SCA vs CSA vs RCA: What Changed and Why It Matters

The Timeline: CSA to RCA to SCA

The MRCGP clinical skills assessment has been through three distinct formats since 2007. Each change was driven by external circumstances and a desire to improve assessment reliability.

The CSA ran for 13 years as the gold standard clinical skills assessment for GP trainees. It was a face-to-face exam held at the RCGP's headquarters in Euston, London, using trained role players. Candidates completed 13 stations, each lasting 10 minutes, in a circuit format.

When COVID-19 made in-person assessment impossible in 2020, the RCGP introduced the RCA as an emergency replacement. Instead of simulated consultations, candidates submitted video recordings of real patient consultations from their own practice. Assessors then marked these recordings against modified criteria.

The SCA launched in November 2023 as a permanent replacement for both the CSA and RCA. It is a remote exam using simulated patients via video and telephone, with 12 stations of 12 minutes each. The RCGP has confirmed the SCA is the ongoing format and there are no plans to return to the CSA.

How the Format Changed

The most significant format change between the CSA and SCA is the move from face-to-face to remote delivery. This removes physical examination from the assessment entirely and changes how the Relating to Others domain is demonstrated. Non-verbal communication, body language mirroring, and physical comfort (a hand on the shoulder) are no longer available. Candidates must verbalise their empathy and listening more explicitly.

The shift from 10-minute to 12-minute stations gives candidates slightly more time, but the SCA also has a broader scope within each station. The extra 2 minutes are not spare time; they are needed for the expanded consultation structure.

The move from candidate-selected cases (RCA) back to standardised cases (SCA) is arguably the most important change. In the RCA, candidates chose their best consultations to submit, which introduced a selection effect that artificially inflated performance. The SCA removes this entirely.

How the Marking Changed

The three-domain structure has remained consistent across all three exams, though the domain names and descriptors have evolved. The SCA's domain names are more explicit: "Relating to Others" replaces "Interpersonal Skills," and "Medical Complexity" is added to the Clinical Management domain name to emphasise that examiners assess how candidates handle complex, uncertain, or ambiguous clinical scenarios.

The most significant marking change is the standard-setting methodology. The SCA uses borderline regression, where the pass mark is calculated based on the performance of candidates judged by examiners to be on the borderline between pass and fail. This means the pass mark adjusts with each diet, reflecting the difficulty of the cases and the performance of the cohort.

For a detailed breakdown of how each domain is assessed, see our SCA Marking Scheme Explained guide.

How Pass Rates Compare

The drop in pass rates from CSA to RCA to SCA is notable but does not necessarily mean each successive exam is harder. Several factors explain the trend.

The CSA's higher pass rate partly reflected the face-to-face format, where candidates could use physical examination skills and non-verbal communication more effectively. The RCA's pass rate was inflated by candidate case selection. The SCA's lower rate reflects the return to standardised cases, the remote format, and a different standard-setting methodology.

The first-time pass rate for the SCA (typically 70% to 77%) is closer to the RCA's overall rate, suggesting that well-prepared candidates perform at a similar level across formats. The overall SCA rate is pulled down by repeat candidates, who face a steeper challenge.

For the full breakdown of SCA pass rates by diet, see our SCA Pass Rate 2026 guide.

What Stayed the Same

Despite the format changes, the fundamental purpose and standard of the clinical skills assessment has remained consistent across all three versions.

• The standard: All three exams assess competence at the level of a newly qualified, independent GP. The threshold has not changed.
• Three marking domains: Data gathering, clinical management, and interpersonal skills have been the core assessment areas throughout, even as domain names and descriptors have evolved.
• The RCGP curriculum: All three exams draw from the same curriculum framework. The 12 clinical experience groups that underpin the SCA blueprint are the same areas the CSA and RCA covered.
• Consultation skills over knowledge: The clinical skills assessment has always been about how you consult, not what you know. Knowledge is tested by the AKT. The CSA, RCA, and SCA all assess your ability to apply knowledge in a patient-centred consultation.
• Validity period: A pass in any of the three exams is valid for seven years from the date the assessment was taken.

Why the SCA Replaced the RCA

The RCA was introduced as an emergency measure during COVID-19 and was never intended to be permanent. The RCGP identified several issues with the format that drove the transition to the SCA.

Standardisation. In the RCA, candidates selected their own consultations. This meant some candidates submitted straightforward cases while others chose complex ones. There was no control over case mix, making it difficult to compare candidates fairly.

Reliability. Real patient consultations are unpredictable. Some patients are articulate and cooperative; others are not. The variability in real consultations introduced noise into the assessment that standardised cases eliminate.

Fairness. Candidates in different training practices had access to different patient populations and clinical scenarios. A trainee in an inner-city practice with high mental health burden had different case selection options from a trainee in a rural dispensing practice. The SCA levels this playing field.

Differential attainment. The RCGP's analysis showed that differential attainment patterns persisted in the RCA, and in some analyses were wider than in the CSA. The SCA was designed with explicit fairness measures, including standardised cases, examiner calibration, and ongoing psychometric review.

The RCGP's position is that the SCA combines the standardisation of the CSA with the remote delivery that COVID-19 demonstrated was feasible. It is not a temporary measure. It is the permanent format.

What This Means for Your Preparation

If you trained during the CSA era, your instinct may be to prepare using CSA-style study groups and face-to-face role play. If you trained during the RCA era, you may be used to reviewing your own consultations and selecting strong performances. Neither approach fully prepares you for the SCA.

The key differences that affect your preparation:

• You cannot choose your cases. Unlike the RCA, you will face whatever cases the RCGP sets. This means you must be prepared across all 12 clinical experience groups, not just the areas where you feel strongest. See our RCGP Clinical Experience Groups Explained guide for a breakdown of each group.
• You must practise remotely. Face-to-face role play is useful for developing consultation skills, but it does not replicate the SCA format. Practise via video and telephone to build comfort with the remote dynamic.
• You have 12 minutes, not 10. The extra time changes the consultation structure. You have more room for emotional response and shared decision-making, but you also need to fill the time productively. Practise the timing until you can reliably hit the halfway transition point at minute 6.
• Physical examination is not assessed. In the CSA, examination technique was part of the assessment. In the SCA, relevant examination findings are provided to you. This frees up time but also means you cannot use examination as a "thinking pause."
• Old resources are partially useful. Clinical knowledge, consultation frameworks (Calgary-Cambridge, SPIKES), and NICE guidelines are the same regardless of exam format. But any resource that focuses on case selection (RCA) or face-to-face technique (CSA) needs to be adapted for the SCA context.

MedTutor's 100 SCA simulations are designed specifically for the SCA format: remote, voice-based, 12-minute consultations with standardised cases and structured feedback on all three marking domains. For a comprehensive preparation strategy, see our How to Pass the MRCGP SCA guide.