly qualified, independent GP

Standard descriptors

Guidance on the passing grade (the standard) for each of the domains, as used by the examiners themselves, is as follows.

Data gathering and diagnosis (passing level)

  • Systematically gathers and organises relevant and targeted information to address the needs of the patient and their problem(s).
  • Adopts a structured and informed approach to problem-solving, generating an appropriate differential diagnosis or relying on first principles where the presentation is undifferentiated, uncertain, or complex.

Capabilities linked to this area, with specific descriptors

Data gathering
  • Systematically gathers information, using questions targeted to the problem, ensuring patient safety.
  • Makes effective use of existing information about the problem and the wider context.
  • Establishes the presence or absence of red flags.
  • Elicits relevant psychological and social information to place the patient’s problem(s) in context.
Making a diagnosis
  • Uses a structured and evidence-based approach to diagnostic reasoning.
  • Uses an understanding of probability based on prevalence, incidence, and natural history to aid decision-making.
  • Revises hypotheses as necessary in the light of additional information.
  • Addresses problems that present early and/or in an undifferentiated way by integrating all the available information to help generate a reasonable working hypothesis.

Clinical management and medical complexity (passing level)

  • Demonstrates the ability to formulate safe and appropriate management options which includes effective prioritisation, continuity and time and self-management.
  • Demonstrates commitment to providing optimum care in the short and long-term, whilst acknowledging the challenges.

Capabilities linked to this area, with specific descriptors

Clinical management
  • Considers a “wait and see” approach where appropriate.
  • Encourages patient understanding, skills, and confidence with suggestions for self-care or lifestyle modification.
  • Applies local and/or national guidelines, including for drug and non-drug therapies. 
  • Demonstrates principles of safe prescribing.
  • Refers when required, being mindful of available resources.
  • Suggests safe and sensible follow-up arrangements, as well as continuity of care.
  • Ensures care is coordinated within the practice team and/or with other services, where necessary.
  • Varies management options responsively according to the circumstances, priorities and preferences of all those involved.
  • Makes safe, evidence-based decisions that are defensible even when difficult.
  • Thinks flexibly around problems, generating functional solutions.
Medical complexity
  • Concurrently manages all health conditions, both short and long-term, acute and chronic, and multi-morbidity.
  • Prioritises management options based on an understanding of risk.
  • Manages uncertainty, including that experienced by the patient.
  • Adjusts care as necessary in the management of multiple problems, recognising the implications of multi-morbidity and polypharmacy.
  • Manages health improvement, rehabilitation, prevention, and health promotion.
Practising holistically, promoting health, and safeguarding
  • Engages support agencies targeted to the needs of the patient and/or their family and carers. 
  • Recognises and responds to adult and child safeguarding concerns including ensuring information is shared and referrals are made when required.

Relating to others (passing level)

  • Demonstrates ethical awareness.
  • Shows ability to communicate in a person-centred way.
  • Demonstrates initiative and flexibility in using various consultation approaches in order to overcome any communication barriers and to reach a shared understanding with the patient.

Capabilities linked to this area, with specific descriptors

Fitness to practise
  • Shows respect for patients, treating them fairly and without discrimination.
  • Takes ownership of decisions and with confidence, whilst being aware of own limitations.
Maintaining an ethical approach
  • Recognises cultural and personal differences in patients and/or colleagues.
  • Recognises that everyone has their own values and beliefs.
  • Acts non-judgmentally with equity and fairness.
  • Recognises and respects patient autonomy.
  • Acts with beneficence, and in the patient's best interests.
  • Shows awareness of medico-legal concepts, such as informed consent, mental capacity and best interests of the patient
Communication and consultation skills
  • Explores and clarifies the patient’s agenda, health beliefs and preferences.
  • Employs a range of communication skills, both verbal and non-verbal, including active listening skills.
  • Responds to important, significant cues (verbal and non-verbal). Uses language that is understandable and takes into consideration the needs and characteristics of the patient.
  • Uses a variety of communication techniques and materials to adapt explanations to the patient.
  • Uses the patient’s understanding, agenda, health beliefs and preferences to help tailor any explanation offered.
  • Works in partnership with the patient, negotiating a mutually acceptable plan which is clear and understandable.
  • Checks the patient’s understanding of the consultation including any agreed plans.
  • Demonstrates an empathic approach, including a willingness to help and care for the patient.
Working with colleagues
  • Works collaboratively, understanding the context within which different team members work, respecting their role, and valuing their opinions.
  • Shows respect for colleagues, treating them fairly and without discrimination.
Practising holistically, promoting health, and safeguarding
  • Recognises and acknowledges the impact of the problem on the patient, their family and/or carers.
  • Challenges assertively unhelpful health beliefs or behaviours, whilst remaining respectful and maintaining a continuing and productive relationship.
  • Recognises what matters to the patient and works collaboratively to enhance patient care.

Understanding the standards

It is important to recognise these are not descriptions of candidate behaviours needed to pass in every case. For example, there may be no need to demonstrate ethical awareness in the Relating to others domain: They are not a 'tick box' for passing the examination. However, they are used by examiners to guide judgements and set grades and standards where appropriate for the case, to enhance reliability and consistency.

Reliability and standard setting

The examiner marks the same case all day, thereby increasing standardisation and reliability of the process. Each case and the examiners marking that case are carefully calibrated for the examination. All examiners are trained to mark in the same way, using standardised grade descriptors applied to a case-specific marking schedule.

Examiners mark against a predetermined standard for all 3 marking domains. To reflect the capability coverage within the clinical management and medical complexity domain this is weighted in comparison to the other 2 domains.

Pass marks

The trainee's mark is determined by their performance across the whole assessment; trainees will not have to pass a certain number of stations in order to pass.

In addition to the marking of the individual domains, examiners will be asked to judge the candidate's general performance in each case. Their response will be carried forward to determine the pass mark for the case through a standard setting process known as Borderline Regression, meaning there is no fixed pass mark for each case. The Borderline Regression method is an established and appropriate model of standard setting for medical OCSE-type examinations.

It maybe that your performance in a case did not reach the pass mark for that specific case. This will not mean you have failed the entire exam as it is the accumulative mark you have received for the 12 cases which give you your overall mark. 

There are 4 global standard setting descriptors linked to fitness to practise:

  • Pass : Meets the standard for an independent newly qualified GP who is fit to consult. (Any omissions or errors made are minor/trivial). 
  • Bare Pass: A just passing candidate. Omissions or errors made, but candidate has done enough to demonstrate fitness to consult as an independent newly qualified GP. 
  • Bare Fail: A just failing candidate. Presented some evidence, but insufficient for fitness to consult as an independent, newly qualified GP. Omissions or errors likely to impact on patient care / outcomes. 
  • Fail: Does not meet the standard for an independent newly qualified GP who fit to consult. Minimal evidence presented and/or patient put at risk of harm. 

Complaints, reviews and appeals

If you wish to make a complaint about the SCA examination or lodge an appeal against an examination result, please read the MRCGP Examination Feedback and Complaints Policy and Procedure.

Summary reports

The first November 2023 examination was sat by 508 candidates during a three-day period between 7 and 10 November 2023.

337 candidates were successful, resulting in an overall pass rate of 66.34%. It is important to note that it is not a straightforward comparison to the previous RCA diets as this is a new examination. The proportion of candidates sitting the examination for the first time was 72.6% and the pass rate for this particular group was 70.55%. The mean score on this occasion was 83 out of 126 and the highest mark was 116.5.

The second week of the first November 2023 examination was sat by 607 candidates during a three-day period between 14 and 16 November 2023.

405 candidates were successful, resulting in an overall pass rate of 66.72% which is marginally higher than the first week in November (66.34%). The proportion of candidates sitting the examination for the first time was 86.8% and the pass rate for this particular group was 70.78%. The mean score on this occasion was 84 out of 126 and the highest mark was 116.5. Regrettably, due to an IT incident occurring on 14 November, 52 candidates were not provided with results due to an insufficient number of cases which could be marked.