Reasoning GP · SCA for international medical graduates

The SCA for international medical graduates, honestly

If you trained outside the UK, the SCA can feel like it is marking something nobody explained. This page sets out the published facts, the habits that most often cost IMGs marks, and practical ways to close the gap.

The pass-rate gap, stated plainly

The RCGP publishes how candidates perform, and it shows a real gap. In its interim report on SCA performance (November 2023 to June 2024), the overall pass rate was about 70% across 5,582 sittings. The RCGP’s MRCGP annual report for 2023–24 gives first-attempt SCA pass rates of around 94% for UK graduates and around 52% for international medical graduates, a ratio of about 1.8. The same report found that SCA pass rates had risen more for IMGs (by 8.49 percentage points) than for UK graduates (3.47) compared with the old CSA. More recent figures are in the RCGP's annual reports.

Those numbers are not about ability or medical knowledge. Many excellent doctors trained abroad fail first time, and the reasons are well described. The SCA rewards a particular style of consultation and a detailed feel for how the NHS works. Both can be learned quickly once they are named, and the advice below aims to name them.

Relating to Others: natural, not scripted

Relating to Others is where many IMGs lose marks, often while trying hardest. Common patterns:

  • Stock empathy phrases. “I can understand how difficult this must be for you,” said in every case and before the patient has said anything difficult, sounds like a formula. Examiners reward responses to what this patient actually said: “You said you've hardly slept since the funeral. Tell me about that.”
  • ICE as a checklist. Asking “What are your ideas, concerns and expectations?” in one breath gets a one-word answer. Ask naturally, at the right moment: “What were you hoping we could do today?”
  • Telling rather than sharing. In many health systems the doctor decides. In UK general practice the patient decides with you. Offer options, give a view if asked, check what matters to them, and accept a different choice.
  • Signposting that sounds like a script. “Now I am going to ask you some questions about…” before every topic slows you down. Short, plain links work better.

The Examiner Marking tool flags, under each domain, the patterns that most often pull internationally trained graduates down a grade.

Practise this, not just read it. The IMG Track turns this page into practice: habit swaps with natural lines to say, UK context cards (fit notes, DVLA, capacity, Gillick, confidentiality, safeguarding, Pharmacy First) and timed “explain it plainly” drills, with a four-week plan.

UK health-system context that comes up again and again

Fit notes and work

Patients self-certify for the first seven days. After that, a fit note can say “not fit” or “may be fit” with adjustments. Explore what the job involves and what the patient wants.

Driving and the DVLA

It is usually the patient's legal duty to tell the DVLA about a relevant condition. Know when to advise them to stop driving, and the GMC guidance on when a doctor may disclose.

Safeguarding

Children and adults at risk, information sharing, and who refers to whom. Expect third-party callers and professionals, not just patients.

Autonomy and shared decisions

Capacity is assumed unless shown otherwise. Informed choice includes the right to decline. Respect confidentiality, including with relatives.

Antibiotic expectations

Many consultations turn on a patient who expects antibiotics. Explore why, explain clearly, and consider a back-up prescription where guidance supports it. Do not lecture.

Safety-netting and follow-up

Specific red flags, a timescale and a route back (the practice, NHS 111 or 999). “Come back if it gets worse” is not enough.

Telephone and video skills

Most SCA cases are video, and some are telephone only. On the phone you lose every visual cue, so make listening audible (“take your time”, “I'm just noting that down”), check understanding more often, and summarise. On video, look at the camera when you speak, keep your notes off-screen and ask the patient to describe or show what you cannot examine. Our SCA case bank includes 81 telephone-only cases for practice.

Practising with UK colleagues and getting support

  1. Practise with UK-trained colleagues as patients. They will react the way UK patients do, and they will notice phrasing that sounds odd. The Live Group Mock and role-play packs make this easy.
  2. Get feedback on real consultations. Ask your trainer to review recorded consultations, and use real-consultation feedback on de-identified transcripts to spot repeated habits.
  3. Use the AI patient for volume, not judgement. The AI simulator is good for trying a new phrase twenty times, but it cannot judge warmth or body language. See its limits.
  4. Use the support that exists for you. Your deanery's professional support or IMG programme (names vary by region), your training programme director, the GMC's free Welcome to UK Practice sessions and the RCGP's SCA guidance are all there to help. Asking early is a sign of good judgement.

Start free

Five sample Hot Seat cases, the full SCA Guide and one free run of the AI Patient Simulator are open to everyone, with no card needed. The whole SCA suite (all 359 cases, the AI mock circuit, group mocks and the Resit Clinic) is in the Gold plan.

Try the free Hot Seat casesRead the free SCA GuideSee plans and pricing
Free means free: no card and no countdown. Paid plans can be cancelled or paused at any time.

Frequently asked questions

Do IMGs have a lower SCA pass rate?
Yes. The RCGP's MRCGP annual report for 2023–24 shows first-attempt SCA pass rates of around 94% for UK graduates and around 52% for international graduates. The gap narrowed compared with the old CSA, but it remains large. See the RCGP's published reports for current figures.
Why do international graduates find the SCA harder?
Usually not because of medical knowledge. Common reasons are a more directive consultation style, stock phrases that sound scripted, and less familiarity with NHS processes such as fit notes, DVLA rules, safeguarding pathways and shared decision-making.
How can IMGs improve in Relating to Others?
Respond to what each patient actually says instead of using fixed empathy phrases, ask about ideas and expectations naturally, share decisions rather than announcing them, and practise with UK-trained colleagues who can tell you how you come across.
Is there SCA support for international medical graduates?
Yes. Deaneries run professional support and IMG programmes, the GMC offers Welcome to UK Practice, and your training programme director can arrange extra help. Ask early rather than after a result.
Should IMGs practise telephone consultations?
Yes. Some SCA cases are audio-only. Without visual cues you need to make your listening audible, check understanding more often and give clear, specific safety-netting.

More SCA guides

SCA casesThe case bank: 300+ SCA practice casesFree SCA casesWhat you can practise without payingSCA mock examRun a timed 12-case diet: AI, solo or with friendsAI SCA simulatorHow the AI patient works, and its limitsSCA dates and fees2026–27 diets, fees, booking and deadlinesSCA resitFailed the SCA? Reading feedback and a 4–8 week planSCA telephone consultationsAudio-only cases: structure, safety-netting, third partiesSCA marking and domainsThe three domains, grades and how the pass mark is setSCA pass ratesWhat the RCGP figures show, and what they do notPaying for SCA preparationExam fee, study budget rules and our plans

gpreasoning.uk is not affiliated with or endorsed by the RCGP. The SCA is run by the Royal College of General Practitioners; for anything official (dates, fees, rules, results) always check the RCGP SCA pages. Our cases are original teaching material written for practice: they are not exam recalls and do not predict what you will meet on the day.