SCA Cases: Which Clinical Areas Are Hardest?

How We Measured Difficulty

There is no official data on which SCA clinical areas have the highest failure rates. The RCGP publishes overall pass rates by diet, but not by clinical area or case type.

So we used a proxy. On MedTutor AI, every completed consultation generates instant AI feedback. Trainees can also request a detailed written review from a GP trainer, scored against the three{" "} RCGP marking domains . This request is optional and requires an active credit, which means trainees choose to use it when they feel they need it.

We looked at the feedback request rate by clinical area: the percentage of completed consultations where the trainee requested expert GP trainer review. Our assumption is straightforward. When trainees feel confident about their performance, they are less likely to request expert review. When they feel uncertain, they ask a human expert to assess them.

Across all 6,671 completed consultations, the average expert feedback request rate is 35.8%. Clinical areas significantly above this average are the ones where trainees feel least confident. These are the hardest areas.

The 6 Hardest Clinical Areas (by Feedback Request Rate)

The platform average is 35.8%. Every clinical area in this table is at least 6 percentage points above that.

Risk Assessment (48.6%): Nearly half of all trainees who complete a Risk Assessment case request expert review. These cases typically involve mental health presentations where you need to assess suicide risk, self-harm risk, or risk to others.

End of Life Care (45.8%): The second-highest feedback request rate. These cases involve DNAR discussions, palliative symptom management, and advance care planning. For a detailed guide, see our{" "} SCA End of Life Care article .

Gastroenterology (43.9%): Gastroenterology cases often involve unexplained weight loss, change in bowel habit, or abdominal pain, all of which require careful{" "} red flag screening{" "} and a management plan that balances investigation with reassurance.

Care of the Elderly (43.6%): Consultations involving frailty, polypharmacy, capacity assessment, or carer concerns. These cases are hard because they often involve multiple problems, multiple stakeholders, and decisions where there is no single right answer. The{" "} shared decision-making {" "} demands are high.

Dermatology (42.2%): Dermatology cases in the SCA are not about visual diagnosis. They test your ability to take a thorough history from a description, differentiate between benign and potentially serious presentations, and manage a patient who may be anxious about skin cancer.

Safeguarding (42.0%): Cases involving child protection, elder abuse, domestic violence, or third-party consultations. These test your understanding of confidentiality boundaries, referral pathways, and how to handle disclosures sensitively. For more, see our{" "} SCA Safeguarding Cases guide .

The 10 Most Practised Clinical Specialties

There are two ways to read this table. The first is raw session count: Mental Health and Women's Health dominate, accounting for over 1,490 sessions between them.

The second is unique trainees. Look at Musculoskeletal: only 316 sessions but 200 unique trainees, the widest spread of any clinical area. By contrast, Child Health has 482 sessions from only 139 trainees, meaning those who practise Child Health cases tend to do multiple.

The 5 Most Popular Individual Cases

The Complaint About Another GP is by far the most practised, with 223 sessions from 195 unique trainees. The case is popular because it combines a strong patient agenda, emotional complexity, and clinical governance in a single 12-minute consultation. It tests all three{" "} RCGP domains{" "} simultaneously.

Follow-up After A&E Visit (204 sessions, 168 trainees) tests your ability to manage a clinical handover. The challenge is{" "} follow-up planning , which our data shows is incomplete in 49.9% of all practice consultations.

Menopause and HRT (158 sessions, 112 trainees) has a higher repeat rate (1.41 sessions per trainee), suggesting trainees return to it to improve. For a clinical guide, see our{" "} SCA Menopause and HRT article .

What Makes an SCA Case Hard?

Looking across both the difficulty data and the practice volume data, a pattern emerges. The hardest SCA cases are not the ones with the most complex medicine. They are the ones that combine clinical decision-making with at least one of the following:

Emotional weight. End of Life Care, Risk Assessment, and Safeguarding cases all involve conversations where the patient or their family is in distress. Managing your own emotional response while maintaining a structured consultation is a skill that requires practice.

Ambiguity. Care of the Elderly cases often involve multiple problems with no clear single diagnosis. Gastroenterology cases frequently present with non-specific symptoms that could be benign or serious. The exam tests how you manage clinical uncertainty, not whether you know the answer.

Strong patient agenda. The Complaint About Another GP case is the most practised because the patient arrives with a fixed expectation.{" "} Strong patient agenda cases {" "} account for 17 of MedTutor's 100 scenarios and are consistently rated as the most challenging.

Shared decision-making demands. Menopause and HRT, PSA Request, and chronic disease management cases all require you to present options, discuss risks and benefits, and arrive at a collaborative plan. Our data shows that{" "} shared decision-making is weak in 24.1% of practice consultations .

How to Prioritise Your Practice Time

If you are preparing for the SCA with limited time, here is how to allocate your practice based on this data:

Step 1: Ensure breadth first. The SCA tests 12 cases from 12 different{" "} clinical experience groups . Complete one case from each group before going deeper. This takes 12 sessions.

Step 2: Identify your personal weak areas. After your first 12 sessions, review your AI feedback. Which domains are consistently flagged? Our data shows most trainees share common weaknesses ( ICE exploration at 69.7%, follow-up planning at 49.9% ), but your specific profile will have its own patterns.

Step 3: Allocate more time to high-difficulty areas. Risk Assessment, End of Life Care, and Safeguarding are the clinical areas where trainees feel least confident. Practise at least 2 to 3 cases in each.

Step 4: Practise the popular cases. The top 5 most practised cases are popular for a reason. If you have time for nothing else, at least practise the{" "} Complaint About Another GP ,{" "} Menopause and HRT , and one{" "} breaking bad news case.

Step 5: Request feedback. Our data shows that feedback-seeking increases from{" "} 24.8% on first consultations to 35.8% on subsequent ones . Do not rely on AI feedback alone for your hardest areas.