What are the SCA marking domains?

Data gathering and diagnosis (DG&D), Clinical management and medical complexity (CM&C), and Relating to others (RTO).

What do CP, P, F and CF mean in the SCA?

Clear pass, pass, fail and clear fail, each defined against "a newly qualified, independent GP": above the standard (CP), sufficiently demonstrated at it (P), insufficiently demonstrated (F), clearly below it (CF) (RCGP).

Is there a fixed SCA pass mark?

No. Each case's pass mark is set by borderline regression from the examiners' global judgments, and your overall result is your aggregate mark across all 12 cases (RCGP).

If I fail one case, do I fail the SCA?

No. The RCGP says failing a case "will not mean you have failed the entire examination", because the result is the aggregate of all 12 cases.

Which domain counts most?

Clinical management and medical complexity, which the RCGP says "is weighted in comparison to the other two domains". It doesn't publish the exact weight on the pages we read.

SCA Marking Scheme: Domains, Grades and Feedback Statements

Name: Confetto
Brand: Confetto
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The short version

Three domains per case: Data gathering and diagnosis (DG&D), Clinical management and medical complexity (CM&C), Relating to others (RTO).
Four grades per domain: CP, P, F, CF, defined against "a newly qualified, independent GP".
CM&C is weighted "in comparison to the other two domains". The RCGP's summary reports give marks out of 126, but not the points per grade.
Global judgment: examiners also judge each case as Pass, Bare Pass, Bare Fail or Fail; this sets each case's pass mark by borderline regression, so there is no fixed pass mark.
Aggregate, not case-by-case: "it is the aggregated mark you have received for the 12 cases which give you your overall mark."
26 feedback statements (8 + 9 + 9) explain where you fell short. They "play no part in the marking process".

The three domains

The domain names below are the RCGP's, written as the RCGP writes them. The items are from the RCGP's SCA toolkit.

Domain	What the RCGP toolkit lists under it
Data gathering and diagnosis (DG&D)	Opens consultation and explores problem · Discovers patient's psycho-social context · Identifies cues · Discovers patient's ICE · Interprets appropriate examination and tests · Generates / tests diagnostic hypotheses · Rules in / out a serious disease · Reaches a working diagnosis and/or analysis
Clinical management and medical complexity (CM&C)	Offers a safe patient-centred management plan · Manages co-morbidity appropriately · Provides follow-up / safety net
Relating to others (RTO)	Generates rapport · Uses open questions appropriately · Clarifies and explores cues offered · Listens and shows curiosity · Uses closed questions appropriately · Explains rationale for questions · Verbalises diagnosis and/or analysis · Shares and uses ICE in plan · Negotiates and uses psycho-social information in plan · Shares risks / safety of options · Supports in decision-making

The toolkit also lists global skills that run through every case: "Structures consultation", "Avoids repetition", "Progresses through tasks", "Demonstrates awareness of ethical implications", "Finishes data gathering by 6-7 minutes", "Uses clear language" and "Remains responsive to the patient".

The four grades

From the RCGP's "Marking and results for the SCA" (definitions relative to the standard of the MRCGP):

Grade	RCGP definition
CP (clear pass)	"This domain is demonstrated above the standard of a newly qualified, independent GP"
P (pass)	"This domain is sufficiently demonstrated at the standard of a newly qualified, independent GP"
F (fail)	"This domain is insufficiently demonstrated at the standard of a newly qualified, independent GP"
CF (clear fail)	"This domain is clearly demonstrated below the standard of a newly qualified, independent GP"

Each domain in each case gets one of these grades, so a full exam produces 36 domain grades (12 cases × 3 domains).

Weighting, global judgment and the pass mark

Weighting. The RCGP says: "To reflect the capability coverage within the clinical management and medical complexity domain this is weighted in comparison to the other two domains." The RCGP pages we read don't publish the points for each grade or the exact weight. The RCGP's diet summary reports do give marks out of 126, for example "The mean score on this occasion was 83 out of 126" (November 2023, week 1).

Global judgment. As well as the domain grades, each examiner gives an overall judgment of the case. The RCGP's descriptors:

Global judgment	RCGP descriptor
Pass	"Meets the standard for an independent newly qualified GP who is fit to consult. (Any omissions or errors made are minor/trivial)."
Bare Pass	"A just passing candidate. Omissions or errors made, but candidate has done enough to demonstrate fitness to consult as an independent newly qualified GP."
Bare Fail	"A just failing candidate. Presented some evidence, but insufficient for fitness to consult as an independent, newly qualified GP. Omissions or errors likely to impact on patient care / outcomes."
Fail	"Does not meet the standard for an independent newly qualified GP who fit to consult. Minimal evidence presented and/or patient put at risk of harm."

The RCGP says this response is "carried forward to determine the pass mark for the case through a standard setting process known as Borderline Regression".

What borderline regression means, in plain words (our explanation of the general method, not RCGP text). Across all candidates who did the same case, the examiners' marks are compared with their global judgments, and the mark that lines up with the borderline point becomes that case's pass mark. A harder case therefore tends to get a lower pass mark and an easier case a higher one, and there is no fixed pass mark set in advance.

The overall result. Your marks for the 12 cases are added together. The RCGP: "it is the aggregated mark you have received for the 12 cases which give you your overall mark", and "candidates will not have to pass a certain number of stations in order to pass." The RCGP pages we read don't describe exactly how the 12 case pass marks are combined into the exam pass mark, and the summary reports don't publish a pass mark for each diet.

Sample marking breakdown

Example written by Confetto to show how the grades combine (not a real candidate or RCGP result). The RCGP doesn't publish the points per grade, so this shows the pattern, not a mark out of 126.

Case (practice)	DG&D	CM&C	RTO	Global judgment	Feedback statement the examiner might give
1. Back pain, wants a scan	P	P	CP	Pass	none
2. Low mood, telephone	P	F	P	Bare Fail	"Inappropriate or inadequate arrangements for follow-up, continuity and/or safety netting"
3. Diabetes review, three problems	F	P	P	Bare Fail	"Ineffective approach or prioritisation in data gathering, when presented with multiple or complex problems"
4. Child with fever, parent on video	P	P	P	Pass	none
5. Antibiotic request	CP	CP	P	Pass	none
6. Abnormal blood test result	P	F	P	Bare Fail	"The management plan relating to investigations was inappropriate or not reflective of current practice"
7. Carer worried about memory	P	P	F	Bare Pass	"Teamwork and/or understanding of others' roles was insufficiently recognised or responded to"
8. Contraception	P	P	P	Pass	none
9. Chest pain, audio only	CP	P	P	Pass	none
10. Polypharmacy, older patient	F	CF	P	Fail	"The implications of co-morbidity were insufficiently considered"
11. Request for a sick note	P	P	P	Pass	none
12. Palliative care, family member	P	P	CP	Pass	none

How to read it:

Four cases have a failed CM&C or DG&D domain, but the candidate could still pass overall: the RCGP adds up all 12 cases, and the CP grades in cases 5, 9 and 12 help.
The pattern matters more than any one case. Three of the four weak cases are CM&C (safety-netting, investigations, co-morbidity). Because CM&C is weighted, that is the domain to fix first.
The feedback statements point to the fix. "Co-morbidity" and "follow-up, continuity and/or safety netting" are specific; practice those two skills, not "the SCA" in general.

The 26 feedback statements

The RCGP says: "Feedback will be case-specific and linked to the marking domains." "Any domain which is failed by the examiner will receive feedback." "Feedback will be released with your results." And: "The feedback statements are not performance indicators and play no part in the marking process for the examination." Full wording, as the RCGP writes it:

Domain 1: Data gathering and diagnosis (8)

#	Statement
1	Data gathering was insufficient to enable safe assessment of the condition/situation
2	Existing information about the case was insufficiently utilised
3	Relevant psychological or social information insufficiently recognised or responded to
4	Data gathering was unsystematic and/or disorganised
5	Ineffective approach or prioritisation in data gathering, when presented with multiple or complex problems
6	The implications of relevant findings identified during the data gathering were insufficiently recognised or understood
7	Differential diagnoses or hypotheses were inadequately generated or tested
8	Decision-making or diagnosis was illogical, incorrect or incomplete

Domain 2: Clinical management and medical complexity (9)

#	Statement
1	The management plan relating to referral was inappropriate or not reflective of current practice
2	The management plan relating to prescribing of medication was inappropriate or not reflective of current practice
3	The management plan relating to investigations was inappropriate or not reflective of current practice
4	The management plan relating to prevention, health promotion or rehabilitation was inadequate or inappropriate
5	The plan relating to the medical management of risk was inadequate or inappropriate
6	The implications of co-morbidity were insufficiently considered
7	Uncertainty, including that experienced by the patient, was managed ineffectively
8	Inappropriate or inadequate arrangements for follow-up, continuity and/or safety netting
9	Time management in the consultation was ineffective

Domain 3: Relating to others (9)

#	Statement
1	Communication skills, including the non-verbal, responding to cues and/or active listening were insufficiently demonstrated
2	The person's agenda, health beliefs and/or preferences were insufficiently explored
3	The circumstances, relevant cultural differences and/or preferences of those involved were insufficiently responded to
4	Explanations were inadequately shared or adapted for the person's needs
5	A judgemental approach was shown to the person
6	Respect and/or sensitivity shown to the person was inadequate or inappropriate
7	Ownership or responsibility for decision-making was inadequate or inappropriate
8	Teamwork and/or understanding of others' roles was insufficiently recognised or responded to
9	Safeguarding concerns were inadequately recognised or responded to

What to do with the statements after a result: SCA results and dates.

Shared decision making: where Relating to others and CM&C meet

Two RTO toolkit items, "Shares risks / safety of options" and "Supports in decision-making", and the CM&C item "Offers a safe patient-centred management plan" all describe shared decision making. NICE's guideline on it (NG197, 2021) calls it a "collaborative process" and recommends:

discussing the risks, benefits and consequences of each option, including no treatment;
giving risk as absolute risk and natural frequencies (for example "about 2 in 100 people"), not only percentages or relative risk;
"chunk and check": giving information in "smaller, more manageable chunks" and checking understanding;
teach-back: asking the person to explain back what was discussed.

In a 12-minute case that means two or three real options, one plain sentence of risk for each, a question about what matters to the patient, and a plan you agree together.

Common mistakes by domain

Domain	Mistake	Matching RCGP feedback statement
DG&D	No red-flag questions in a new symptom	D1 #1 "Data gathering was insufficient to enable safe assessment…"
DG&D	Asking for information that was in the case notes	D1 #2 "Existing information about the case was insufficiently utilised"
CM&C	"Come back if it gets worse" as the only safety-net	D2 #8 "…follow-up, continuity and/or safety netting"
CM&C	Prescribing without checking kidney function, interactions or allergies	D2 #2 "…prescribing of medication…" / D2 #6 "…co-morbidity…"
CM&C	Running out of time before the plan	D2 #9 "Time management in the consultation was ineffective"
RTO	Hearing the concern but not using it in the plan	D3 #2 "The person's agenda, health beliefs and/or preferences were insufficiently explored"
RTO	Explaining in medical words	D3 #4 "Explanations were inadequately shared or adapted for the person's needs"
RTO	Missing a small safeguarding cue	D3 #9 "Safeguarding concerns were inadequately recognised or responded to"