How SCA Marking Works: The Basics

Every SCA case is marked independently by a single examiner across three domains. The examiner watches your recorded consultation and awards a grade for each domain, plus an overall judgment of your performance on that case. Your final result is determined by your cumulative performance across all 12 stations, not by passing a set number of individual cases.

The three domains are:

  • Data Gathering and Diagnosis: Can you take a focused, safe history and reach a working diagnosis?
  • Clinical Management and Medical Complexity: Can you formulate an evidence-based, patient-centred management plan?
  • Relating to Others: Can you communicate with empathy, build rapport, and work with the patient?

These domains map to the capabilities the RCGP expects of a newly qualified, independent GP. They are not a checklist. Examiners use them as a framework for judging whether your overall performance meets the standard, not as a tick-box exercise.

For a broader overview of SCA preparation strategy, see our How to Pass the MRCGP SCA guide.

Domain 1: Data Gathering and Diagnosis

This domain assesses whether you can systematically gather relevant information and reach a sensible working diagnosis. The RCGP expects you to take a targeted history (not an exhaustive one), identify red flags, place the patient's problem in its psychological and social context, and use clinical reasoning to generate a differential diagnosis.

The key word is "targeted." Examiners do not want to see you ask every question on a mental checklist. They want to see you ask the right questions for this patient with this presentation, then demonstrate that you can synthesise the information into a clinical hypothesis.

What scores well:

  • Asking focused, relevant questions that show you're thinking diagnostically as you go
  • Verbalising your working diagnosis out loud by the 6-minute mark
  • Establishing the presence or absence of red flags early
  • Exploring the patient's ideas, concerns, and expectations as part of data gathering (not as a separate checklist item)

What loses marks:

  • Spending 9 to 10 minutes on history and running out of time for management
  • Asking formulaic questions that don't match the presentation (e.g., routine smoking and alcohol history when the patient presents with a specific acute problem)
  • Failing to verbalise a diagnosis. If the examiner doesn't hear your reasoning, they cannot credit it.

Cases that test data gathering heavily include TIA Emergency Management (where you need to identify a time-critical presentation and act on it), Health Anxiety: Brain Tumour Fear (where the history drives the entire consultation), and Irregular Periods and Fertility Anxiety (where you need to distinguish between multiple possible diagnoses under time pressure).

Domain 2: Clinical Management and Medical Complexity

This domain is weighted more heavily than the other two, carrying 4.5 marks per station compared to 3 for Data Gathering and 3 for Relating to Others. It assesses whether you can formulate a safe, evidence-based management plan that is tailored to the patient, not a generic protocol.

The RCGP expects you to demonstrate safe prescribing, appropriate referral decisions, effective prioritisation when there are multiple issues, and a commitment to both short-term and long-term care. You also need to show you can manage complexity, meaning co-morbidities, polypharmacy, social factors that affect treatment, and cases where the "textbook answer" doesn't fit the patient's reality.

What scores well:

  • Offering a management plan that references current guidelines without sounding like you're reading from a script
  • Shared decision-making: presenting options, discussing risks and benefits, and involving the patient in the plan
  • Safety-netting with specific red flags and clear follow-up arrangements
  • Acknowledging complexity rather than oversimplifying

What loses marks:

  • Rushing through management in the final 2 to 3 minutes because you spent too long on history
  • Prescribing without checking allergies, interactions, or patient preferences
  • Failing to safety-net
  • Offering a plan that doesn't account for the patient's social circumstances (e.g., suggesting a medication regime a shift worker can't follow)

Cases that test clinical management include Lost Pregabalin Prescription: Controlled Drug Dilemma (where prescribing governance and patient welfare conflict), Statin Counselling and QRISK Assessment (where you need to explain a risk tool and negotiate treatment), and Perinatal Mental Health: Sertraline in Pregnancy (where prescribing decisions are complicated by pregnancy and breastfeeding).

Domain 3: Relating to Others

This domain is assessed throughout the entire consultation, from your opening greeting to your closing safety net. It covers empathy, active listening, ethical awareness, person-centred communication, and your ability to adapt your consultation style to the patient in front of you.

Unlike the other two domains, Relating to Others doesn't have a discrete time block. You demonstrate it continuously through how you ask questions, how you respond to emotion, how you handle disagreement, and how you involve the patient in decisions.

What scores well:

  • Picking up on and responding to emotional cues ("I can hear this is really worrying you")
  • Using the patient's own words and concerns when building the management plan
  • Adapting your communication to the patient's needs (simpler language for low health literacy, more detailed explanation for an anxious patient who wants information)
  • Demonstrating genuine empathy, not performative sympathy

What loses marks:

  • Doctor-centred consulting: talking at the patient rather than with them
  • Ignoring emotional cues and pushing through to the clinical content
  • Formulaic ICE exploration ("Do you have any ideas? Any concerns? Any expectations?") delivered as a checklist
  • Failing to involve the patient in the management decision

Cases that test Relating to Others include Termination of Pregnancy (where non-judgmental care is paramount), Angry Parent Requesting Antibiotics (where you need to de-escalate before you can manage), and Gambling Addiction (where the patient is disclosing something deeply personal and your response sets the tone for the entire consultation).

How the Domains are Weighted

Clinical Management and Medical Complexity is weighted at 4.5 marks per station, compared to 3 marks each for Data Gathering and Relating to Others. This gives a maximum of 10.5 marks per station and 126 across all 12 stations. The higher weighting reflects the number of RCGP capabilities linked to Clinical Management: it covers the management plan itself plus the complexity of handling co-morbidity, polypharmacy, and real-world constraints.

Examiners are not aware of the weighting when they mark. Some cases naturally lean more heavily on data gathering (e.g., an undifferentiated presentation where the diagnosis is the challenge), while others lean on clinical management (e.g., a known diagnosis where the management decision is complex).

The practical takeaway: don't try to game the weighting. If you demonstrate competence across all three domains in every case, the weighting takes care of itself. The trainees who fail are not the ones who misjudged the weighting. They are the ones who ran out of time for management or ignored the patient's emotional state.

How the Pass Mark is Set: Borderline Regression

There is no fixed pass mark for the SCA. Each diet's pass mark is calculated using borderline regression, a statistical method commonly used in medical OSCE-type exams.

In simple terms: in addition to scoring each domain, examiners make a separate overall judgment for each candidate at each station. They categorise the candidate's performance as clearly above the pass level, borderline, or clearly below. The borderline regression method then calculates the average score of candidates judged to be borderline. That average becomes the pass mark for that diet.

This means the pass mark shifts slightly from one diet to the next, depending on the overall performance of the cohort and the difficulty of the cases. It also means there is no "magic number" of stations you need to pass. Your cumulative performance across all 12 determines the outcome.

The most recent published data shows the January 2026 diet had an overall pass rate of 68.91% (521 candidates, 359 successful). The first-time pass rate was 74.7%. These figures are broadly consistent with previous diets, though the October 2025 diet was notably lower at 59.75%.

The Grading Scale: CP, P, F, CF

For each domain in each case, the examiner awards one of four grades:

Clear Pass (CP): Performance is demonstrated above the standard of a newly qualified, independent GP. You showed fluent, confident competence in this domain.

Pass (P): Performance is sufficiently demonstrated at the standard expected. You met the requirements, even if it wasn't polished.

Fail (F): Performance is insufficiently demonstrated. You showed some ability but fell below the required standard.

Clear Fail (CF): Performance is clearly below the standard. Significant gaps or concerning behaviours were observed.

A Clear Pass doesn't require a perfect consultation. It requires consistent, confident competence. Most successful candidates receive a mix of CPs and Ps across their 12 cases, with the occasional F that is compensated by strong performance elsewhere.

What to Do If You Fail a Domain

Failing a domain in one or two cases does not necessarily mean you fail the exam. Your overall score is cumulative. A strong performance across the majority of your 12 stations can compensate for a weaker station.

If you do fail the SCA overall, your results will include feedback statements for each domain in each case. These are specific and actionable. Common feedback includes: "Did not establish the presence or absence of red flags" (Data Gathering), "Management plan was not tailored to the patient's circumstances" (Clinical Management), or "Did not explore the patient's perspective" (Relating to Others).

Review these with your GP trainer. Identify which domain you consistently scored lowest in, and target your practice accordingly. If Data Gathering is the issue, practise with undifferentiated presentations like Health Anxiety: Brain Tumour Fear or Tired All The Time: Unexplained Fatigue. If Clinical Management is the weakness, focus on cases with complex prescribing or multi-issue management like Polypharmacy in the Elderly or Hypertension Management in an Elderly Patient. If Relating to Others is the gap, practise sensitive and emotionally charged cases like Domestic Violence: Wrist Injury or Bereavement in an Elderly Patient.

Browse all 100 SCA practice cases to find the right cases for your development areas.