Succeed with your SCA Consultation Domains

Preparing for the MRCGP SCA can feel overwhelming, but breaking it down by domains helps bring structure and focus. This blog explores the three core domains that form the backbone of your assessment - Data Gathering & Diagnosis, Clinical Management & Managing Complexity, and Relationship & Communication.

Domain 1: Data Gathering & Diagnosis (36 marks)

The first step in any consultation is understanding the "why". This domain focuses on how thoroughly and efficiently you gather information to form a diagnosis or list of differentials. You’re not just asking questions, but you should be able to demonstrate clinical reasoning.

Verbalize red flag questions where relevant (e.g. chest pain? weight loss? suicidal ideation?). If you suspect something serious or even if you’re narrowing down a few possibilities, verbalise this in simple language to the patient. This approach also gives the examiner clear insight into your thought process. For example, if a patient presents with fatigue, talk through whether you’re considering anaemia, thyroid dysfunction, depression, or something more serious. Also, safeguarding must never be missed and it is important to consider the wider picture: who else might be at risk if this patient is struggling?

Domain 2: Clinical Management & Managing Complexity (54 marks)

This is the highest weighted domain and where most marks are won. It’s not just about what you know, but what you do with that knowledge. Can you make a safe plan? Can you share that plan effectively with your patient? Whether the case is straightforward or complex, your job is to prioritise safety. Clearly explain your thinking, and offer safety-netting that is personalized and specific. A vague “come back if symptoms worsen” is inadequate and you need to explain what to look for and how to act.

Once you’re confident there’s nothing urgent, move on to making a concrete plan. Explain whether treatment is needed or if reassurance is more appropriate. Make sure your patient understands not just the what, but the why. Continuity of care is a crucial part of managing complexity as this demonstrates you’re looking beyond the short-term fix.

Domain 3: Relationship & Communication (36 marks)

This is the domain that makes all the difference. It's often the deciding factor between a borderline pass and a clear pass. Clinical knowledge is important, but how you connect with the patient is what truly shines. Your tone, body language, and warmth set the emotional tone of the consultation. Acknowledge distress, validate concerns, and adapt your communication to the patient’s background, language, and understanding. Mirror their vocabulary, slow down when needed, and check in often to make sure you’re both on the same page. Clarity builds trust, and trust leads to better outcomes.

Passing the SCA is about balancing clinical knowledge, safe decision-making, and human connection. Each domain is important, and success comes from consistency across all three. Good luck!