The SCA, explained properly

What the 3 minutes are actually for

• Mine, don't skim. The records contain deliberate signal: the medication started four weeks ago, the DNA'd reviews, the nurse's note, the carer flag. Candidates who restate what the notes already say waste consultation minutes and signal template-thinking.
• Predict the station. Ask: what is this case probably testing? Where's the trap? What must I have done by minute 7? Our case briefs train exactly this — every Hot Seat case opens with an exam-format record extract.
• Most cases are the patient — but expect some to be a carer, a relative, another professional, or a results/data discussion. Physical examination is never assessed; findings are given if you ask for the right ones.

The exact phrases examiners pick from

When a domain doesn't reach the standard, examiners select from a fixed list of feedback statements. Reverse-engineer them — each is a thing to not do.

• Data Gathering & diagnosis: data gathering insufficient for a safe assessment; existing record information under-used; psychosocial information missed; unsystematic/disorganised gathering; poor prioritisation across multiple problems; implications of abnormal findings not grasped; differentials inadequately generated or tested; decision-making illogical, incorrect or incomplete.
• Clinical management & medical complexity: referral, investigation or prevention/health-promotion plan not reflective of current practice; medical management of risk inadequate; implications of comorbidity under-considered; uncertainty (including the patient's) managed poorly; inadequate follow-up/continuity/safety-netting; ineffective time management.
• Relating to others: non-verbal cues/active listening not shown; agenda, health beliefs or preferences under-explored; circumstances/cultural differences not responded to; explanations not adapted to the person; a judgemental approach; insufficient respect or sensitivity; ownership of decisions inappropriate; teamwork/others' roles not recognised; safeguarding concerns not recognised or acted on.

• The room is your responsibility. Book it well in advance, test the kit on the same computer, same network, same chair, days before. A "do not disturb" sign and a colleague guarding the door are not paranoia.
• Tech checklist: wired connection if possible, camera at eye level, face lit from the front, headset tested, phone OUT of the room except as instructed for invigilation.
• Between cases, breathe out the last one. Three minutes is enough: ten seconds to let it go, the rest to mine the next records. Nobody else knows how the last station went — including, often, the candidate. Examiners watch one case each; case 7's examiner never saw case 6.
• The buzzer is not failure. Plenty of passing consultations are cut off mid-close. What can't be missing is the management — another reason the minute-7 rule matters.
• If technology fails, follow the invigilator's instructions and keep evidence (times, screenshots where permitted). Interrupted diets are handled by the college — your job is only to document and stay calm.

The exam-day timeline

• Candidate registration (45 min). Log in to Osler; the invigilator does your ID check (government photo ID — passport or UK driving licence; a selfie emailed to [email protected] is the fallback if your camera won't focus) and a 360° environment check — they may take up to 30 minutes to appear.
• Rounds 1–6 (1h 30). 15 minutes per station: 3 minutes reading then a 12-minute video or telephone consultation. A 15-second gap between stations to compose yourself (not a break).
• Comfort break (10 min) after case 6 — a blue coffee-cup icon and countdown appear.
• Rounds 7–12 (1h 30), same structure.
• Wrap-up & reruns (45 min). You stay under exam conditions and may not log out until the invigilator gives permission.

Navigating the platform

• Before you start: an automatic device check (mic, video, internet), then position your face until the on-screen oval turns blue (yellow = not aligned), and an audio test. Use the walkthrough as many times as you like beforehand.
• During a case: your brief and your private notes carry over from reading time; you can minimise/close the brief and expand notes using the on-screen icons. A red one-minute warning then a 5-second countdown signals the end; completed stations get a green tick.
• Telephone cases (about 3 of the 12) show a phone image — you hear the role-player but don't see them, and they/​the examiner don't see you, though you stay on camera for the invigilator.
• To reach the invigilator: the hand-raise button (mid-consultation) or the direct-message function. You must message them when leaving and returning during the break.

Your desk — and reruns

• Allowed: a water bottle, a wipeable whiteboard + marker, and a paper BNF. Banned: any clinical guidance, charts or posters on the walls — clear them before the environment check. No phone use during the break.
• Reruns (45 min reserved). Granted for genuine disruption — repeated signal drops or severe external noise. Flag any issue immediately — for rounds 1–6 during the break, for rounds 7–12 in the 5 minutes straight after case 12 — or a lead-examiner review can't be guaranteed. A rerun appears as an Ad-hoc Station at the foot of your schedule.
• If tech fails: press refresh (≈15 s to reconnect) or log out and back in (you return to your station). IT helpline: 020 3188 7680 — keep your phone to hand, as they'll call you.

Booking, attempts & kit

• 9 sittings a year (monthly except July, August & December), bookable up to 12 months ahead on Fourteen Fish. A maximum of 4 attempts across any version (CSA/RCA/SCA) — usually no more than 2 in ST3 — so time it well and don't resit before you've fixed the flagged areas.
• Kit: updated Chrome or Edge; a PC, laptop or Mac only (no phones/tablets); the same device and location as your device check. Wired headphones are fine and often fix sound issues; Bluetooth is not permitted.
• No physical examination is required — cases are written without it, or examination findings are supplied in the pre-reading by another professional.

What the cases emphasise

• Expect uncertain diagnosis, polypharmacy and comorbidity — this is not one problem done well in 12 minutes. Role-players may be the patient, a parent/carer or a health/social-care professional.
• Cases reach into less-everyday territory: domestic abuse, FGM, transgender care, assisted-dying requests, safeguarding.
• Of the 12 blueprint areas, the college flags a top 5 likely in every diet: under-19s; gender, reproductive & sexual health; long-term conditions; older adults; mental health.