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Preparing for the SCA

About case content

The case information for each consultation will be provided in the reading time before the start of that case. For some cases it may be obvious as to the content of the consultation, but in some cases it will not be. The ‘purpose’ of the consultation may therefore not be apparent in advance.

Cases will reflect real life general practice and are based on real patient consultations. The selected cases in each exam will be those that reflect the prevalence of conditions encountered in General Practice. There may be some cases on clinical areas you will not have encountered in your surgeries but you will have the skills from your workplace consulting as well as your background knowledge in order to complete the case.  

The SCA assesses a sample of general practice capability areas that trainees are expected to have mastered through their workplace-based assessment programme (WPBA). This means the criteria for both examinations (SCA and WPBA) are aligned and transparent. In developing the capability areas of WPBA, a trainee will become familiar with the capabilities assessed in the SCA. It is important to remember that each case will not include all these capability areas. However, they will be covered across the entire examination.

Each SCA examination day will differ, and the twelve cases cannot be predicted in advance. The RCGP will use cases from a bank of hundreds, all of which are mapped to the curriculum.

Blueprint

A ‘blueprint’ has been developed to ensure the spread of each assessment is representative and not focussed on any one area of practice. The blueprint uses some of the same names as the clinical experience groups in WPBA; these will be familiar to trainees and educators.

This case selection does not represent a ranking of the value or importance of that area to the SCA or to future general practice, and trainees should prepare equally for all groups.

Blueprint list of Clinical Experience Groups:

  1. Patient less than 19 years old
  2. Gender, reproductive and sexual health, including women's, men's, LGBTQ+, gynae and breast
  3. Long-term condition, including cancer, multi-morbidity, and disability
  4. Older adults, including frailty and people at the end of life
  5. Mental health, including addiction, smoking, alcohol, substance misuse
  6. Urgent and unscheduled care
  7. Health disadvantage and vulnerabilities, including veterans, mental capacity, safeguarding, and communication difficulties
  8. Ethnicity, culture, diversity, inclusivity
  9. New presentation of undifferentiated disease
  10. Prescribing
  11. Investigation / Results
  12. Professional conversation / Professional dilemma

Case examples

These consultations were created as an educational resource for GP training, to provide examples of typical GP consultations, such as they may appear in the SCA.

Please note:

  • These specific cases and the actors involved will not appear in the SCA.
  • All cases in the SCA examination will last 12 minutes, however some of these consultation clips are longer than this.
  • The doctors in these consultations were either newly qualified or still in training and are playing a simulated role, assigned to them for educational purposes. They had no prior warning about the content of the case.
  • Their performance is not accompanied by grading or with judgement about standards.
  • These videos were not recorded using our assessment platform. All consultations for the SCA will be conducted via Osler-online, a bespoke examination platform. Consultations will be conducted in GP practices and will be remotely invigilated.  

We want to acknowledge and express gratitude for the contribution of all the participants in producing this educational resource.

  1. All the clips are remote video consultations. You may wish to cover the images and listen to the sound only, as if they were telephone consultations. Some SCA consultations will be by telephone.
  2. Watching each case, you might consider the SCA marking and standard setting. Has the trainee done enough to pass in each domain for this case?
  3. There are two examples for some cases. Notice the different approaches offered by each doctor. Are both reasonable?
  4. We have reproduced the trainee notes for each case, below.
  5. You may wish to roleplay the case yourself first, before considering the notes below or watching the clips.
  6. Each case is followed by notes and questions. These are not intended as a complete checklist of expected actions: They are offered as guidance to the priorities and challenges in the case and approaches that may be taken for each. Above all, they are to support the cases as an educational resource for GP Training, with questions to support reflection and discussion.
  7. Here are some generic questions you might consider:
    • Before the consultation starts, what is notable in the case notes?
    • As the consultation unfolds, what are the issues that might be addressed?
    • What are the challenges?
    • What did the doctor do well? What might you learn from their approach?
    • What might you do differently if you undertook this consultation?
    • Notice the approaches to communication seen in the clips. Consider the clarity of explanations offered. Notice the use of time.
    • Consider the effectiveness (or otherwise) of the consultation being conducted remotely.
    • How do you think the patient is feeling during and at the end of the consultation?

Video examples of SCA cases

Instructions to candidate

  • Christine Davis
  • 47 years old
  • Normal smear three years ago
  • IUS in situ one year ago
  • Pregnancies 21 and 23 years ago
  • NHS Health Check two years ago: BP 122/67; BMI 25; Q risk 1.8
  • Never smoked tobacco

Questions for discussion and notes

  • Is there any helpful information in the case notes, to read before starting the consultation?
  • What might be the cause of Christine Davis’ symptoms?
  • She is worried, how might you explore that? What are her priorities, and how might these be incorporated into your actions/explanations?
  • With a symptom like memory loss with multiple possible causes, how do GPs effectively focus our time for data gathering?
  • Should a ‘GP COG’ or other brief memory assessment be completed now?
  • How do you ensure the patient is safe, or evaluate risk?
  • Is there any advice you might offer about how she can manage her symptoms, or optimise her health?
  • Does uncertainty about the cause of her symptoms remain at the end? How might you communicate uncertainty to the patient, if so?
  • What might you plan to do next? 

The purpose of this case is to explore memory loss. It is unclear as to the exact cause of the symptoms. There may be aspects of cognitive decline. However, menopause may be contributory as may anxiety and overwork. An examination including memory assessment and investigations including  blood tests would be useful next steps. Patient-centred acknowledgement of uncertainty is important.

Instructions to candidate

  • Name: Alice Brenner
  • Age: 20
  • Seen five weeks ago by another GP who wrote notes as below:
    • Oligomenorrhoea, acne.
    • No hirsuitism, BP 122/65. Non smoker. Alcohol 6 Units per week.
    • BMI 21
    • Issued: Duac Gel at night.
    • For bloods and ultrasound of her pelvis
  • Last week: Ultrasound scan of pelvis: Multiple small cysts on both ovaries consistent with polycystic ovaries. Otherwise normal study.
  • One month ago: Blood results: LH, FSH, Testosterone, Prolactin, SHBG, TFTs: All normal

Questions for discussion and notes

  • Is there any helpful information in the case notes before starting the consultation?
  • How might you effectively explain these results and check understanding? 
  • Given she has PCOS, what management options should you consider, including acne treatment, contraception, CVD risk, etc.? What might you advise her about self-care? 
  • How might you discuss the possible impact on fertility? 
  • Are there cues about how she is feeling, about her skin and her life in general? How might you respond?

The purpose of this case is to explain results and a new diagnosis of PCOS sensitively and effectively to a young woman who has concerns about her skin and possible future fertility. There may be a considerable amount of information to be shared. This should be balanced with responsiveness to her cues and priorities. 

Instructions to candidate

  • Name: Elisa Fillipeck
  • Age: 72
  • Social and family history
    • Married
    • Lifelong non-smoker
    • Occasional alcohol on special occasions
    • No FH of Ovarian/Breast cancer
  • Current medication: Duloxetine 60mg once daily in the morning
  • Past medical history:
    • 20 years ago: Diagnosis of anxiety with depression, treated with a variety of antidepressants
    • 3 years ago:  Pelvic discomfort, diagnosed with a cystocele and had a colporrhaphy
    • 2 years ago: Seen again by gynaecologist for pelvic discomfort, referred to the pelvic physiotherapist and prescribed oestrogen cream – neither helped
    • 4 months ago:  Saw gynaecologist again for pelvic discomfort and a CT of her pelvis and abdomen was arranged
    • 1 month ago: Saw GP who changed her anxiety/depression medication to duloxetine
  • Last week: Letter from gynaecologist

District General Hospital
Dear General Practitioner
Elisa Fillipeck, Cherry Tree Farm

Dear Doctor,

Thank you for referring this lady for what looks like a 3rd opinion into her pelvic pain.

I understand she has long standing pelvic discomfort which she describes as a dragging sensation and discomfort when going for walks or on standing for extended periods. 

She has had surgery to treat a cystocele, pelvic physiotherapy and used oestrogen cream, none of which have helped.

She asked for another opinion as her friend has had similar symptoms and was diagnosed with cancer. 

She was very anxious but I could find no abnormality on examination and more to reassure her than anything else I organised a CT scan of her abdomen and pelvis. This was completely normal. 

I have let her know the result. I have not planned to see her again.

Yours sincerely,
Dr Neena Jha
Consultant Gynaecologist

 

Questions for discussion and notes

  • Is there any helpful information in the case notes, to read before starting the consultation? How might you integrate the information gathered at previous consultations as well as the current presentation of the patient in order to formulate a treatment plan?
  • How do you think the patient is feeling about her pain and about the investigations so far? Why do you think it is particularly hard to bear this pain? What are her wishes and preferences about next steps, and how can we involve her in planning for these? 
  • What treatment options are possible and/or evidence-based?
  • What follow-up might you suggest? How might continuity of care help?

The purpose of this case is to support, manage and advise a patient who has ongoing symptoms of pelvic pain with all physical causes excluded, sensitively and empathically.

Instructions to candidate

  • Name: Gerry Freeman
  • Age: 82
  • Social and family history:
    • Retired telephone engineer
    • Married with 2 adult children
  • Past medical history:
    • Patient at this practice for 40 years
    • Hypertension diagnosed 34 years ago
    • Ankle swelling 20 years ago
    • Cramp 7 years ago
    • Atrial fibrillation 6 years ago
    • Moderate OA knees 4 years ago
  • Current medication:
    • Quinine 200mg once a day
    • Ramipril 10mg once a day
    • Furosemide 20mg once a day
    • Apixaban 5mg twice a day
    • Omeprazole 20mg once a day 
  • Results from 2 months ago:
    • FBC, U+E normal
    • Creatinine clearance 98 mL/minute (normal)
    • Photo submitted earlier that day by the patient

Red rash on Caucasian skin

 Questions for discussion and notes

  • Is there any helpful information in the case notes, to read before starting the consultation? 
  • Is the picture helpful? What is your differential diagnosis for the rash, before you start the consultation? What information do you need to establish the cause of the rash?
  • How might you establish risk and decide upon urgency of next steps? 
  • What should you decide/advise about his medication? 
  • What are his concerns and priorities, and how might these be taken into consideration? Are there solutions you might explore to help with his social situation and support his wife?

The purpose of this case is to recognise a petechial rash, the need for urgency in arranging investigations, the safety (or otherwise) of continuing long-term medication and an empathic consideration of his home situation with suggestion of solutions that might help.

Instructions to candidate

  • Name: Benny Parulekar
  • Age: 2
  • Seen YESTERDAY by another GP in practice:
    • Mild infantile eczema, flexures and neck, nil infected
    • Brought by nanny
    • Thriving, happy
    • Issued: Emollients, hydrocortisone 1%
  • Past medical history:
    • Up to date with immunisations
    • Born at term
    • 6 week check: NAD
    • Aged 14 months – viral wheeze
    • Aged 8 months – fussy eater, seen by Health Visitor
    • Aged 7 months – eczema, mild
    • Aged 5 months – URTI

Questions for discussion and notes

  • Is there any helpful information in the case notes, to read before starting the consultation? What do you think about the management of Benny’s condition so far?
  • Why might the father (Alan) have booked this consultation, given his son was seen only yesterday? Why is he worried, and what are his concerns? How might you explore these concerns? How might you establish trust and an ongoing supportive relationship with this family?
  • What advice and explanations might you offer? Would you refer to a specialist clinic, for example for allergy testing? Is there anything else you would suggest now?

The purpose of this case is to explore parental concerns, negotiate an evidence-based plan that is mutually agreeable and build a trusting relationship with a family that have had cause to doubt the opinion of the GP in the past.

Instructions to candidates

  • Email from district community nurse dated today:

Dear GP

I have just seen Mr McLean as part of my routine visit to see his wife. He has had diarrhoea for the past few days.

  • Afebrile, Tongue dry, abdomen soft and non-tender
  • BP 120/70 sitting (BP 110/60 standing) All other findings normal
  • Blood glucose from finger prick 7
  • Urinalysis normal with no ketones.

I asked him to give you a call as he wasn’t his normal happy self.

Thanks,
District Nurse

 
  • Name: Steven McLean
  • Age: 75
  • Past medical history:
    • Type 2 diabetes diagnosed 10 years ago
    • Essential hypertension diagnosed 10 years ago
    • On carer's register (wife has dementia)
  • Current medication:
    • Metformin: 500mg tablets two tablets every morning and evening
    • Candesartan: 8mg one daily
    • Atorvastatin: 20mg one daily
  • Summary of attendance at Practice Diabetic Clinic 3 months ago:
    • Doing well with no symptoms. Recent Diabetic retinal screening - normal. Foot check - normal. BP 146/82 (stable)
    • Routine bloods: electrolytes normal. GFR 55 (CKD3) has been at this for around 2 years. HbA1c 53.  Liver function tests normal, cholesterol normal
    • Continue medication 

Questions for discussion and notes

  • Is there any helpful information in the case notes, to read before starting the consultation? For example, note the difference in blood pressure readings in the case notes: Is this significant and if so, what should be done about it? Is this man at risk of Acute Kidney Injury?
  • Do you suspect a diagnosis of Gastroenteritis?
  • Is there a need for further examination and/or investigation? If so, what is the urgency of organising these?
  • What should you decide/advise about his medication?
  • What management steps will you suggest now?
  • What are your patient’s priorities and concerns? Are there any considerations in his social situation that need to be addressed? What flexible solutions might you offer for him and his wife?

The purpose of this case is to assess and safely manage an acute illness in a vulnerable patient with diabetes, on whom his wife is dependent for care: To recognise the medical risk including possible kidney injury, the need to stop medication temporarily (sick day rules) and advise the patient regarding self-care including rehydration. To consider his social situation and priorities, while ensuring safety of next steps, including follow-up.

Webinars

The trainer webinar provides an overview of the SCA, specifically for GP trainers. It covers the transition from the RCA, the examination platform, GP surgery requirements, booking and reservations, and ways in which trainers can help their trainees prepare. The webinar is presented by RCGP Chief Examiner Professor Rich Withnall and SCA Project Lead Liam Wynne.

The trainee webinar is an introduction to the SCA, which has been produced to provide trainees with key information they need to sit the SCA examination from November 2023. The webinar is presented by RCGP Chief Examiner Professor Rich Withnall, SCA Project Lead Liam Wynne, and SCA Clinical Lead Susan Bodgener.

We also delivered Q&A sessions on the SCA. They covered a series of preselected and live questions from trainers and trainees respectively. These were presented by RCGP Assistant Director of Exams Stuart Copus, SCA Project Lead Liam Wynne, and SCA Clinical Lead Susan Bodgener.

Training and preparation courses

We offer preparation courses which have been specifically designed by examiners and GP experts to assist trainee GPs in passing the SCA examination. Please note these courses have delegate fees attached.

Currently, all preparation courses are sold out. We hope to include more later in the year, so please keep checking this page for updates.

Consultation toolkit

This toolkit is an educational resource developed by the North West England Deanery GP School, and updated for the SCA. It's designed for GP trainees to use, working with their educational supervisors, to prepare for the SCA.

About the toolkit

This video contains background information, including a description of successful exam support programmes for the CSA and RCA. Each programme utilised the toolkit to analyse trainee performance and plan educational strategies to develop weaker competencies before sitting the exams.

This presentation offers a guide to the separate sections of the toolkit. It suggests how to get started with your own analysis and development prior to sitting the SCA.

Accessing the toolkit

The toolkit can currently be found on the North West Deanery website. It consists of:

  • Consultation overview
  • RAG tool
  • 29 competency areas, which include educational activities and reflective exercises. These relate to:
    • Data gathering tasks
    • Clinical management tasks
    • Relating to others skills
    • Global skills

Access the SCA consultation toolkit

Tips for using the toolkit

  • Remember to analyse only the consultation tasks first. Calibrate your performance with your supervisors, then repeat your analysis, thinking about the "relating to others" and "global" skills to seek improvement.
  • Follow your identification of weaker areas, work through the activities drawn from the education sections matched to specific competencies.
  • If you identify multiple weak areas, you must allow enough time to improve before you are ready to sit the SCA.
  • Choose the education activities with your supervisor that seem most appropriate for your learning style and approach. The education sections are extensive and intended to be used selectively.
  • Practise skills, in order to embed any changes or improvements you have developed.

This approach will help you optimise your performance, despite exam pressure on the day.

Acknowledgement

With thanks to the toolkit's authors Dr Anne Hawkridge FRCGP and Dr David Molyneux FRCGP, and to the North West England Deanery GP School, for developing and sharing this resource.