MRCGP SCA practice by marking domain

Three domains, graded in every consultation

The RCGP describes three domains for each SCA case: Data gathering and diagnosis, Clinical management and medical complexity, and Relating to others. Reviewing several consultations by domain can reveal repeated behaviours to work on, while one difficult case on its own may not show a reliable pattern.

• Data gathering and diagnosis — targeted enquiry that changes your working diagnosis
• Clinical management and medical complexity — safe, practical plans under uncertainty and comorbidity
• Relating to others — ideas, concerns and expectations, plain-language explanation, shared decisions
• Domain-by-domain self-audit, so you practise the behaviour that needs the most attention

A domain-by-domain self-audit

Review three recent consultations, real or simulated, in each domain. A repeated pattern can identify a more specific practice target than a topic list alone.

• Data gathering: did I ask anything that changed my working diagnosis, or did I confirm what I already assumed?
• Data gathering: did I screen for the serious thing, or did I hope it was not there?
• Clinical management: could the patient repeat my plan back accurately? Could they act on it tonight?
• Clinical management: did I say what should happen if it gets worse, and by when?
• Relating to others: did I find out what they were actually worried about, and respond to it?
• Relating to others: did I agree the plan, or deliver it?

• How the domains are graded
• Practise the relating-to-others behaviours

Practise the domains across clinical contexts

A domain skill that only works in a familiar topic is not yet reliable.

• Communication skills
• Time management
• Mental health stations
• Paediatric consultations